| 1. |
- Grubb, Anders, et al.
(författare)
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Cystatin C, a marker for successful aging and glomerular filtration rate, is not influenced by inflammation.
- 2011
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 71, s. 145-149
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Background. The plasma level of cystatin C is a better marker than plasma creatinine for successful aging. It has been assumed that the advantage of cystatin C is not only due to it being a better marker for glomerular filtration rate (GFR) than creatinine, but also because an inflammatory state of a patient induces a raised cystatin C level. However, the observations of an association between cystatin C level and inflammation stem from large cohort studies. The present work concerns the cystatin C levels and degree of inflammation in longitudinal studies of individual subjects without inflammation, who undergo elective surgery. Methods. Cystatin C, creatinine, and the inflammatory markers CRP, serum amyloid A (SAA), haptoglobin and orosomucoid were measured in plasma samples from 35 patients the day before elective surgery and subsequently during seven consecutive days. Results. Twenty patients had CRP-levels below 1 mg/L before surgery and low levels of the additional inflammatory markers. Surgery caused marked inflammation with high peak values of CRP and SAA on the second day after the operation. The cystatin C level did not change significantly during the observation period and did not correlate significantly with the level of any of the four inflammatory markers. The creatinine level was significantly reduced on the first postoperative day but reached the preoperative level towards the end of the observation period. Conclusion. The inflammatory status of a patient does not influence the role of cystatin C as a marker of successful aging, nor of GFR.
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| 2. |
- Björk, Jonas, et al.
(författare)
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A new tool for predicting the probability of chronic kidney disease from a specific value of estimated GFR.
- 2010
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; Jul 1, s. 327-333
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. To demonstrate how patients' probability of having chronic kidney disease (CKD) stage 3-5 (measured GFR <60 mL/min/1.73 m(2)) can be predicted from a specific value of estimated glomerular filtration rate (eGFR). Material and methods. The probability of CKD stage 3-5 was predicted from a logistic regression model (n = 850) using three different eGFR prediction equations: Lund-Malmö, MDRD and CKD-EPI. Population weighting was used to illustrate how this probability varies in three different populations: original sample (55% true prevalence of CKD stage 3-5), a screening (6.7% prevalence) and a CKD population (84% prevalence). Results. All three eGFR-equations had high classification ability (area under the receiver-operating-characteristic curve = 97%). The probability of CKD stage 3-5 increased with decreasing eGFR, varied substantially among the populations studied and to some extent between the eGFR-equations. Using the Lund-Malmö equation as illustration, the probability of CKD stage 3-5 is > 90% only when eGFR is <38 mL/min/1.73 m(2) in a screening population, whereas it is > 90% already when eGFR is <51 mL/min/1.73 m(2) in a CKD population. Conversely, the probability of CKD stage 3-5 is <10% if eGFR > 59 mL/min/1.73 m(2) in a screening population, whereas it is <10% only when eGFR is > 88 mL/min/1.73 m(2) in a CKD population. Conclusion. Instead of reporting diagnostic accuracy as sensitivity, specificity, and predictive values, actual eGFR supplemented with the probability that it represents a true GFR <60 mL/min/1.73 m(2) may be more valuable for physicians. Clinical (pre-test) probability in the population must be considered when predicting this probability.
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| 3. |
- Björk, Jonas, et al.
(författare)
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Revised equations for estimating glomerular filtration rate based on the Lund-Malmö Study cohort.
- 2011
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Ingår i: Scandinavian Journal of Clinical and Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 71, s. 232-239
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Tidskriftsartikel (refereegranskat)abstract
- Abstract Objective. To increase the accuracy of estimated GFR (eGFR) from creatinine overall and at measured GFR ≥90 mL/min per 1.73 m(2) by revising the Lund-Malmö (LM) equations, to elaborate on more complex forms to improve the LM and CKD-EPI equations further, and to assess benefits of adding lean body mass (LBM). Material and methods. Swedish Caucasians (n = 850, 376 women; median 60, range 18-95 years) referred for GFR measurement (plasma iohexol-clearance: median 55, range 5-173 mL/min/1.73 m(2)) constituted the Lund-Malmö Study cohort. Bias, precision, accuracy, expressed as median absolute percentage difference and percentage of estimates ±10% (P(10)) and ±30% (P(30)) of measured GFR, and classification ability with respect to five GFR stages were compared with the original LM, CKD-EPI and MDRD equations. Results. LM Revised overall performed better than LM Original without LBM due to increased accuracy at measured GFR ≥90 mL/min/1.73 m(2). Further extensions of the CKD-EPI or LM equations did not substantially improve overall performance. In particular, the performance of LM Revised at measured GFR ≥90 mL/min/1.73 m(2) could not be improved further without decreasing accuracy and classification ability at lower GFR-levels. Adding LBM to the equations had no strong effect on accuracy. Conclusion. Comparisons with the CKD-EPI and MDRD equations suggest that the LM equations are superior for the present Swedish population, due to markedly higher accuracy of the LM equations at measured GFR <30 mL/min/1.73 m(2). However, the LM equations cannot be recommended for use in general clinical practice until validated in other populations.
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| 4. |
- Nyman, Ulf, et al.
(författare)
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Revised Swedish guidelines on intravenous iodine contrast medium-induced acute kidney injury 2022: A summary
- 2023
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 64:5
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Forskningsöversikt (refereegranskat)abstract
- The Swedish Society of Uroradiology has revised their computed tomography (CT) guidelines regarding iodine contrast media-induced acute kidney injury (CI-AKI). They are more cautious compared to the European Society of Urogenital Radiology and the American College of Radiology since the actual risk of CI-AKI remains uncertain in patients with moderate to severe kidney damage due to a lack of prospective controlled studies and mainly based on retrospective propensity score-matched studies with low-grade evidence. Another source of uncertainty is the imprecision of glomerular filtration rate (GFR) estimating equations. However, randomized hydration studies indictae an upper limit risk of CI-AKI of about 5% for outpatients with a GFR in the range of 30-44 or 45-59 mL/min/1.73m(2) combined with multiple risk factors. Apart from GFR limits, the guideline also includes limits for systemic contrast medium exposure expressed in gram-iodine/GFR ratio.
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| 5. |
- Holmquist, Fredrik, et al.
(författare)
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Can iterative reconstruction algorithms replace tube loading compensation in low kVp hepatic CT? Subjective versus objective image quality
- 2020
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Ingår i: Acta Radiologica Open. - : SAGE Publications. - 2058-4601 .- 2058-4601. ; 9:3
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Tidskriftsartikel (refereegranskat)abstract
- Background: Hepatic computed tomography (CT) with decreased peak kilovoltage (kVp) may be used to reduce contrast medium doses in patients at risk of contrast-induced acute kidney injury (CI-AKI); however, it increases image noise. To preserve image quality, noise has been controlled by X-ray tube loading (mAs) compensation (TLC), i.e. increased mAs. Another option to control image noise would be to use iterative reconstructions (IR) algorithms without TLC (No-TLC). It is unclear whether this may preserve image quality or only reduce image noise. Purpose: To evaluate image quality of 80 kVp hepatic CT with TLC and filtered back projection (FBP) compared with 80 kVp with No-TLC and IR algorithms (SAFIRE 3 and 5) in patients with eGFR <45 mL/min. Material and Methods: Forty patients (BMI 18-32 kg/m(2)) were examined with both protocols following injection of 300 mg I/kg. Hepatic attenuation, image noise, enhancement, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and subjective image quality were evaluated for each patient. Results: Comparing TLC/FBP with No-TLC/IR-S5, there were no significant differences regarding hepatic attenuation, image noise, enhancement, SNR and CNR: 114 vs. 115 HU, 14 vs. 14 HU, 55 vs. 57 HU, 8.0 vs. 8.4, and 3.8 vs. 4.0 in median, respectively. No-TLC/IR-S3 resulted in higher image noise and lower SNR and CNR than TLC/FBP. Subjective image quality scoring with visual grading showed statistically significantly inferior scores for IR-S5 images. Conclusion: CT of 80 kVp to reduce contrast medium dose in patients at risk of CI-AKI combined with IR algorithms with unchanged tube loading to control image noise does not provide sufficient diagnostic quality.
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| 6. |
- Nyman, Ulf, et al.
(författare)
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The Lund-Malmo creatinine-based glomerular filtration rate prediction equation for adults also performs well in children
- 2008
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Ingår i: Scandinavian Journal of Clinical & Laboratory Investigation. - : Informa UK Limited. - 1502-7686 .- 0036-5513. ; 68:7, s. 568-576
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Tidskriftsartikel (refereegranskat)abstract
- Objective . To evaluate the clinical performance in a paediatric population of the Lund-Malmo creatinine-based glomerular filtration rate (GFR) prediction equations, primarily developed for adults. Material and methods . Iohexol clearance was used as the gold standard in 85 paediatric Caucasian patients (0.3-17 years; 37 F/48 M). One Lund-Malmo equation was based on age and gender (LM) and one included lean body mass (LM-LBM). Comparisons focused on correlation (adjusted R-2), bias (median percent error) and accuracy (proportions of predicted GFR differing <= 30 % from measured GFR) (mL/min/1.73 m(2)). The performances were compared with those of the Modification of Diet in Renal Disease (MDRD) Study equation, a dedicated paediatric creatinine equation, Counahan-Barratt (CB) and a cystatin C-based equation. Results . The MDRD equation performed poorly with a median bias of 96 %. Of the remaining equations, only the LM-LBM produced significant bias (+10 % in median) according to line of identity regression analysis. The LM equation yielded marginally higher accuracy (76 %) than the LM-LBM equation (74 %) and the CB (73 %), but lower than the cystatin C-based equation (82 %). However, the estimated accuracy figures for these four equations were generally imprecise and none of the differences compared with the LM equation was statistically significant. Conclusion . In contrast to most creatinine-based GFR prediction equations, the LM equation performs adequately for both children and adults. This may be due to the unique model-building principles used when the LM equation was established. Further validation in a larger paediatric population is necessary.
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| 7. |
- Holmquist, Fredrik, et al.
(författare)
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80-kV(p) hepatic CT to reduce contrast medium dose in azotemic patients: a feasibility study
- 2020
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Ingår i: Acta Radiologica. - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 61:4, s. 441-449
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Tidskriftsartikel (refereegranskat)abstract
- Background Low peak kilovoltage (kV(p)) computed tomography (CT) may be used to reduce contrast medium doses in patients at risk of contrast medium-induced acute kidney injury if image noise can be controlled by increasing X-ray tube loading (mAs). Purpose To evaluate objective and subjective image quality in 80-kV(p) CT with reduced contrast medium dose and compensated mAs for unchanged image noise in patients with estimated glomerular filtration rate Material and Methods 80-kV(p) CT with 300 mg I/kg in 40 patients (body mass index 18-32 kg/m(2), glomerular filtration rate <45 mL/min) and 120-kV(p) CT with 500 mg I/kg in 40 patients (body mass index = 17-30 kg/m(2), glomerular filtration rate >= 45 mL/min) was compared on mean hepatic attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, effective radiation dose, and subjective image quality. Results There were no significant differences regarding median hepatic post-contrast attenuation, image noise, contrast medium enhancement, signal-to-noise ratio, contrast-to-noise ratio, or effective dose between the 80-kV(p) and 120-kV(p) cohorts: 114/110 HU; 14/14 HU; 57/53 HU; 8.0/7.4; 3.8/3.5; and 5.3/5.9 mSv, respectively. However, subjective image visual grading showed statistically significantly inferior scores for 80 kV(p) for six of eight items. After exclusion of seven inferior examinations not caused by the chosen kV(p) technique, only three items showed inferior scores for 80 kV(p). Only 5% of gradings regarding overall image quality were Conclusion Despite lower subjective image quality, objective data indicate that 80-kV(p) CT with reduced contrast medium doses and compensated mAs may have the potential to provide satisfactory diagnostic quality in patients with body mass index <30 kg/m(2), which could benefit patients at risk of contrast medium-induced acute kidney injury.
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| 8. |
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| 9. |
- Haglund, Marie, et al.
(författare)
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Kontrastnefropati efter datortomografi. Hydrering och anpassad kontrastmedelsdos ger bästa profylax
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:40, s. 2864-2870
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Tidskriftsartikel (refereegranskat)abstract
- Nefrotoxicitet efter kontrastmedelstillförsel, räknat som en 25-procentig stegring av kreatinin i plasma, förekom hos 12 procent i en oselekterad grupp patienter som genomgått datortomografi. Generell arterioskleros kan läggas till övriga kända riskfaktorer för utveckling av kontrastmedelsnefrotoxicitet. Uppskattning av njurfunktion, t ex med hjälp av lämplig formel, bör göras före kontrastmedelstillförsel, särskilt hos patienter över 70 års ålder. För att minimera risken för njurpåverkan bör kontrastmedelsdosen uttryckt i gram jod understiga det numeriska värdet av den glomerulära filtrationshastigheten (GFR) uttryckt i ml/min.
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| 10. |
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