[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.

Sonographic evaluation of the lower uterine segment in patients with previous cesarean delivery.

OBJECTIVE: To evaluate the appearance of the lower uterine segment (LUS) in pregnant women with previous cesarean delivery and to compare the LUS thickness with that in women with unscarred uteri. METHODS: In a prospective study, sonographic examination was performed on 53 pregnant women with previous cesarean delivery (cesarean group), 40 nulliparas (nullip-control), and 40 women who had 1 or more childbirths with unscarred uteri (multip-control) between 36 and 38 weeks' gestation to assess the appearance and compare the thickness of the LUS. In the cesarean group, the sonographic findings were correlated with the delivery outcome and the intraoperative LUS appearance. RESULTS: In the cesarean group, 44 patients (83.0%) had a normal-appearing LUS indistinguishable from that of control groups; 2 patients (3.8%) had an LUS defect suggestive of dehiscence; and 7 patients (13.2%) had thickened areas of increased echogenicity with or without myometrial thinning. Although the cesarean group had a thinner LUS (1.9 +/- 1.4 mm) when compared with both the nullip-control group (2.3 +/- 1.1 mm; P > .05) and the multip-control group (3.4 +/- 2.2 mm; P < .001), only the latter difference achieved statistical significance. One of the 2 patients who had a sonographically suspected LUS defect had confirmed uterine dehiscence during surgery. An intraoperatively diagnosed paper-thin LUS, when compared with an LUS of normal thickness, had significantly smaller sonographic LUS measurements (1.1 +/- 0.6 versus 2.0 +/- 0.8 mm, respectively; P = .004). CONCLUSIONS: Prior cesarean delivery is associated with a sonographically thinner LUS when compared with those with prior vaginal delivery. Prenatal sonographic examination is potentially capable of diagnosing a uterine defect and determining the degree of LUS thinning in patients with previous cesarean delivery.