Measured and estimated glomerular filtration rates in voluntary kidney donors - before and after nephrectomy.

Madhivanan, S (2007) Measured and estimated glomerular filtration rates in voluntary kidney donors - before and after nephrectomy. Masters thesis, Christian Medical College, Vellore.


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INTRODUCTION : The assessment of renal functions has always remained a challenge for nephrologists. The accurate assessment is paramount for several reasons like categorizing patients into the different groups, comparison of renal function amongst different populations, determining the therapeutic measures needed at different categories of renal dysfunction in chronic kidney disease patients and so on. The simple measurement of plasma creatinine and the estimated glomerular filtration rate (GFR) using the various equations have been the mainstay of renal function assessment in the bedside. The other methods of direct measurement are cumbersome to perform on a day-to-day basis and are quite expensive. This has forced the nephrology community to accept the former (compromising on the accuracy) to that of the latter methods. Several new methods like the technetium 99m-labeled diethylene triaminopentaacetic acid (99mTc-DTPA) renal scintigraphy have been claimed to measure GFR accurately. But these have not been standardized. Also various biochemical markers like cystatin C (CysC) and beta- 2 microglobulin have been claimed to reflect smaller degrees of renal changes better but have not come into widespread clinical use. AIM : To assess the correlation between measured and estimated GFR in voluntary kidney donors, pre and post nephrectomy and to determine the post-nephrectomy GFR in VKDs. MATERIALS AND METHODS : Pre- and post-nephrectomy (after 3 months) GFR measurement was done by 99mTcDTPA scintigraphy and estimations using creatinine (CG, MDRD formulae) and serum Cystatin C (Grubb’s equation). DISCUSSION : Forty-three donors (15 males, mean age of 43.02 ± 12.05 years) were studied. CG estimations used actual and lean body weight (CGGFRA, CGGFRL). Modification of diet in renal diseases formula used MDRD1 and MDRD2 formulae. The measured values were 92.37 ± 26.79-ml/min/1.73 m2 at baseline and 53.58 ± 17.18-ml/min/1.73 m2 after 3 months. The estimated values at the same time points by CGGFRA, CGGFRL, MDRD1 and MDRD2 were 78.34 ±16.30, 58.12 ±12.35, 84.61± 15.68, 90.82 ± 19.29 ml/min/1.73 m2 respectively, pre-nephrectomy and 56.78 ± 12.90, 42.42 ± 10.00, 62.07 ± 11.34 61.67 ± 12.33 ml/min/1.73 m2 respectively, post-nephrectomy. As CysC is better predictor of changes in GFR, it was performed in a subset (n=21). The Pre- and post- nephrectomy CysC GFR using the Grubb’s equation was 90.48 ± 28.04 and 56.73 ± 15.87- ml/min/1.73 m2. Significant intraclass correlation coefficient was noted between 99mTCDTPA GFR and CysCGFR (0.83 and 0.67, pre and post), but not with others. CG and MDRD GFRs had correlation. Post-nephrectomy GFR decline by all methods were significant with 99mTCDTPA GFR (41.99%) recording the maximum decline. CONCLUSION : Cystatin C GFR predicts 99mTC-DTPA GFR reasonably well, pre- and post-nephrectomy. Creatinine based estimated GFRs don’t. However, CG and MDRD have acceptable correlation between them. The post-nephrectomy decline in the GFR was significant by all methods with the highest decline noted with 99m TC-DTPA.

Item Type: Thesis (Masters)
Uncontrolled Keywords: glomerular filtration rates ; voluntary kidney donors ; before and after nephrectomy.
Subjects: MEDICAL > Nephrology
Depositing User: Kambaraman B
Date Deposited: 11 Jul 2017 06:49
Last Modified: 11 Jul 2017 06:49

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