Comparación entre la depuración de creatinina en orina de 24 horas y la fórmula de Cockcroft - Gault para estimar el filtrado glomerular en mujeres gestantes atendidas en un hospital de Lima / Comparing creatinine clearance in 24 hour urine and Cockcroft-Gault formula to determine glomerular filtration rate in pregnant women attended in a Lima hospital

La filtración glomerular se calcula por la depuración de creatinina endógena (DCE) en orina de 24 horas, con limitaciones en su recolección y dificultades para los pacientes. Sin embargo, existen fórmulas propuestas para estimar esta función renal. Objetivo. Aplicar la fórmula Cockcroft-Gault de filtración glomerular y compararla con método químico colorimétrico en gestantes. Diseño. Estudio observacional, correlacional, prospectivo y transversal. Lugar. Laboratorio central, Hospital Nacional Sergio Bernales de Lima, Perú. Participantes. Mujeres gestantes. Métodos. Previo consentimiento informado, se procesaron muestras de sangre y orina de 24 horas de 92 gestantes, entre noviembre 2015 y enero 2016. Se utilizó el coeficiente de correlación de Pearson entre los resultados DCE de la fórmula Cockcroft-Gault y la obtenida en suero-orina de 24 horas. Resultados. La muestra tuvo una distribución normal analizada por el estimador Smirnov-Kolmogorov. El promedio de la DCE en orina de 24 horas fue 73,65 ± 19,85 mL/min, la obtenida por la fórmula Cockcroft-Gault fue 99,82 ± 18,75 mL/min, con diferencia significativa a la prueba t para muestras relacionadas (p < 0,000), y la correlación entre dichos métodos de laboratorio fue baja (r=0,561) en todas las gestantes y por trimestre, mostrando falta de correlación con la prueba coeficiente de correlación-concordancia de Lin (ccc) (p < 0,01). La sensibilidad (S) fue 0,50; especificidad (E) 0,591, el valor predictivo positivo (VPP) 0,212 y el negativo (VPN) 0,881. Conclusiones. La DCE obtenida por fórmula Cockcroft­ Gault con la DCE suero-orina de 24 horas en gestantes tuvo baja correlación (r =[0,4 a 0,67]), con niveles bajos de S, E VPP y VPN, por lo que no es recomendable su uso en gestantes.

Glomerular filtration rate (GFR) is calculated by the endogenous creatinine clearance (DCE) in 24-hour urine, with limited collection and difficulties for patients. There are formulas proposed to estimate renal function. Objective. To use the Cockcroft-Gaul formula of glomerular filtration and to compare it with the chemical colorimetric method in pregnant women. Design. Observational, correlational, prospective and transversal study. Setting. Central Laboratory, Sergio Bernales National Hospital, Lima, Peru. Participants. Pregnant women. Methods. Using prior informed consent blood samples and 24-hour urine of 92 pregnant women between November 2015 and January 2016 were processed. The Pearson correlation coefficient was used to compare the DCE results obtained with the Cockcroft­ Gault formula and the serum-24 hours urine. Results. The sample had a normal distribution analyzed by Kolmogorov-Smirnov estimator. The average DCE in 24 hours urine was 73.65 ± 19.85 mL /min, and that obtained by the Cockcroft-Gault formula was 99.82 ± 18.75 mL/min, with t test significant difference in related samples (p <0.000); the correlation between these laboratory methods was low (r = 0.561) in all pregnant women and by trimesters, showing lack of correlation with the coefficient of the Lin correlation-matching (ccc) (p <001) Sensitivity (S) was 0.50, specificity (Sp) 0.591, positive predictive value (PPV) 0.212 and negative predictive value (NPV) 0.881. Conclusions. The DCE obtained by Cockcroft-Gault with the DCE serum-24 hours urine in pregnant women had low correlation (r = [OA to 0.67]) with low levels of S, Sp, PPV and NPV, so it is not recommended for use in pregnant women.

Eficacia de las fórmulas MDRD-abreviada y Cockcroft-Gault para la detección de insuficiencia renal crónica en la atención primaria / Effectiveness of the Cockcroft-Gault and MDRD-abbreviated formula for the detection of chronic renal failure in primary care

Se realizó un estudio comparativo y prospectivo de tipo cohortes, que incluyó a 1038 pacientes, atendidos en el consultorio médico No. 5 de la Policlínica Universitaria "Joel Benítez Borges" de Cauto Cristo, provincia de Granma, desde abril del 2011 hasta noviembre del 2012, a fin de determinar la eficacia de las fórmulas MDRD-abreviada, Cockcroft-Gault y Cockcroft-Gault corregida para la detección de insuficiencia renal crónica en los afectados con creatinina sérica normal. Se comparó el grupo de pacientes con creatinina sérica normal según filtrado glomerular normal o disminuido. La prevalencia de insuficiencia renal crónica fue de 11,9, 10,9 y 11,0 % para las fórmulas MDRD-abreviada, Cockcroft-Gault y Cockcroft-Gault corregida, respectivamente. Se demostró la sencillez y eficacia de la fórmula MDRD-abreviada en el cribaje de la insuficiencia renal crónica, fundamentalmente en mujeres añosas e hipertensas.

A comparative and prospective study of cohorts type, which included 1038 patients, assisted in the doctor's office No. 5 of "Joël Benítez Borges" University Polyclinic in Cauto Cristo, Granma province was carried out from April, 2011 to November, 2012, in order to determine the effectiveness of the MDRD-abbreviated formula, and the Cockcroft-Gault and Cockcroft-Gault formulas corrected for the detection of chronic renal failure in the affected patients with normal serum creatinine. The group of patients with normal serum creatinine was compared according to normal or decreased glomerular filtrate. The prevalence of chronic renal failure was of 11,9, 10,9 and 11,0 % for the MDRD-abbreviated formula, Cockcroft-Gault and Cockcroft-Gault corrected, respectively. It was demonstrated the simplicity and effectiveness of the MDRD-abbreviated formula in the screening of the chronic renal failure, mainly in aged and hypertensive women.

Comparative performance of the equations for estimating GFR in type 2 diabetic patients / 中华内分泌代谢杂志

Serum creatinine was determined by enzymatic method.99mTc-GFR was measured by 99mTc-DTPA dynamic renal imaging and considered as GFR marker in 210 males and 180 females with type 2 diabetes,eGFR was calculated by Cockcroft-Gault formula,MDRD equation7,abbreviated MDRD equation,modified MDRD equation for Chinese (c-7GFR4 and c-aGFR4),and CKD-EPI equation.They were analyzed by correlation,regression,Bland-Altman analysis and receiver operating characteristic (ROC) curve analysis.The correlation coefficients for Cockcroft-Gault formula,MDRD equation7,abbreviated MDRD equation,c-7GFR4,c-aGFR4,and CKD-EPI equation were 0.79,0.76,0.77,0.76,0.76,0.81 respectively.And the differences were-14.99,-18.85,-23.79,-25.85,-32.07,and-7.16,respectively.The area under ROC curves were 0.91,0.88,0.89,0.88,0.90,and 0.92,respeetively.Kappa values were 0.67、0.52、0.39、0.49、0.46、0.54respectively.The CKD-EPI equation seams to be the most accurate measurement among the six methods when the serum creatinine was determined by enzymatic method in Chinese type 2 diabetic patients.

Enfermedad renal oculta en pacientes con diabetes mellitus / Hidden renal disease in patients with diabetes mellitus

Se realizó un estudio observacional de prevalencia para caracterizar, desde enero hasta julio de 2009, a 110 adultos con enfermedad renal oculta y diabetes mellitus, pertenecientes al área de salud del Policlínico Comunitario Docente Alberto Fernández Montes de Oca del municipio de San Luis, provincia de Santiago de Cuba, en quienes se estimaron los valores del filtrado glomerular por la fórmula de Cockcroft-Gault corregida para la superficie corporal y basada en la creatinina sérica, así como de la ecuación derivada del estudio de modificación de la dieta en las nefropatías (MDN), más conocida por sus siglas en inglés MDRD (modification of diet in renal disease). Los datos fueron procesados con el sistema Epi Info, versión 6.0. Entre los principales resultados sobresalió la elevada prevalencia de enfermedad renal oculta en pacientes con diabetes mellitus, sobre todo en aquellos que la padecían desde hacía más de 10 años.

A prevalence observational study was carried out from January to July 2009 to characterize 110 adults with hidden renal disease and diabetes mellitus, belonging to the health area of Alberto Fernández Montes de Oca Community Teaching Polyclinic from San Luis municipality, Santiago de Cuba province, in whom rates of glomerular filtration by means of modified Cockcroft-Gault's formula for body surface area and based on serum creatinine were estimated, as well as the equation derived from diet modification study in nephropathies, more commonly known as modification of diet in renal disease (MDRD). Data processing was made with Epi Info system, version 6.0. Among main results was a high prevalence of hidden renal disease in patients with diabetes mellitus, particularly in those who were suffering from it for more than 10 years.

Utilidad clínica de la cistatina C como marcador precoz de enfermedad renal crónica / Clinical utility of cystatin C as an early marker of chronic kidney disease

Determinar y establecer la utilidad de la Cistatina C como marcador de enfermedad renal en pacientes del Hospital General del Oeste “Dr. José Gregorio Hernández” de Caracas, Venezuela. Estudio clínico evaluativo de cohortes de 96 pacientes, 54 (56,25 %) mujeres y 42 (43,75 %) hombres. Se midieron los siguientes parámetros: creatinina sérica, Cistatina C y proteinuria en 24 horas. La depuración de creatinina se midió por la fórmula de Cockcroft - Gault y se compararon estos métodos diagnósticos mediante coeficiente de correlación de Pearson y se calculó sensibilidad, especificidad y valor predictivo negativo. Los métodos diagnósticos para conocer la función renal utilizados en este trabajo (creatinina sérica, depuración de creatinina y proteinuria en 24 horas, fórmula de Cockcroft-Gault y Cistatina C) resultaron estadísticamente significativos al comparar poblaciones con o sin enfermedad renal. Se realizaron mediciones de Cistatina C y se evidenció que de 35 pacientes (36,4%) con resultados anormales, 20 (57,14%) tienen enfermedad renal crónica. La Cistatina C tiene una sensibilidad de 83,3% y una especificidad del 79,2% (IC 69,1 a 100%). La creatinina sérica tuvo una sensibilidad de 66,7% y especificidad de 84,7%, con IC de 75,2 a 93,7%. La fórmula de Cockcroft Gault tiene una sensibilidad de 95,8% y especificidad de 40,3%, con IC de 28,3 a 52,3% y la depuración de creatinina tuvo una sensibilidad de 100% y especificidad de 73,6%, con IC de 62,7 a 84,5%. La Cistatina C se comportó como uno de los mejores indicadores (determinado por el índice de validez) de la función renal después de la depuración de creatinina para la enfermedad renal crónica

To assess the value of Cystatin C as a marker of kidney disease in a group of patients from the Hospital General del Oeste “Dr. José Gregorio Hernández” from Caracas, Venezuela. A clinical cohort study of 96 subjects, 54 (56,25 %) women and 42 (43,75 %) men. We measured seric creatinine, Cystatin C, 24 hour proteinuria and creatinine clearance; this last was done applying the Cockcroft – Gault. All the diagnostic methods were compared by Pearson´s correlation and, also sensitivity, specificity and negative predictive value were determined. The diagnostic methods used were statistically significant in our study when we compared two groups, one with kidney disease and one without it. With Cystatin C we found 35 (36,4%) with abnormal results and from these, 20(57%) have chronic renal disease, so cystatin was 83,3% sensitive and 79% specific. %). Séric creatinina was 66,7% and specifity of 84,7%, with a Confidence Interval of 75,2 to 93,7%. Cockcroft Gault formula has a sensibilidad of 95,8% and specificity of 40,3%, CI 28,3 a 52,3%; creatinine cleareance has a sensitivity of 100% and specificity of 73,6%, with a CI of 62,7 to 84,5%. Cystatin C was one of the best indicators of renal function after creatinine clearance

Studies on Serum Creatinine and Creatinine Clearance in Hypertensive Patients.

Objectives: To assess the serum creatinine and creatinine clearance values in hypertensive patients for providing information to the health-policy planners, clinical practitioners about the importance of routine monitoring of serum creatinine and creatinine clearance in hypertensive patients for prevention of ESRD and other consequences to combat morbidity and mortality and to reinforce the need to consider these parameters in daily clinical practice. Study design: It was a cross-sectional study. Setting: The study was conducted at Department of Physiology and Biochemistry of Mymensingh Medical College, Medicine Unit of Mymensingh Medical College Hospital. Study period: The period of the study was January 2005 to December 2005. Participants: A total number of seventy subjects were included in this study. Out of 70 subjects, 40 (forty) were hypertensive patients and 30 (thirty) were normotensive & healthy controls. Intervention: The subjects were selected on the basis of history and clinical examination. Convenient sampling technique was applied. During visit the available hypertensive patients and controls (normotensive & healthy) those who were present were selected. Having received their written consent they were interviewed & examined by prepared personal data sheet and sample of blood (after overnight fasting) was drawn for biochemical examination. Main outcome measure: Mean values of serum creatinine and creatinine clearance. Result: Serum creatinine was greater in hypertensive than those of normotensive. Creatinine clearance was less in hypertensive than those of normotensive. Serum creatinine & creatinine clearance in between males hypertensive & control shows that CrCl were statistically significant but not the serum creatinine. In females of hypertensive & control shows no differences in case of SCr & CrCl. Among 40 hypertensive the number of “Getting treatment - regular” & “ Getting treatment-irregular” was 14 (35%) & 26 (65%) respectively. Similarly in patients “suffering less than 5 yrs” and “suffering 5 yrs & above” the differences are also not statistically significant. Conclusion: The observations of this study revealed that most of the hypertensive patients were taking treatment irregularly and there was significant alteration of biochemical parameters in hypertensive patients. Therefore, for routine monitoring of hypertensive patients to prevent the end stage renal disease (ESRD) and other consequences, the reinforcement of the investigations of these parameters may be recommended in daily clinical practice.