Few days ago, we discussed what is the normal for albumin amount in your urine and total protein amount?
In a 24 hour urine collection, it would be considered normal to have up to150 mg per day of protein, of which approximately 10 mg is albumin.
Normal urine albumin to creatinine ratio is <17 mg albumin/g creatinine for men, < 25 mg albumin/g creatinine for women. The normal urine protein to creatinine ratio is < 200 mg protein/gram creatinine.
Urinary protein can be comprised of both albumin and other proteins.Therefore, the urine albumin would not account for all protein excretion.
Microalbuminuria refers to albumin excretion of 30-300 mg/day, which correlates to a urine albumin:creatinine ratio of 17-250 mg/g for men and 25-355 mg/g for women.
Sunday, April 4, 2010
Antibody Mediated Rejection Review
https://www.pediatric-nephrology.com/daily-updates/2010/04/04/175-amrcedars.html
Check out the link to this nice review posted on a pediatric nephrology blog.
A nice read!
Check out the link to this nice review posted on a pediatric nephrology blog.
A nice read!
Bone marrow transplantation and solid organs
The recent issue of Transplantation embarks on two articles on simultaneously doing a bone marrow transplantation and pancreas and islet cell respectively.
The first paper is a basic science study that showed bone marrow derived pancreatic cells are mobilized into injured pancreatic tissue and contribute to β-cell regeneration. Transplantation of BM-derived cells improved the function of injured pancreas, although the response is not sufficient to restore sustained normoglycemia is their conclusion.
The second paper was on islet cell transplants, another basic science study. Cotransplantation of bone marrow cells with islets was associated with enhanced islet graft vascularization and function in this paper.
This concept of bone marrow transplantation along with solid organs is not novel now. It was first reported few years ago in NEJM of actual 5 cases of kidney transplants along with bone marrow and the need for immunosuppresion was eliminated in these patients. This is true thinking out of the box. Long terms outcomes of these patients is still underway.
The first paper is a basic science study that showed bone marrow derived pancreatic cells are mobilized into injured pancreatic tissue and contribute to β-cell regeneration. Transplantation of BM-derived cells improved the function of injured pancreas, although the response is not sufficient to restore sustained normoglycemia is their conclusion.
The second paper was on islet cell transplants, another basic science study. Cotransplantation of bone marrow cells with islets was associated with enhanced islet graft vascularization and function in this paper.
This concept of bone marrow transplantation along with solid organs is not novel now. It was first reported few years ago in NEJM of actual 5 cases of kidney transplants along with bone marrow and the need for immunosuppresion was eliminated in these patients. This is true thinking out of the box. Long terms outcomes of these patients is still underway.
Saturday, April 3, 2010
IN THE NEWS: Tyrosine Kinase Inhibitors and CKD
A recent retrospective study in Annals of Oncology takes on the use of the tyrosine kinase inhibitors sunitinib and sorafenib in the CKD patients and even patients on dialysis. Onco-Nephrology or the role of the nephrologists in the care of the cancer patients is becoming more and more important as most new chemo drugs are known to cause some degree of renal damage.
Tyrosine kinase inhibitors have anti VEGF effects and now have known to cause AKI, AIN, proteinuria, HTN and sometimes a pre eclampsia like syndrome as well.
Using them in CKD patients would scare me. This study , although retrospective showed that with dose modifications, even patients on dialysis and CKD received it with no renal toxicity. Perhaps dialysis removes some metabolite that might be reno toxic.
This is more and more important as nephrologist we might get scared of few cases in the literature causing injury but for that specific patient with cancer, these drugs might be those few months of quality of life and hope.
Having studies like these are important to stress that in the big scheme of things, these drugs still are good for treating Renal Cell Cancer and just because they have renal side effects, we should not avoid them. Rather, use them with caution and watch for changes in crt, HTN and proteinuria and monitor patients more closely.
Other key references:
http://www.ncbi.nlm.nih.gov/pubmed/20142724
http://www.ncbi.nlm.nih.gov/pubmed/19421832
http://www.ncbi.nlm.nih.gov/pubmed/18709027
http://www.ncbi.nlm.nih.gov/pubmed/19054798
Tyrosine kinase inhibitors have anti VEGF effects and now have known to cause AKI, AIN, proteinuria, HTN and sometimes a pre eclampsia like syndrome as well.
Using them in CKD patients would scare me. This study , although retrospective showed that with dose modifications, even patients on dialysis and CKD received it with no renal toxicity. Perhaps dialysis removes some metabolite that might be reno toxic.
This is more and more important as nephrologist we might get scared of few cases in the literature causing injury but for that specific patient with cancer, these drugs might be those few months of quality of life and hope.
Having studies like these are important to stress that in the big scheme of things, these drugs still are good for treating Renal Cell Cancer and just because they have renal side effects, we should not avoid them. Rather, use them with caution and watch for changes in crt, HTN and proteinuria and monitor patients more closely.
Other key references:
http://www.ncbi.nlm.nih.gov/pubmed/20142724
http://www.ncbi.nlm.nih.gov/pubmed/19421832
http://www.ncbi.nlm.nih.gov/pubmed/18709027
http://www.ncbi.nlm.nih.gov/pubmed/19054798
Friday, April 2, 2010
IN THE NEWS- MORE NEPHROLOGY CONSULTS
A recent study in JAMA March 2010 issue suggests that the use of eGFR is making people question the results and send more referrals to Nephrology by 70%.
Is that a good thing or bad thing?
The study was a community based cohort study with time series analysis and from 2003-2007. They found that the first visit nephrology consults were increased significantly among patients with severe kidney disease, middle aged women and the very elderly, and severe comorbidities. No outcome measures were done.
This raises a few concerns and questions. A nice editorial in the same issue of JAMA, was even more fun to read.
Does one reading of eGFR enough? Do we classify people in one ready or one calculation at one period in time. GFR separated by 3 months might be better, 2 months or 1 month? Based on KQIGO, direct measurements of estimated GFR seprated by more than or equal to 3 months would be preferred.
The editorial points out that these studies don't define outcome. Calling someone CKD with GFR less than 60 has been challenged before and especially in extremes of ages as there is a natural decline in GFR as we age.
What the editorial nicely stresses is perhaps in the older age population, a GFR less than 45cc.min/1.73m2 is a better cut off. This might not hold true for someone with proteinuria, hematuria or strong family history of kidney disease.
What the problem is the measurements of GFR - we don't have a good method yet?
Neither of the GFR calculators are perfect, nor is the basis of it- Creatinine. but that's the best marker we have. Till we find a troponin for the kidney, we are going to run into this problem for a while.
Is that a good thing or bad thing?
The study was a community based cohort study with time series analysis and from 2003-2007. They found that the first visit nephrology consults were increased significantly among patients with severe kidney disease, middle aged women and the very elderly, and severe comorbidities. No outcome measures were done.
This raises a few concerns and questions. A nice editorial in the same issue of JAMA, was even more fun to read.
Does one reading of eGFR enough? Do we classify people in one ready or one calculation at one period in time. GFR separated by 3 months might be better, 2 months or 1 month? Based on KQIGO, direct measurements of estimated GFR seprated by more than or equal to 3 months would be preferred.
The editorial points out that these studies don't define outcome. Calling someone CKD with GFR less than 60 has been challenged before and especially in extremes of ages as there is a natural decline in GFR as we age.
What the editorial nicely stresses is perhaps in the older age population, a GFR less than 45cc.min/1.73m2 is a better cut off. This might not hold true for someone with proteinuria, hematuria or strong family history of kidney disease.
What the problem is the measurements of GFR - we don't have a good method yet?
Neither of the GFR calculators are perfect, nor is the basis of it- Creatinine. but that's the best marker we have. Till we find a troponin for the kidney, we are going to run into this problem for a while.
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