[Clinical epidemiologic assessment of the incidence of chronic kidney diseases registered in Romania, Iasi County, in the years of 2004-2008]. / Evaluari clinico-epidemiologice asupra incidentei unor boli cronice de rinichi, inregistrate in România si judetul Iasi, in perioada 2004-2008.

UNLABELLED: Authors present the results of a study carried out in Iasi County and Romania, comparatively, between 2004-2008, in order to know the incidence of the main chronic kidney diseases (CKDs) (nephritic syndrome and nephrosis, chronic renal failure, kidney and urinary lithiasis) and those with a major role in their etiology (essential arterial hypertension--EAHT and diabetes mellitus--DM). RESULTS: The distribution of cases at the county and national level was assessed both for CKDs and EAHT and DM, respectively, by area, sex and age groups. Clinical epidemiological research highlighted high values of CKDs incidence, taking into account a defficiency in standardized data collecting, processing, and interpretation to allow a database useful for elaboration and implementation of prevention programmes.

[Stage 3-5 chronic kidney disease--what is the real prevalence in Romania?]. / Boala cronica de rinichi in Romania: care este prevalenta reala in populatia generala adulta?

UNLABELLED: A high prevalence of reduced GFR has been reported in Western populations. However, little is known about the real prevalence of chronic kidney disease (CKD) in Eastern Europe. Our aims were 1) to identify the true burden of CKD in a large adult population sample; 2) to compare the GFR estimates by the "classic" MDRD4 formula with the GFR derived from the formula proposed recently by Levey. METHODS: Data from 19.509 consecutive Caucasian adult ambulatory patients, referred to two laboratories affiliated to two regional referral centers in Romania, were recorded. Collected data were on age, gender, and serum creatinine (Scr). For one center, total cholesterol, LDL- and HDL-cholesterol, and Hb values were also available. GFR was determined by the classic four-variable MDRD formula (MDRD4) GFR1 = 186 x Scr(-1.154) X age(-0.203) (x 0.742 if female) and by the new MDRD formula (modMDRD4): GFR2 = 175 x corrected Scr(-1.154 x age(-0.203) (x 0.742 if female). RESULTS: 19394 patients (mean age 47.7 years, 39.1% males, mean Scr 0.9 mg/dL) were analyzed. The prevalence of CKD (defined as GFR < 60 ml/min/1.73 m2) was 8.8% (according to MDRD4), and 11.7% (modMDRD4). Therefore, 506 patients (5%) classified by the "classical" MDRD4 formula with a GFR1 of 60-89 mL/min/1.73 m2 have in fact CKD. Stage III CKD was present in 10.74% of patients (males 9.04%, females 11.82%), stage IV CKD in 0.57% (0.72%-0.47%), and stage V in 0.39% (0.29-0.45%). As expected, in the elderly population, the burden of CKD is much higher: 39.74%, with 9.30% of elderly having GFR severely reduced (< 45 ml/min). The prevalence of end-stage renal disease was at least double in the elderly compared to non-elderly. There was a linear relationship between anemia occurrence, lipid abnormalities, and GFR reduction. CONCLUSION: The prevalence of chronic kidney disease in this large Eastern European unselected population is high (8.8-11.7%), similar to the NHANES III population. Almost 40% of elderly subjects have reduced GFR, with one in 10 patients having a severe reduction of renal function.

[Assessing renal function in elderly people]. / Evaluarea functiei renale la vârstnici.

Accurate renal function measurement is important for identification of chronic renal disease which may allow early implementation of renoprotective therapy and proper medication dosing among elderly individuals. This paper proposed to review available data about the strengths and weaknesses of current methods of measuring and estimating of renal function and to appoint which of them is the best in older people. Serum creatinine and creatinine clearance are inaccurate screening tests for renal failure in elderly subjects leading to under-recognition and/or underestimation of the degree of renal failure due to the reduced muscle mass and the inappropriate collection of a timed urine sample (urinary incontinence, cognitive impairment). For all their limitations, formulaic estimates of glomerular filtration rate can provide better information in this population. Further researches must be focused on development of a more precise estimation equation and on implementation in clinical practice of a novel marker of renal function, serum cystatin C, claimed to be superior to plasma creatinine in the elderly individuals.

[Multiple myeloma. Diagnostic errors]. / Mielomul multiplu. Erori de diagnostic.

Multiple myeloma is a disease with slow incidence and polymorphous signs and symptoms. We need don't overlook the unspecific symptoms like headache or bone pain.