ABSTRACT
PURPOSE: High variability has been observed in the estimation of the glomerular filtration rate (GFR) in older patients, according to the formula used and no single formula has been recommended to date. The aim of this study was to quantify the precision and accuracy of the GFR estimated by means of three formulas and the measurement of cystatin C. METHODS: This prospective study was conducted in an acute care geriatric unit. Participants were patients, aged 70 years and over, having a possible 24-hour urine collection. The GFR was estimated using the Cockroft-Gault (CG), the Modification of Diet in Renal Disease (MDRD), and the Creatinine Clearance (Cl-Cr) formulas. The serum level of cystatin C was also measured. RESULTS: Eighty-one patients were included in the study. CG formula underestimated the GFR by a mean difference of 8.65 ml/min, compared with MDRD formula. Cl-Cr underestimated the GFR by a mean difference of 7.56 ml/min, compared with CG formula, and by a mean difference of 16.79 ml/min, compared with the MDRD formula. The degree of discrepancy between CG and Cl-Cr estimates, and between Cl-Cr and MDRD estimates decreased as the estimated GFR approached normal values. MDRD best matched the measurement of cystatin C, followed by CG and Cl-Cr (Kappa coefficient=0.43, 0.22 and 0.16, respectively). CONCLUSION: Our study confirms the high variability of GFR in older patients and particularly in those with abnormal renal function, depending on the formula used. Serum cystatine C level and MDRD formula appear to be the most concordant estimates of GFR in this population.
Subject(s)
Glomerular Filtration Rate/physiology , Inpatients , Urinalysis/methods , Aged , Aged, 80 and over , Albuminuria/epidemiology , Creatinine/blood , Creatinine/urine , Cystatin C , Cystatins/urine , Humans , Prospective Studies , Sensitivity and SpecificitySubject(s)
Kidney Transplantation , Liver Transplantation , Renal Insufficiency/therapy , Adult , Aged , Female , Humans , Male , Middle AgedSubject(s)
Graft Rejection/pathology , Growth Substances/biosynthesis , Kidney Transplantation/pathology , Transcription, Genetic , Becaplermin , Biomarkers , Chronic Disease , Epidermal Growth Factor/biosynthesis , Fibroblast Growth Factor 2/biosynthesis , Follow-Up Studies , Graft Rejection/immunology , Growth Substances/analysis , Humans , Interleukin-1/biosynthesis , Kidney Transplantation/immunology , Platelet-Derived Growth Factor/biosynthesis , Proto-Oncogene Proteins c-sis , RNA, Messenger/biosynthesis , Time Factors , Transforming Growth Factor beta/biosynthesis , Tumor Necrosis Factor-alpha/biosynthesisSubject(s)
Diabetes Mellitus, Type 1/surgery , Diabetic Nephropathies/surgery , Graft Rejection/epidemiology , Kidney Failure, Chronic/surgery , Kidney Transplantation/immunology , Pancreas Transplantation/immunology , Acute Disease , Adult , Drug Therapy, Combination , Female , Follow-Up Studies , Histocompatibility Testing , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Kidney Transplantation/mortality , Male , Middle Aged , Pancreas Transplantation/mortality , Postoperative Complications/epidemiology , Retrospective Studies , Survival Rate , Time FactorsSubject(s)
Kidney Transplantation , Neoplasms/epidemiology , Postoperative Complications , Skin Neoplasms/epidemiology , Adult , Age Factors , Analysis of Variance , Carcinoma, Basal Cell/epidemiology , Carcinoma, Squamous Cell/epidemiology , Drug Therapy, Combination , Follow-Up Studies , Hepatitis B Surface Antigens/analysis , Histocompatibility Testing , Humans , Immunosuppressive Agents/therapeutic use , Incidence , Kidney Transplantation/immunology , Multivariate Analysis , Proportional Hazards Models , Renal Dialysis , Reoperation , Retrospective Studies , Risk Factors , Time FactorsSubject(s)
Graft Survival , Kidney Transplantation/mortality , Kidney Transplantation/physiology , Postoperative Complications/mortality , Actuarial Analysis , Adult , Cause of Death , Cyclosporine/therapeutic use , Follow-Up Studies , Graft Rejection/epidemiology , Graft Rejection/mortality , Humans , Immunosuppressive Agents/therapeutic use , Kidney Transplantation/pathology , Recurrence , Retrospective Studies , Risk Assessment , Risk Factors , Time Factors , Treatment FailureSubject(s)
Graft Rejection/epidemiology , Graft Survival , Kidney Transplantation/physiology , Liver Transplantation/physiology , Postoperative Complications , Adolescent , Adult , Aged , Creatinine/blood , Female , Follow-Up Studies , Histocompatibility Testing , Humans , Kidney Transplantation/immunology , Liver Transplantation/immunology , Male , Middle Aged , Renal Dialysis , Retrospective Studies , Time FactorsSubject(s)
Graft Rejection/pathology , Growth Substances/biosynthesis , Kidney Transplantation/pathology , Biopsy , Blood Pressure , Chronic Disease , Drug Therapy, Combination , Epidermal Growth Factor/biosynthesis , Fibroblast Growth Factor 2/biosynthesis , Graft Rejection/metabolism , Graft Rejection/physiopathology , Growth Substances/analysis , Humans , Immunosuppressive Agents/therapeutic use , Interleukin-1/biosynthesis , Kidney Transplantation/immunology , Kidney Transplantation/physiology , Platelet-Derived Growth Factor/biosynthesis , Polymerase Chain Reaction , Proteinuria , RNA, Messenger/biosynthesis , Transcription, Genetic , Transforming Growth Factor beta/biosynthesis , Tumor Necrosis Factor-alpha/biosynthesisSubject(s)
Cyclosporine/therapeutic use , Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Neoplasms/epidemiology , Adult , Cyclosporine/adverse effects , Drug Therapy, Combination , Female , Follow-Up Studies , Humans , Incidence , Leukemia/epidemiology , Lymphoma/epidemiology , Male , Melanoma/epidemiology , Risk Factors , Skin Neoplasms/epidemiology , Time FactorsSubject(s)
Body Weight , Creatinine/blood , Kidney Transplantation/physiology , Tissue Donors , Adolescent , Adult , Aged , Analysis of Variance , Cadaver , Child , Child, Preschool , Female , Humans , Infant , Male , Middle Aged , Multivariate Analysis , Regression AnalysisSubject(s)
Cyclosporine/therapeutic use , Graft Survival , Kidney Transplantation , Neoplasms/epidemiology , Adult , Carcinoma/epidemiology , Drug Therapy, Combination , Female , Follow-Up Studies , Glioblastoma/epidemiology , Humans , Immunosuppression Therapy/methods , Immunosuppressive Agents/therapeutic use , Incidence , Kidney Transplantation/immunology , Kidney Transplantation/mortality , Male , Retrospective Studies , Sarcoma, Kaposi/epidemiology , Skin Neoplasms/epidemiology , Survival Rate , Time FactorsSubject(s)
Adrenal Cortex Hormones/administration & dosage , Antilymphocyte Serum/therapeutic use , Azathioprine/therapeutic use , Cyclosporine/therapeutic use , Graft Survival/immunology , Kidney Transplantation/immunology , Adrenal Cortex Hormones/therapeutic use , Cyclosporine/administration & dosage , Drug Therapy, Combination , Follow-Up Studies , Graft Rejection/prevention & control , Humans , Kidney Transplantation/mortality , Kidney Transplantation/physiology , Retrospective Studies , Survival Rate , Time FactorsABSTRACT
Amyloidosis is a rare, fatal disease caused by deposition of a sulfated mucopolysaccharide in various tissues and organs. Seven to ten per cent of patients with multiple myeloma, a disease of abnormal myeloid cells, have associated amyloidosis. A case of amyloidosis associated with multiple myeloma is described and a differential diagnosis for oral amyloidosis is presented to familiarize the practitioner with this entity.