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Pruebas de función renal
Dr. Cristhian Mauricio Bueno Lara
Especialista en Medicina Interna – Universidad Autónoma de Buca...
Filtrado glomerular
Marcadores exógenos
Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrolog...
Filtrado glomerular
Creatinina
Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth ...
Depuración creatinina: (140 – Edad) x (Peso en Kg) / 72 x Creatinina sérica en
mg/dL x (0.86 si se es mujer)
Filtrado glom...
Filtrado glomerular
Creatinina
MDRD
2006
Comparador:
Iotalamato
Filtrado glomerular
Creatinina
MDRD
2006
Depuración creatinina: 175 x ( Creatinina sérica x 0.0011312)-1.154 x (Edad en
años)-0.203 x (0.742 si es mujer) x (1.212 ...
Filtrado glomerular
Creatinina
CKD EPI
2009
Comparador:
Iotalamato
Filtrado glomerular
Creatinina
CKD EPI
2009
Mujer afroamericana
Si CrS ≤ 0.7: 166 x (Creatinina sérica/ 0.7)-0.329 x 0.993Edad de paciente
Si CrS > 0.7: 166 x (Creati...
Filtrado glomerular
Creatinina
Pierre Delanaye and Christophe Mariat. The applicability of eGFR equations to different pop...
Filtrado glomerular
Creatinina
2010
Fórmulas Exactitud Subestimación Sobrestimación
Cockroft Gault 63 % 8% 29%
MDRD 65% 20% 15%
CKD EPI 69% 8% 23%
Filtrado gl...
Filtrado glomerular
Creatinina
Genero: Masculino
Raza: Negra
Edad: 84 años
Peso: 46 kg
Creatinina: 1.2 mg/dl
Cockcroft Gau...
Filtrado glomerular
Creatinina
2004
Filtrado glomerular
Creatinina
Filtrado glomerular
Creatinina
2012
Comparador:
Iohexol
BIS 1:
TFG: 3736 x Creatinina-0.87 x Edad-0.95 x (0.82 si es mujer...
Filtrado glomerular
Creatinina
2012
Filtrado glomerular
Cistatina C
2008
Filtrado glomerular
Cistatina C
2008
Filtrado glomerular
Cistatina C
2008
Filtrado glomerular
Cistatina C
2008
Filtrado glomerular
Otros marcadores
2015
Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth edition 2015
Filtrado glomerula...
Patrick T. Murray. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from
the 10th...
• Molécula de 140 kDa
• Medición en orina por ensayo colorimétrico.
Jennifer R. Charlton, Didier Portilla and Mark D. Okus...
Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers.
Nephrol D...
Marcadores Injuria Aguda
Interleucina 18
2002
• Familia de las proteínas ligadas a ácidos grasos (FABP)
• Expresada en el intestino, páncreas, riñón, pulmones y estómag...
Marcadores Injuria Aguda
Proteína asociada a ácidos grasos
hepáticos
2007
Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers.
Nephrol D...
Marcadores Injuria Aguda
Molécula de injuria renal 1 (KIM-1)
2012
Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers.
Nephrol D...
Marcadores Injuria Aguda
2009
76%
Sensibilidad
85.1%
Sensibilidad
GRACIAS
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Pruebas de función renal - 2015

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Evaluación de los diferentes métodos vigentes de función renal y una introducción a los marcadores de injuria renal con mayor evidencia en la actualidad.

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Pruebas de función renal - 2015

  1. 1. Pruebas de función renal Dr. Cristhian Mauricio Bueno Lara Especialista en Medicina Interna – Universidad Autónoma de Bucaramanga Fellow en Nefrología – Universidad del Valle
  2. 2. Filtrado glomerular Marcadores exógenos Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth edition 2015
  3. 3. Filtrado glomerular Creatinina Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth edition 2015
  4. 4. Depuración creatinina: (140 – Edad) x (Peso en Kg) / 72 x Creatinina sérica en mg/dL x (0.86 si se es mujer) Filtrado glomerular Creatinina From 249 pairs of measured creatinine clearances in males, creatinine excretion (mg/kg) was found to decrease linearly with age. The linear regression of creatinine excretion against age led to development of a formula which can be used to successfully predict creatinine clearance from age, weight, andserum creatinine. [TheSCI® indicates that project, a case report, proved unsuccessful. My second research project was to verify the accu- racy of a nomogram which predicted creatinine clearance based on serum creatinine, age, and weight.1 The investigation expanded to include a review of 505 pairs of measured endogenous creatinine clearance values in males. Of the 505, 249 pairs were reproducible and arbitrarily as- CockcroftDW &GaultMH.Predictionofcreatinineclearancefromserumcreatinine.Nephron16:31-41, 1976.[DepartmentsofMedicine,QueenMaryVeterans’Hospital,Montreal,Quebec,andMemorial University;St.John’s,Newfoundland,Canada] ThisWeek’sCitationClassic® CC/NUMBER48 NOVEMBER30,1992Cockcroft and Gault 1976 Comparador: Depuración de creatinina
  5. 5. Filtrado glomerular Creatinina MDRD 2006 Comparador: Iotalamato
  6. 6. Filtrado glomerular Creatinina MDRD 2006
  7. 7. Depuración creatinina: 175 x ( Creatinina sérica x 0.0011312)-1.154 x (Edad en años)-0.203 x (0.742 si es mujer) x (1.212 si es raza negra) Filtrado glomerular Creatinina Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth edition 2015 MDRD No valida en menores de 18 años, mayores de 70 años y mujeres embarazadas.
  8. 8. Filtrado glomerular Creatinina CKD EPI 2009 Comparador: Iotalamato
  9. 9. Filtrado glomerular Creatinina CKD EPI 2009
  10. 10. Mujer afroamericana Si CrS ≤ 0.7: 166 x (Creatinina sérica/ 0.7)-0.329 x 0.993Edad de paciente Si CrS > 0.7: 166 x (Creatinina sérica/ 0.7)-1.209 x 0.993Edad de paciente Hombre afroamericano Si CrS ≤ 0.7: 163 x (Creatinina sérica/ 0.9)-0.411 x 0.993Edad de paciente Si CrS > 0.7: 163 x (Creatinina sérica/ 0.7)-1.209 x 0.993Edad de paciente Mujer otras razas Si CrS ≤ 0.7: 144 x (Creatinina sérica/ 0.7)-0.329 x 0.993Edad de paciente Si CrS > 0.7: 144 x (Creatinina sérica/ 0.7)-1.209 x 0.993Edad de paciente Hombre otras razas Si CrS ≤ 0.7: 141 x (Creatinina sérica/ 0.7)-0.411 x 0.993Edad de paciente Si CrS > 0.7: 141 x (Creatinina sérica/ 0.7)-1.209 x 0.993Edad de paciente Filtrado glomerular Creatinina
  11. 11. Filtrado glomerular Creatinina Pierre Delanaye and Christophe Mariat. The applicability of eGFR equations to different populations. Nat. Rev. Nephrol. 9, 513–522 (2013) 14 | SEPTEMBER2013 | VOLUME9 www.nature.com/nrneph arenot considered. Moreover, sincetherelation- ship between serum creatinineand GFRisnot linear but exponential,an increaseof serum creatininefrom 53 mol/l to 106 mol/l will beequivalent, in termsof percentageof decreased GFR, to aserum creatinine increasefrom177 mol/l to354 mol/l.Thisexponential relationshipisfundamental andmaybemissedif serum creatininealoneisconsidered.3,6,28 drug-dosingrecommendations. MDRDequation In 1999, Levey et al. proposed anew creatinine-based equation,theMDRD equation (Table1).Thisequation wasintended to estimate‘true’ GFRmeasured by the urinaryclearanceof iothalamateandindexedbyBSA.28 TheindexingbyBSA probablyexplainswhy‘weight’was Table 1 | Comparison of methodologies used for the development of the three most used creatinine-based GFRequations Feature Cockcroft–Gault equation MDRD equation CKD-EPI creatinine equation Year of publication 1976 1999 2009 Sample size 249 1,628 5,504 Reference method Creatinine clearance Iothalamate Iothalamate Mean GFR±SD 73±37ml/ min 40±21ml/ min/ 1.73 m2 68±40ml/ min/ 1.73 m2 Percentage women 4 40 43 Percentage Caucasians 100 88 63 Mean age±SD (years) NA 51±13 47±15 Mean BMI±SD (kg/ m2) NA 27±4 28±6 Abbreviations: BMI, bodymass index; CKD-EPI, Chronic Kidney Disease EpidemiologyCollaboration; GFR, glomerular filtration rate; MDRD, Modification of Diet in Renal Disease; NA, not available; SD, standard deviation. © 2013MacmillanPublishersLimited.All rightsreserved
  12. 12. Filtrado glomerular Creatinina 2010
  13. 13. Fórmulas Exactitud Subestimación Sobrestimación Cockroft Gault 63 % 8% 29% MDRD 65% 20% 15% CKD EPI 69% 8% 23% Filtrado glomerular Creatinina Wieneke Marleen Michels. Performance of the Cockcroft-Gault, MDRD, and New CKD- EPI Formulas in Relation to GFR, Age, and Body Size. Clin J Am Soc Nephrol 5: 1003–1009, 2010
  14. 14. Filtrado glomerular Creatinina Genero: Masculino Raza: Negra Edad: 84 años Peso: 46 kg Creatinina: 1.2 mg/dl Cockcroft Gault: 29.8 ml/min/1.73 m2 Grado 4 CKD EPI: 64 ml/min/1.73 m2 Grado 2
  15. 15. Filtrado glomerular Creatinina 2004
  16. 16. Filtrado glomerular Creatinina
  17. 17. Filtrado glomerular Creatinina 2012 Comparador: Iohexol BIS 1: TFG: 3736 x Creatinina-0.87 x Edad-0.95 x (0.82 si es mujer) BIS 2: TFG: 767 x Cistatina-0.61 x Edad-0.57x Creatinina-0.40 x (0.87 si es mujer)
  18. 18. Filtrado glomerular Creatinina 2012
  19. 19. Filtrado glomerular Cistatina C 2008
  20. 20. Filtrado glomerular Cistatina C 2008
  21. 21. Filtrado glomerular Cistatina C 2008
  22. 22. Filtrado glomerular Cistatina C 2008
  23. 23. Filtrado glomerular Otros marcadores 2015
  24. 24. Richard J. Johnson, John Feehally, Jurgen Floege. Comprehensive clinical nephrology. Fifth edition 2015 Filtrado glomerular Urea
  25. 25. Patrick T. Murray. Potential use of biomarkers in acute kidney injury: report and summary of recommendations from the 10th Acute Dialysis Quality Initiative consensus conference. Kidney International (2014) 85, 513–521 Marcadores Injuria Aguda
  26. 26. • Molécula de 140 kDa • Medición en orina por ensayo colorimétrico. Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers. Nephrol Dial Transplant (2014) 29: 1301–1311 Marcadores Injuria Aguda N-Acetil – β – D- Glucosaminidasa Original Article Measurement of tubular enzymuria facilitatesearly detection of acute renal impairment intheintensivecareunit Justin Westhuyzen1 , Zoltan H. Endre2 , Graham Reece3 , David M. Reith4 , David Saltissi2 and ThomasJ. Morgan3 1 Conjoint Renal Laboratory, Queensland Health Pathology Service, 3 IntensiveCareUnit and 2 Department of Renal Medicine, Royal BrisbaneHospital, Brisbane, Australia and 4 Dunedin School of Medicine, University of Otago, Dunedin, Nephrol Dial Transplant (2003) 18: 543–551 Original Article Measurement of tubular enzymuria facilitates early detection of acute renal impairment in the intensive care unit 1 2 3 4 2 Nephrol Dial Transplant (2003) 18: 543–551 2003 100% Sensibilidad 81% Especificidad 26 Pacientes
  27. 27. Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers. Nephrol Dial Transplant (2014) 29: 1301–1311 Marcadores Injuria Aguda Interleucina 18 • Células mononucleares, macrófagos y células túbulos proximales.
  28. 28. Marcadores Injuria Aguda Interleucina 18 2002
  29. 29. • Familia de las proteínas ligadas a ácidos grasos (FABP) • Expresada en el intestino, páncreas, riñón, pulmones y estómago. Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers. Nephrol Dial Transplant (2014) 29: 1301–1311 Marcadores Injuria Aguda Proteína asociada a ácidos grasos hepáticos
  30. 30. Marcadores Injuria Aguda Proteína asociada a ácidos grasos hepáticos 2007
  31. 31. Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers. Nephrol Dial Transplant (2014) 29: 1301–1311 Marcadores Injuria Aguda Molécula de injuria renal 1 (KIM-1)
  32. 32. Marcadores Injuria Aguda Molécula de injuria renal 1 (KIM-1) 2012
  33. 33. Jennifer R. Charlton, Didier Portilla and Mark D. Okusa. A basic science view of acute kidney injury biomarkers. Nephrol Dial Transplant (2014) 29: 1301–1311 Marcadores Injuria Aguda Lipocalina asociada a la gelatinasa del neutrófilo
  34. 34. Marcadores Injuria Aguda 2009 76% Sensibilidad 85.1% Sensibilidad
  35. 35. GRACIAS

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