Plasmatic cystatin C for the estimation of glomerular filtration rate in intensive care units

in Intensive Care Medicine (2004), 30(5), 980-983

OBJECTIVE: To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN: Prospective observational study. SETTING: Medical intensive care unit at a ... [more ▼]

OBJECTIVE: To compare the sensitivity of cystatin C and creatinine in detecting decreased glomerular filtration rate. DESIGN: Prospective observational study. SETTING: Medical intensive care unit at a university hospital. PATIENTS AND PARTICIPANTS: Fourteen patients hospitalised in a medical intensive care unit. INTERVENTIONS: Cystatin C and creatinine plasmatic levels were measured in 40 blood samples taken with an interval of at least 24 h. MEASUREMENTS AND RESULTS: Glomerular filtration rate was estimated by creatinine clearance using 24-h urine collection and the classical Cockcroft-Gault equation. The ability of cystatin C to detect a glomerular filtration rate under 80 ml/min per 1.73 m(2) was significantly better than that of creatinine ( p<0.05). CONCLUSIONS: Cystatin C, a new plasmatic marker of renal function, could be used to detect renal failure in intensive care in the future. [less ▲]

Effect of hemodiafiltration on pulmonary hemodynamics in endotoxic shock

in Artificial Organs (2003), 27(12), 1128-1133

Hemofiltration can improve pulmonary hemodynamics during septic shock. The main objective of the study was to determine whether hemodiafiltration (HDF) would also have beneficial effects on pulmonary ... [more ▼]

Hemofiltration can improve pulmonary hemodynamics during septic shock. The main objective of the study was to determine whether hemodiafiltration (HDF) would also have beneficial effects on pulmonary hemodynamics during septic shock. In the Endo group, six anesthetized pigs received a 0.5 mg/kg endotoxin infusion over 30 min. In the HDF group (n = 6), HDF was started 30 min after the end of the endotoxin infusion, while in the Control group (n = 4) they received HDF but no endotoxin infusion. Pulmonary hemodynamics were analyzed in detail with a four-element windkessel model. Although in the Control group, HDF did not alter pulmonary hemodynamic parameters, in the HDF group, it was responsible for an amplification of the deleterious pulmonary vascular response to endotoxin insult. Our results show that HDF must be used cautiously in septic shock since it can precipitate right heart failure by increasing pulmonary vascular resistance. [less ▲]

Blood pressure control in treated hypertensive patients: clinical experience

Poster (2003, May 13)

Too many treated hypertensive patients remain uncontrolled all over the world. Patients' compliance but also the management of adequate treatment by the physician are essential to improve blood pressure ... [more ▼]

Too many treated hypertensive patients remain uncontrolled all over the world. Patients' compliance but also the management of adequate treatment by the physician are essential to improve blood pressure control. Aim: The present study assesses the prevalence of control of SBP and DBP among patients referred to an hypertension clinic by general practitioners and specialists to measure treatment efficacy. Characteristics of uncontrolled patients' treatment are analysed. Were recorded: Office Blood Pressure (OBP), 24hours ABPM, history of cardiovascular risk factors and detailed current antihypertensive treatment. [less ▲]

Prevention de la nephropathie diabetique: de la microalbuminurie a l'insuffisance renale terminale.

in Revue Médicale de Liège (2003), 58(5), 297-306

Diabetic nephropathy is one of the leading causes of end-stage renal failure in western countries. This disease develops over several years. Early stages, if they are detected in time, can lead to ... [more ▼]

Diabetic nephropathy is one of the leading causes of end-stage renal failure in western countries. This disease develops over several years. Early stages, if they are detected in time, can lead to preventive treatment at a moment when the disease is still reversible. This paper reviews the main primary and secondary preventive measures that have been proven efficacious. Those are essentially the optimal treatment of hyperglycaemia and hypertension, and probably the use of agents that specifically block the renin-angiotensin axis. We briefly discuss the results of the main studies that have led to those conclusions. [less ▲]

L'intérêt de la cystatine C dans l'évaluation de la fonction rénale

in Nephrologie (2003), 24(8), 457-68

Glomerular filtration rate (GFR) is the best indicator of renal function. GFR is usually estimated by serum creatinine or the creatinine clearance calculated on urine collected over 24 hours or with the ... [more ▼]

Glomerular filtration rate (GFR) is the best indicator of renal function. GFR is usually estimated by serum creatinine or the creatinine clearance calculated on urine collected over 24 hours or with the Cockcroft formula. These methods are however limited. Serum creatinine has a very poor sensitivity and urine collection is difficult. Cystatin C is a protease inhibitor produced in a constant manner by nucleated cells. This molecule is freely filtrated by the glomerule and quite completely catabolized in the proximal tubules. Its plasmatic concentration might thus be used to estimate GFR. Presently available data allow to conclude that plasmatic cystatin C is at least as good as serum creatinine to estimate GFR. It is less sensible to changes in body mass. Its determination appears more sensitive to detect early mild changes in GFR. Reference values are presently available for the different methods of determination. Cystatin C plasma level determination is more expensive than routine creatinine plasma determination. In the absence of very significant advantages, this might explain its limited use in daily clinical practice. [less ▲]

Follow-up of iron microalbuminuria in hypertensive patients: a belgian promise survey

in Acta Clinica Belgica (2003), 58-3(4), 328

Prévention primaire des maladies rénales et secondaire de l'insuffisance rénale

in Médi-Sphère (2003), 192

Il est apparu important de rèsumer les points capitaux à respecter lors de tout contact avec un patient, d'une part pour le proteger du développement de la maladie rénale (si possible) et pour freiner l ... [more ▼]

Il est apparu important de rèsumer les points capitaux à respecter lors de tout contact avec un patient, d'une part pour le proteger du développement de la maladie rénale (si possible) et pour freiner l'évolution de celle-ci une fois constituée d'autre part, l'objectif étant alors d'éviter l'insuffisance rénale sévère, stade où l'intervention du médecin n'est plus que symptomatique. Généralement fortuite, l'insuffisance rénale gagne à être diagnostiquée précocement. L'intervention du néphrologue sera également d'autant plus efficace que rapide. [less ▲]

Belgian peer review experience on the Achille's heel in haemodialysis care: vascular access

in EDTNA/ERCA Journal (2002), 28(4, Oct-Dec), 164-166

AIMS: In order to improve the supervision and to evaluate the quality of care in dialysis units, a national project was promoted as a Peer Review. It consisted of systematic, continuous and critical ... [more ▼]

AIMS: In order to improve the supervision and to evaluate the quality of care in dialysis units, a national project was promoted as a Peer Review. It consisted of systematic, continuous and critical evaluation of the care and the application of international guidelines and compared the reality of care with standards. METHOD: The first chart consisted of the evaluation of infectious episodes of vascular access. This point is particularly relevant since infection represents the second cause of mortality in haemodialysis. A questionnaire concerning each patient was designed. Questions concerned the description of vascular access and the related infectious events. Each questionnaire included 21 items. The project involved 29 dialysis centres, 1,644 patients and 1,775 vascular accesses. The database included 90,525 data. RESULTS: Among the 29 centres, the native arteriovenous fistula (AVF) is the first choice (67.5%) in vascular access, but the proportion of AVF decreases with age contrary to the catheter, which is more frequently chosen, in older patients. Independent of age, 20% of hospitalisations are among patients with catheters and only 7% among patients with AVF. The RR (relative risk) of being hospitalised (any complication of vascular access) is 1.68 for patients with catheters compared to patients with AVF. The rate of infections does not increase with age but is higher for patients with catheters (RR = 2.26). The number of infections appears to be dependent on the staphylococcus aureus carriage in the year. CONCLUSIONS: This first step allows each centre to compare itself to others in an anonymous way. This approach should lead to specific recommendations to improve the quality of care in dialysis units. [less ▲]

Comparison of plasma cardiac troponins T and I in chronically hemodialyzed patients in relation to cardiac status and age

in Clinical Chemistry & Laboratory Medicine (2002), 40(3), 240-245

Markers of oxidative stress limited to increased risk of cardiovascular disease in chronic hemodialysis patients

in Free Radical Biology & Medicine (2001), 31(suppl), 345