The value of urine protein/creatinine (upcr) and albumin/creatinine ratios (uacr) in assessing renal disease in HIV infection

Size: px
Start display at page:

Download "The value of urine protein/creatinine (upcr) and albumin/creatinine ratios (uacr) in assessing renal disease in HIV infection"

Transcription

1 The value of urine protein/creatinine (upcr) and albumin/creatinine ratios (uacr) in assessing renal disease in HIV infection A Samarawickrama, S Holt, K Nambiar, M Fisher, Y Gilleece Brighton and Sussex University Hospitals Introduction Numerous causes of renal disease in HIV infection 1,2,3 HIV infection HIV-associated nephropathy HIV-associated immune complex kidney diseases Combination antiretroviral therapy (cart) Tenofovir (TDF) ± protease inhibitors Other pathologies Opportunistic infections Hypertension Diabetes Hepatitis B/C co-infection 1. Post FA, Holt SG. Curr Opin Infect Dis 2009;22: Gupta SK, Eustace JA et al. Clin Infect Dis 2005;40(11): Wyatt CM, Morgello S et al. Kidney Int 2009;75(4):

2 Introduction Low level and albuminuria common 1,2 Significance? Value in screening and monitoring? Different markers for assessing renal disease Estimated glomerular filtration rate (egfr) Insensitive in early renal disease Does not correlate well with tubular dysfunction 3 Urine protein/creatinine ratio (upcr) Detects total urinary protein due to glomerular and/or tubular pathology Urine albumin/creatinine ratio (uacr) Detects protein leakage from glomerulus 1. Gupta SK, Parker RA et al. Nephrol Dial Transplant 2005;20: Hall AM, Edwards SG et al. Am J Kidney Dis 2009;54(6): Levey AS, Coresh J et al. Ann Intern Med 2003 Jul 15;139(2): Aims To assess proportion of patients with significant (upcr > 50 mg/mmol) To analyse utility of measuring upcr and uacr concurrently in differentiating tubular from glomerular dysfunction 2

3 Methods All simultaneous upcr and uacr results analysed between 1 st January 2006 and 31 st August 2009 Relevant data collected Patient demographics HIV factors Nadir CD4 count Duration of HIV diagnosis cart details Markers of renal function egfr upcr uacr Plasma phosphate Fractional excretion (FE) phosphate upcr uacr Protein and albumin measured in spot urine samples in mg/mmol Methods Proteinuria classified using EACS guidelines 1 Concurrent upcr and uacr results Low level upcr < 50 mg/mmol upcr > 50 mg/mmol uacr < 30 mg/mmol Glomerular upcr > 50 mg/mmol uacr > 30 mg/mmol Patients with heavy (upcr > 100 mg/mmol) further assessed Statistical significance assessed One-way analysis of variance (ANOVA) - continuous variables χ 2 test - categorical variables 1. European AIDS Clinical Society Guidelines: 5th Edition, November

4 Results 6132 upcr results (1437 patients) 9.5% (95% CI ) had significant 206 concurrent upcr and uacr results (123 patients) Low level 145 samples 33 samples Glomerular 28 samples Normal ranges: upcr < 30 mg/mmol, uacr < 3.5 mg/mmol Significant : > 50 mg/mmol; heavy : > 100 mg/mmol Patient Characteristics Characteristic Total cohort (n=1437) Significant (n=136) Ethnicity, white (%) Sex, male (%) Sexuality, MSM (%) Age, median (IQR)* 42 (36-49) 47 (39-55) Years HIV positive, median (IQR)* 6 (2-11) 10 (6-15) Nadir CD4 count, median (IQR) 230 ( ) 160 (79-255) cart-experienced (%) * Age at first sample used when more than one matched upcr/uacr sample available 4

5 Laboratory Parameters: egfr 200 Estimated Glomerular Filtration Rate (MDRD) 150 egfr(ml min 1.73 m 2 ) CKD 1 CKD 2 CKD 3 0 CKD 4 CKD 5 Trivial Glomerular Proteinuria Classification No significant difference in egfr between each group (p = 0.425) Plasma Phosphate and FE Phosphate Plasma Phosphate Fractional Excretion of Phosphate Plasma Phosphate (mmol/l) Normal Fractional Excretion (%) Normal Trivial Glomerular Proteinuria Classification Trivial Glomerular Proteinuria Classification significantly associated with lower plasma phosphate (p = 0.002) and higher FE phosphate (p < ) 5

6 TDF Use and Proteinuria Low level (n=145) (n=33) Glomerular (n=28) p value Any TDF use up to sampling (%) TDF at time of sampling (%) TDF use associated with tubular No association between TDF use at time of sampling and Heavy Proteinuria or glomerular pathology Number of patients (n=18) Mean uacr (mg/mmol) [NR: < 3.5] Mean upcr (mg/mmol) [NR: < 30] Mean uacr/ upcr ratio (%) Low ratio Probable tubular Low ratio Glomerular High ratio Renal biopsy 8 patients had renal biopsy All results correlated with definitions 6

7 Heavy Proteinuria or glomerular pathology Number of patients (n=18) Mean uacr (mg/mmol) [NR: < 3.5] Mean upcr (mg/mmol) [NR: < 30] Mean uacr/ upcr ratio (%) Low ratio Probable tubular Low ratio Glomerular High ratio 3 patients with probable tubular dysfunction - low uacr/upcr ratios Heavy Proteinuria: Diagnoses - Hepatitis B coinfection on TDF - Transient - resolved without treatment - Hepatitis C coinfection on pegylated interferon and ribavirin Probable tubular - Likely TDFrelated tubular injury (n=2) - Tubulointerstitial injury secondary to renal stones Diagnoses made on renal biopsy findings Glomerular (n=12) - Focal segmental glomerulosclerosis - Lupus nephritis - Immune complex-mediated mesangiocapillary glomerular injury - Membranous glomerulonephritis - Hypertensive glomerulosclerosis and lithium-induced interstitial fibrosis - Diabetes and hypertension (n=2) - Renovascular disease - Single kidney hyperfiltration injury - Hypoplastic left kidney with hyperfiltration injury in right kidney 7

8 Heavy Proteinuria: Diagnoses - Hepatitis B coinfection on TDF - Transient - resolved without treatment - Hepatitis C coinfection on pegylated interferon and ribavirin Probable tubular - Likely TDFrelated tubular injury (n=2) - Tubulointerstitial injury secondary to renal stones Diagnoses made on renal biopsy findings Glomerular (n=12) - Focal segmental glomerulosclerosis - Lupus nephritis - Immune complex-mediated mesangiocapillary glomerular injury - Membranous glomerulonephritis - Hypertensive glomerulosclerosis and lithium-induced interstitial fibrosis - Diabetes and hypertension (n=2) - Renovascular disease - Single kidney hyperfiltration injury - Hypoplastic left kidney with hyperfiltration injury in right kidney Conclusions High upcr Low uacr Low plasma phosphate High FE phosphate Glomerular High upcr High uacr Need to measure both upcr and uacr Use of upcr alone risks misdiagnosing glomerular disease as tubular unnecessary alteration of cart regimens? Using uacr alone as screening test may not detect tubular dysfunction 8

9 Conclusions Patients with heavy uacr/upcr ratio more useful than absolute levels Measuring both upcr and uacr assists in diagnosing type of renal disease and identifies those in whom a renal biopsy may be useful upcr and uacr cheap and easy to measure in routine practice Novel biomarkers of renal disease (e.g. retinol-binding protein, cystatin C, N-acetyl-β-D-glucosaminidase, β2-microglobulin) expensive and not routinely available Future developments Prospective study to validate cut-off levels 9

10 EACS Guidelines: Diagnosis of Renal Disease Proteinuria/ microhaematuria upcr < 50 or uacr < 30 upcr or uacr haematuria + haematuria upcr > 100 or uacr > ml/min Regular follow-up egfr ml/min Check risk factors for CKD and nephrotoxic medications Discontinue or adjust drug doses where appropriate Perform renal ultrasound If haematuria with any level of refer to nephrologist; otherwise consider referral < 30 ml/min Discontinue or adjust drug doses where appropriate Perform renal ultrasound Refer to nephrologist European AIDS Clinical Society Guidelines: Prevention and Management of Non-Infectious Co-Morbidities in HIV, 5th Edition, November

CHRONIC KIDNEY DISEASE

CHRONIC KIDNEY DISEASE MANAGEMENT OF CHRONIC KIDNEY DISEASE IN ADULTS KEY MESSAGES 1 SCREENING CRITERIA Screen: Patients with DM and/or hypertension at least yearly. Consider screening patients with: Age >65 years old Family

More information

Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification

Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification Chronic Kidney Disease: Proposed Revisions to the ICD-9-CM Classification Lesley Stevens MD Tufts-New England Medical Center National Kidney Foundation Objectives Kidney Failure Stages of Chronic Kidney

More information

CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES

CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES CHRONIC KIDNEY DISEASE PRACTICE GUIDELINES Reviewed and approved 5/2014 Risk Chronic kidney disease is defined as either kidney damage or decreased kidney function (decreased GFR) for 3 or more months.

More information

CKD Model Technical Document

CKD Model Technical Document CKD Model Technical Document This report arises from the project EConDA which has received funding from the European Union in the framework of the Health Programme. Project number: 2012 12 13 Introduction

More information

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria.

Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. Kidney Complications Diabetic Nephropathy Diabetic nephropathy is detected clinically by the presence of persistent microalbuminuria or proteinuria. The peak incidence of nephropathy is usually 15-25 years

More information

Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE

Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE Chronic Kidney Disease (CKD)Management in General Practice SUMMARY GUIDE Early detection of CKD using kidney health check Who is at higher risk of kidney disease? Age > 50 years Diabetes High blood pressure

More information

Diabetes and the Kidneys

Diabetes and the Kidneys Diabetes and the Kidneys Aim(s) and objective(s) This guideline focuses on the detection, prevention, and management of kidney disease in people with diabetes. The management of end-stage renal disease

More information

Renal Function test (RFT)

Renal Function test (RFT) Renal Function test (RFT) creatinine &GFR T.A Khadija Balubaid kbalubaid@kau.edu.sa KAU-Faculty of Science- Biochemistry department Clinical biochemistry lab (BIOC 416) 2013 Creatinine Creatinine is a

More information

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1

Chronic Kidney Disease (CKD) Algorithm. Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm Chronic Kidney Disease (CKD) Algorithm Page 1 Chronic Kidney Disease (CKD) Algorithm (See NICE Clinical Guideline CG73 1 and Quality Standards 2 ) Who should have

More information

Prevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한

Prevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한 Prevalence and risk factor of chronic kidney disease in elderly diabetic patients in Korea 성애병원 내과 김정한 Introduction CKD의 정의와 egfr의 측정 CKD의 risk factor와 mechanism 한국의 CKD prevalence 와 prognosis CKD의 치료와

More information

Guideline for Microalbuminuria Screening

Guideline for Microalbuminuria Screening East Lancashire Diabetes Network Guideline for Microalbuminuria Screening Produced by: Task and Finish Group, Clinical Standards Group Produced: August 2006 Approved by: East Lancashire Diabetes Network

More information

The sensitive marker for glomerular filtration rate (GFR) Estimation of GFR from Serum Cystatin C:

The sensitive marker for glomerular filtration rate (GFR) Estimation of GFR from Serum Cystatin C: The sensitive marker for glomerular filtration rate (GFR) Estimation of GFR from Serum Cystatin C: The good correlation allows close estimation of GFR Cystatin C GFR GFR in serum estimated* measured* n

More information

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK

HIV and Hepatitis Co-infection. Martin Fisher Brighton and Sussex University Hospitals, UK HIV and Hepatitis Co-infection Martin Fisher Brighton and Sussex University Hospitals, UK Useful References British HIV Association 2010 http://www.bhiva.org/documents/guidelines/hepbc/2010/ hiv_781.pdf

More information

U p d at e. Key Advisor: Professor Rob Walker. keyword: Renal Impairment. 18 I BPJ I Issue 6

U p d at e. Key Advisor: Professor Rob Walker.  keyword: Renal Impairment. 18 I BPJ I Issue 6 U p d at e Key Advisor: Professor Rob Walker 18 I BPJ I Issue 6 www.bpac.org.nz keyword: Renal Impairment Action plan for Chronic Kidney Disease (Based on egfr) egfr ml/min/1.73 m 2 Description Clinical

More information

Calculating the stage of Renal Disease

Calculating the stage of Renal Disease Calculating the stage of Renal Disease When the Refresh Template/Check Labs button is depressed, the box next to MDRD, will be automatically checked. In order to use this in the calculation of the stage

More information

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013

Definition, Prevalence, Pathophysiology and Complications of CKD. JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 Definition, Prevalence, Pathophysiology and Complications of CKD JM Krzesinski CHU Liège-ULg Core curriculum Nephrology September 28 th 2013 KI supplements January 2013 Objectives of the course on CKD:

More information

Appendix D Information and Guidance on CKD

Appendix D Information and Guidance on CKD Appendix D Information and Guidance on CKD There is now a wealth of information available to guide clinicians in identifying and managing patients with CKD and many of them are collected together in this

More information

Sussex CKD Guidelines November 2009

Sussex CKD Guidelines November 2009 Sussex CKD Guidelines November 2009 These guidelines are based on NICE CKD guidelines (Sept 2008) for use in primary and secondary care in East and West Sussex and Brighton and Hove. Prepared by, and correspondence

More information

Renal Disease in Type 2 Diabetes Mellitus

Renal Disease in Type 2 Diabetes Mellitus Renal Disease in Type 2 Diabetes Mellitus 6th Collaborative DiGP/HSE/UCC Conference 25 th September 2013 Dr. Eoin O Sullivan Consultant Endocrinologist Bon Secours Hospital Cork Case 69 year old woman

More information

Estimated GFR Based on Creatinine and Cystatin C

Estimated GFR Based on Creatinine and Cystatin C Estimated GFR Based on Creatinine and Cystatin C Lesley A Stevens, MD, MS Tufts Medical Center, Tufts University School of Medicine Boston MA Chronic Kidney Disease-Epidemiology Collaboration UO1 DK 053869,

More information

Diabetic Kidney Disease AADE Practice Advisory Issued November 21, 2013

Diabetic Kidney Disease AADE Practice Advisory Issued November 21, 2013 Diabetic Kidney Disease AADE Practice Advisory Issued November 21, 2013 Major risk factors for kidney disease include high blood pressure, diabetes, cardiovascular disease and family history of kidney

More information

Chronic Kidney Disease. Janak de Zoysa

Chronic Kidney Disease. Janak de Zoysa Chronic Kidney Disease. Janak de Zoysa CKD. CKD is defined as abnormalities of kidney structure or function, present for > 3 months, with implications for health. CKD is classified based on cause, GFR

More information

Dissecting the pathogenesis of diabetic kidney disease

Dissecting the pathogenesis of diabetic kidney disease Dissecting the pathogenesis of diabetic kidney disease Bryan Conway Scottish Senior Clinical Fellow/Honorary Consultant Nephrologist University of Edinburgh/Royal Infirmary Edinburgh Overview Epidemiology

More information

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results

Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Systolic Blood Pressure Intervention Trial (SPRINT) Principal Results Paul K. Whelton, MB, MD, MSc Chair, SPRINT Steering Committee Tulane University School of Public Health and Tropical Medicine, and

More information

IMPACT OF LEAN AND BONE MASS ON GLOMERULAR FILTRATION RATE ESTIMATION IN PEOPLE LIVING WITH HIV/AIDS

IMPACT OF LEAN AND BONE MASS ON GLOMERULAR FILTRATION RATE ESTIMATION IN PEOPLE LIVING WITH HIV/AIDS IMPACT OF LEAN AND BONE MASS ON GLOMERULAR FILTRATION RATE ESTIMATION IN PEOPLE LIVING WITH HIV/AIDS Corinne Isnard Bagnis and Laurence Pieroni, Rachida Inaoui, Philippe Maksud, Stéphanie Lallauret, Marc-Antoine

More information

Roche for better patient care in kidney disease

Roche for better patient care in kidney disease Roche for better patient care in kidney disease Kidney disease and its growing importance Chronic kidney disease is a serious condition affecting roughly 10% of the adult population 1, many of whom remain

More information

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD

Chronic Kidney Disease and the Electronic Health Record. Duaine Murphree, MD Sarah M. Thelen, MD Chronic Kidney Disease and the Electronic Health Record Duaine Murphree, MD Sarah M. Thelen, MD Definition of Chronic Kidney Disease (CKD) Defined by the National Kidney Foundation Either a decline in

More information

CLINICAL GUIDELINE FOR MANAGEMENT OF CHRONIC KIDNEY DISEASE (CKD) IN ADULTS 1. Aim/Purpose of this Guideline

CLINICAL GUIDELINE FOR MANAGEMENT OF CHRONIC KIDNEY DISEASE (CKD) IN ADULTS 1. Aim/Purpose of this Guideline CLINICAL GUIDELINE FOR MANAGEMENT OF CHRONIC KIDNEY DISEASE (CKD) IN ADULTS 1. Aim/Purpose of this Guideline 1.1 This guideline is intended to assist decision making in all clinical areas admitting or

More information

Interpreting blood tests and other investigations. Dr Satinder Singh University of Birmingham

Interpreting blood tests and other investigations. Dr Satinder Singh University of Birmingham Interpreting blood tests and other investigations Dr Satinder Singh University of Birmingham Learning outcomes To understand which blood tests are needed in patients with hypertension To understand the

More information

Chronic Kidney Disease - A medical or Public health Disease? - an update

Chronic Kidney Disease - A medical or Public health Disease? - an update Chronic Kidney Disease - A medical or Public health Disease? - an update Dr Michael Schulz, MD Consultant Nephrologist & Physician Royal Liverpool University Hospital Senior Associate Lecturer University

More information

Nierfunctiemeting en follow-up van chronisch nierlijden

Nierfunctiemeting en follow-up van chronisch nierlijden Nierfunctiemeting en follow-up van chronisch nierlijden 12 Jan 2016 Patrick Peeters, M.D. Dept Nephrology Ghent University Hospital Plan of presentation 1/ Renal function determination: Measured GFR Estimated

More information

IRIS Staging of CKD (modified 2015)

IRIS Staging of CKD (modified 2015) 1. Staging of CKD based on blood creatinine concentration Staging is undertaken following diagnosis of chronic kidney disease (CKD) in order to facilitate appropriate treatment and monitoring of the patient.

More information

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS. Delineation of Privileges Department of Pediatrics/Division of Pediatric Nephrology

UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS. Delineation of Privileges Department of Pediatrics/Division of Pediatric Nephrology University of Michigan Hospitals and Health Centers UNIVERSITY OF MICHIGAN HOSPITALS AND HEALTH CENTERS Delineation of Privileges Department of Pediatrics/Division of Pediatric Nephrology Name: Please

More information

Prediction of Kidney Disease Progression in Patients with Diabetes

Prediction of Kidney Disease Progression in Patients with Diabetes Prediction of Kidney Disease Progression in Patients with Diabetes John Arthur, MD, PhD Medical University of South Carolina SEKDC Meeting September 8, 2012 Objectives Understand the importance of predicting

More information

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs

Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Last update: February 23, 2015 Hepatitis C Treatment Criteria Commercial & Minnesota Health Care Programs Please see healthpartners.com for Medicare coverage criteria. Table of Contents 1. Harvoni 2. Sovaldi

More information

Detecting and managing Chronic Kidney Disease

Detecting and managing Chronic Kidney Disease Detecting and managing Chronic Kidney Disease KCAT Primary Care Nurse Workshop Conceived and developed by the Kidney Check Australia Taskforce sub-committee for education in nursing in general practice

More information

FREQUENTLY ASKED QUESTIONS ABOUT GFR ESTIMATES

FREQUENTLY ASKED QUESTIONS ABOUT GFR ESTIMATES FREQUENTLY ASKED QUESTIONS ABOUT GFR ESTIMATES Frequently Asked Questions About GFR Estimates Lesley A. Stevens, MD, MS, and Andrew S. Levey, MD Tufts-New England Medical Center January 2007 The following

More information

GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY*

GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* 71 GUIDELINES FOR THE TREATMENT OF DIABETIC NEPHROPATHY* Ryuichi KIKKAWA** Asian Med. J. 44(2): 71 75, 2001 Abstract: Diabetic nephropathy is the most devastating complication of diabetes and is now the

More information

Aim of Presentation. The Role of the Nurse in HIV Care. Global Epidemic 7/24/09

Aim of Presentation. The Role of the Nurse in HIV Care. Global Epidemic 7/24/09 Aim of Presentation The Role of the Nurse in HIV Care Eileen Nixon HIV Nurse Consultant Brighton and Sussex University Hospitals Overview of key issues that affect people with HIV Identify the role of

More information

Creatinine (serum, plasma)

Creatinine (serum, plasma) Creatinine (serum, plasma) 1 Name and description of analyte 1.1 Name of analyte Creatinine 1.2 Alternative names None 1.3 Description of analyte Creatinine is a heterocyclic nitrogenous compound (IUPAC

More information

Update on Hepatitis C. Sally Williams MD

Update on Hepatitis C. Sally Williams MD Update on Hepatitis C Sally Williams MD Hep C is Everywhere! Hepatitis C Magnitude of the Infection Probably 8 to 10 million people in the U.S. are infected with Hep C 30,000 new cases are diagnosed annually;

More information

Hepatitis Update. Study 110: SVR at post-treatment week 24 (SVR24) Jürgen Rockstroh, MD. No ART EFV/TDF/FTC ART/r/TDF/FTC Total

Hepatitis Update. Study 110: SVR at post-treatment week 24 (SVR24) Jürgen Rockstroh, MD. No ART EFV/TDF/FTC ART/r/TDF/FTC Total Hepatitis Update Jürgen Rockstroh, MD Study 11: SVR at post-treatment week 24 (SVR24) Patients with Undetectable HCV RNA (Percentage) 8 7 6 5 4 3 2 1 71 No ART EFV/TDF/FTC ART/r/TDF/FTC Total 69 8 74 n/n

More information

ASSESSMENT OF RENAL FUNCTION

ASSESSMENT OF RENAL FUNCTION ASSESSMENT OF RENAL FUNCTION Anita N. Jackson, Pharm.D. Spring 2012 Laboratory Tests to Assess Renal Function Serum Creatinine (SCr) Breakdown product of creatine metabolism Renal elimination only (90%

More information

Kidney Disease Dr. Eoin Bergin

Kidney Disease Dr. Eoin Bergin Kidney Disease Dr. Eoin Bergin Consultant Nephrologist Midlands Regional Hospital, Tullamore 10 Years in Tullamore The Kidney has 2 main functions: Maintaining a constant extracellular environment Removing

More information

Albuminuria versus GFR as markers of diabetic CKD progression

Albuminuria versus GFR as markers of diabetic CKD progression Albuminuria versus GFR as markers of diabetic CKD progression KDIGO Controversies Conference: Diabetic Kidney Disease New Delhi, March 2012 Richard J MacIsaac PhD FRACP Director of Endocrinology & Diabetes,

More information

Living with Chronic Kidney Disease. Divya Jain Arwindekar, DO Transplant Nephrologist University of Illinois at Chicago

Living with Chronic Kidney Disease. Divya Jain Arwindekar, DO Transplant Nephrologist University of Illinois at Chicago Living with Chronic Kidney Disease Divya Jain Arwindekar, DO Transplant Nephrologist University of Illinois at Chicago What is Chronic Kidney Disease? Chronic Kidney Disease (CKD) Gradual loss of Kidney

More information

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT

PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT PRIOR AUTHORIZATION PROTOCOL FOR HEPATITIS C TREATMENT HARVONI (90mg ledipasvir/400mg sofosbuvir): tablet (PREFERRED AGENT) SOVALDI (sofosbuvir ): 400mg tablets (PREFERRED AGENT ) OLYSIO (simeprivir) PEG-INTRON

More information

Routine HIV Monitoring

Routine HIV Monitoring Routine HIV Monitoring Guideline of the HIV/AIDS Division at San Francisco General Hospital Statement of Guideline: Patients will be routinely evaluated and monitored for HIV parameters, antiretroviral

More information

Serum Creatinine Levels During and After Long-term Treatment with Cyclosporine A in Patients with Severe Atopic Dermatitis

Serum Creatinine Levels During and After Long-term Treatment with Cyclosporine A in Patients with Severe Atopic Dermatitis Acta Derm Venereol 2015; 95: 963 967 CLINICAL REPORT Serum Creatinine Levels During and After Long-term Treatment with Cyclosporine A in Patients with Severe Atopic Dermatitis Jorien VAN DER SCHAFT 1,

More information

Blood or Protein in the Urine: How much of a work up is needed? Diego H. Aviles, M.D.

Blood or Protein in the Urine: How much of a work up is needed? Diego H. Aviles, M.D. Blood or Protein in the Urine: How much of a work up is needed? Diego H. Aviles, M.D. Disclosure In the past 12 months, I have not had a significant financial interest or other relationship with the manufacturers

More information

Interpretation Of Renal Function Tests and The Renal Effects of Lithium. John Collins (April 2014)

Interpretation Of Renal Function Tests and The Renal Effects of Lithium. John Collins (April 2014) Interpretation Of Renal Function Tests and The Renal Effects of Lithium John Collins (April 2014) Causes of Kidney disease Diabetes Glomerulonephritis Genetic disorders- Polycystic kidney disease Causes

More information

Guideline on CKD. Bertram Kasiske, MD Mandaluyong City April 23, Kidney Disease: Improving Global Outcomes.

Guideline on CKD. Bertram Kasiske, MD Mandaluyong City April 23, Kidney Disease: Improving Global Outcomes. Guideline on CKD Bertram Kasiske, MD Mandaluyong City April 23, 2014 What is CKD? When bubbles settle on the surface of the urine, they indicate disease of the kidneys, and that the complaint will be protracted.

More information

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary

UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS. - Summary UNIVERSITY OF MEDICINE AND PHARMACY CRAIOVA DOCTORAL SCHOOL DOCTORATE THESIS - Summary CHRONIC COMPLICATIONS IN PATIENTS WITH TYPE 1 DIABETES MELLITUS - Epidemiological study - PhD Manager: Professor PhD.

More information

Asymptomatic HIV-associated Neurocognitive Disorder (ANI) Increases Risk for Future Symptomatic Decline: A CHARTER Longitudinal Study

Asymptomatic HIV-associated Neurocognitive Disorder (ANI) Increases Risk for Future Symptomatic Decline: A CHARTER Longitudinal Study Asymptomatic HIV-associated Neurocognitive Disorder (ANI) Increases Risk for Future Symptomatic Decline: A CHARTER Longitudinal Study Robert Heaton, PhD 1, Donald Franklin, BS 1, Steven Woods, PsyD 1,

More information

Tubulointerstitial Diseases Lecture -7- Hazem Al-Khafaji

Tubulointerstitial Diseases Lecture -7- Hazem Al-Khafaji Tubulointerstitial Diseases Lecture -7- Hazem Al-Khafaji Tubulointerstitial nephritis Introduction Term first used by Councilman in 1898 Noted the histopathologic changes in autopsy specimens of patients

More information

Diagnosis, classification and staging of chronic kidney disease

Diagnosis, classification and staging of chronic kidney disease Diagnosis, classification and staging of chronic kidney disease Date written: July 2012 Author: David Johnson DIAGNOSIS GUIDELINES a. We recommend that chronic kidney disease (CKD) be diagnosed in all

More information

Sovaldi (sofosbuvir) Prior Authorization Criteria

Sovaldi (sofosbuvir) Prior Authorization Criteria INITIAL REVIEW CRITERIA Sovaldi (sofosbuvir) Prior Authorization Criteria 1. Adult patient age 18 years old; AND 2. Prescribed by a hepatologist, gastroenterologist, infectious disease specialist, transplant

More information

School of Medicine Nephrology clinical undergraduate training: Year 5

School of Medicine Nephrology clinical undergraduate training: Year 5 School of Medicine Nephrology clinical undergraduate training: Year 5 All care is taken to ensure that the information in this handbook is correct at the time of going to print. Handbook Version 2.0 Date

More information

HYPERTENSION ASSOCIATED WITH RENAL DISEASES

HYPERTENSION ASSOCIATED WITH RENAL DISEASES RENAL DISEASE v Patients with renal insufficiency should be encouraged to reduce dietary salt and protein intake. v Target blood pressure is less than 135-130/85 mmhg. If patients have urinary protein

More information

Chronic kidney disease hospitalisations in Australia

Chronic kidney disease hospitalisations in Australia Chronic kidney disease hospitalisations in Australia 2000 01 to 2007 08 August 2010 Australian Institute of Health and Welfare Canberra Cat. no. PHE 127 The Australian Institute of Health and Welfare is

More information

Steroid-Dependent Nephrotic Syndrome. Nicola Sumorok January 10, 2012

Steroid-Dependent Nephrotic Syndrome. Nicola Sumorok January 10, 2012 Steroid-Dependent Nephrotic Syndrome Nicola Sumorok January 10, 2012 Idiopathic Nephrotic Syndrome Nephrotic syndrome without known etiology Heavy Proteinuria > 3.5 g/d in adults or > 1.0 g/m² in children

More information

Identifying and treating long-term kidney problems (chronic kidney disease)

Identifying and treating long-term kidney problems (chronic kidney disease) Understanding NICE guidance Information for people who use NHS services Identifying and treating long-term kidney problems (chronic kidney disease) NICE clinical guidelines advise the NHS on caring for

More information

Diabetic Nephropathy

Diabetic Nephropathy Diabetic Nephropathy Kidney disease is common in people affected by diabetes mellitus Definition Urinary albumin excretion of more than 300mg in a 24 hour collection or macroalbuminuria Abnormal renal

More information

Disclaimer for Bait and Switch

Disclaimer for Bait and Switch Disclaimer for Bait and Switch JNC 8 due out 2011- now due out 2012 JNC 7 2003 ATP IV - due out 2011 now due out 2012 ATP III 2002 Obesity Guidelines due out 2011 now due out 2012 Obesity Guideline 1998

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Diagnostics: Page 2 of 5

Diagnostics: Page 2 of 5 Proteinuria Proteinuria is a condition in which there are increased amounts of protein in the urine. There are a number of different diseases which can result in proteinuria. In the early stages of the

More information

CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE

CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE CHRONIC KIDNEY DISEASE MANAGEMENT GUIDE Outline I. Introduction II. Identifying Members with Kidney Disease III. Clinical Guidelines for Kidney Disease A. Chronic Kidney Disease B. End Stage Renal Disease

More information

Differential Diagnosis of Chronic Kidney Disease (CKD): By primary diseases

Differential Diagnosis of Chronic Kidney Disease (CKD): By primary diseases Research and Reviews Differential Diagnosis of Chronic Kidney Disease (CKD): By primary diseases JMAJ 54(1): 22 26, 2011 Shunya UCHIDA* 1 Abstract In Japan, the number of patients with chronic kidney disease

More information

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents

MEDICAL ASSISTANCE HANDBOOK PRIOR AUTHORIZATION OF PHARMACEUTICAL SERVICES. I. Requirements for Prior Authorization of Hepatitis C Agents MEDICAL ASSISTANCE HBOOK I. Requirements for Prior Authorization of Hepatitis C Agents A. Prescriptions That Require Prior Authorization Prescriptions for Hepatitis C Agents that meet any of the following

More information

Drug induced AIN. Anjali Gupta

Drug induced AIN. Anjali Gupta Drug induced AIN Anjali Gupta History 1792 Admiral Jones Autopsy Specimen 1800 Autopsy lesions referred as productive/ pyelonephritis 1898 Councilman description of AIN 1914- Volhard included AIN in classification

More information

meeting report http://www.kidney-international.org & 2007 International Society of Nephrology

meeting report http://www.kidney-international.org & 2007 International Society of Nephrology http://www.kidney-international.org & 2007 International Society of Nephrology meeting report Chronic kidney disease as a global public health problem: Approaches and initiatives a position statement from

More information

Prior Authorization Conditions for Approval of Hepatitis C Agents

Prior Authorization Conditions for Approval of Hepatitis C Agents Prior Authorization Conditions for Approval of Hepatitis C Agents All requests for Hepatitis C Agents require a prior authorization and will be screened for medical necessity and appropriateness using

More information

Comparison of Estimated Glomerular Filtration Rate (egfr)

Comparison of Estimated Glomerular Filtration Rate (egfr) Comparison of Estimated Glomerular Filtration Rate (egfr) among Three Common Formulas R. Mohammadi Biochemist i (DCLS, Ph.D.) Faculty member of Medical Faculty Introduction Chronic kidney disease (CKD)

More information

ESIM 2014 WHEN CHRONIC BECOMES ACUTE

ESIM 2014 WHEN CHRONIC BECOMES ACUTE ESIM 2014 WHEN CHRONIC BECOMES ACUTE Anna Salina, MD Pauls Stradins Clinical University Hospital Riga, Latvia 37 years old female, 50 kg, 150 cm Complaints Severe edema +8 kg Tiredness, dry cough Chills

More information

Anaemia. Under... of RBCs. Over... of RBCs. Anaemia. CP1 MedSoc Teaching by Suraj Shah. Question: What is the most common cause of anaemia worldwide?

Anaemia. Under... of RBCs. Over... of RBCs. Anaemia. CP1 MedSoc Teaching by Suraj Shah. Question: What is the most common cause of anaemia worldwide? CP1 MedSoc Teaching by Suraj Shah Anaemia Question: What is the most common cause of anaemia worldwide? Definition:.. such that there is insufficient quantity of. to deliver enough Oxygen to the tissues.

More information

Prior Authorization Guideline

Prior Authorization Guideline Prior Authorization Guideline Guideline Name Olysio (simeprevir) Formulary UnitedHealthcare Community & State Formulary Note Approval Date 2/19/2015 Revision Date 4/15/2015 Technician Note : CPS Approval

More information

Understanding. Chronic Kidney Disease

Understanding. Chronic Kidney Disease R E N A L R E S O U R C E C E N T R E Understanding Chronic Kidney Disease Causes of Chronic Kidney Disease Most causes of chronic kidney failure are diseases that are not usually accompanied by symptoms

More information

Clinical Criteria for Hepatitis C (HCV) Therapy

Clinical Criteria for Hepatitis C (HCV) Therapy Diagnosis Clinical Criteria for Hepatitis C (HCV) Therapy Must have chronic hepatitis C (HCV infection > 6 months), genotype and sub-genotype specified to determine the length of therapy; Liver biopsy

More information

InDependent Diabetes Trust

InDependent Diabetes Trust InDependent Diabetes Trust Kidneys and Diabetes Updated July 2015 Registered Company Number 3148360 Registered Charity No 1058284 Contents Introduction Healthy Kidneys Kidney disease and diabetes The use

More information

REF/2011/03/002226 CTRI Website URL - http://ctri.nic.in

REF/2011/03/002226 CTRI Website URL - http://ctri.nic.in Clinical Trial Details (PDF Generation Date :- Thu, 14 Jul 2016 15:20:58 GMT) CTRI Number Last Modified On 28/01/2014 Post Graduate Thesis Type of Trial Type of Study Study Design Public Title of Study

More information

Clinical HEDIS Medicare Stars Quick Reference Guide

Clinical HEDIS Medicare Stars Quick Reference Guide Clinical HEDIS Medicare Stars Quick Reference Guide MEASURE Adult BMI Assessment (ABA) Breast Cancer Screening (BCS) SPECIFICATIONS The percentage of members 18 74 years of age who had an outpatient visit

More information

Mild-to-moderate Chronic Kidney Disease

Mild-to-moderate Chronic Kidney Disease Page 1 of 5 Mild-to-moderate Chronic Kidney Disease If you have chronic kidney disease (CKD) then your kidneys are not working as well as they once did. Various conditions can cause CKD. Severity can vary

More information

Mechanism for Dehydration Associated Kidney Disease

Mechanism for Dehydration Associated Kidney Disease Mechanism for Dehydration Associated Kidney Disease Richard J Johnson, University of Colorado A sugarcane worker dying from kidney failure Dr Johnson has received funding from Danone Research Chronic Kidney

More information

New IDSA/AASLD Guidelines for Hepatitis C

New IDSA/AASLD Guidelines for Hepatitis C NORTHWEST AIDS EDUCATION AND TRAINING CENTER New IDSA/AASLD Guidelines for Hepatitis C John Scott, MD, MSc Associate Professor, UW SoM Asst Director, Liver Clinic, Harborview Medical Center Presentation

More information

Frequently Asked Questions About GFR Estimates

Frequently Asked Questions About GFR Estimates Frequently Asked Questions About GFR Estimates table of contents MEASUREMENT OF KIDNEY FUNCTION 4 1) What is GFR? 4 2) How is GFR measured? 4 3) What does GFR indicate? 4 4) Why measure GFR as an index

More information

Chapter 1. Incidence of End Stage Kidney Disease. ANZDATA Registry 37th Annual Report. Data to 31-Dec-2013

Chapter 1. Incidence of End Stage Kidney Disease. ANZDATA Registry 37th Annual Report. Data to 31-Dec-2013 Chapter 1 Incidence of End Stage Kidney Disease 214 37th Annual Report Data to 31-Dec-213 1-2 Stock and Flow Tables 1.1 and 1.2 show the stock and flow of renal replacement therapy (RRT) patients by country

More information

Clinical HEDIS Medicare Stars Quick Reference Guide

Clinical HEDIS Medicare Stars Quick Reference Guide Clinical HEDIS Medicare Stars Quick Reference Guide MEASURE Adult BMI Assessment (ABA) Breast Cancer Screening (BCS) SPECIFICATIONS The percentage of members 18 74 years of age who had an outpatient visit

More information

CORRELATION OF BETA 2 MICROGLOBULIN WITH SERUM CREATININE AND CREATININE CLEARANCE IN PATIENTS WITH DIFFERENT LEVELS OF RENAL FUNCTION

CORRELATION OF BETA 2 MICROGLOBULIN WITH SERUM CREATININE AND CREATININE CLEARANCE IN PATIENTS WITH DIFFERENT LEVELS OF RENAL FUNCTION ORIGINAL ARTICLE CORRELATION OF BETA 2 MICROGLOBULIN WITH SERUM CREATININE AND CREATININE CLEARANCE IN PATIENTS WITH DIFFERENT LEVELS OF RENAL FUNCTION Shahjahan, Riffat Yasmin, Muhammad Amin Jan Mahsud,

More information

What does Hepatitis C mean to me as a CKD Patient?

What does Hepatitis C mean to me as a CKD Patient? What does Hepatitis C mean to me as a CKD Patient? Clinical Practice Guidelines for the Prevention, Diagnosis, Evaluation and Treatment of Hepatitis C in CKD Introduction Worldwide, about 170 million people

More information

William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum

William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum William B. Schwartz Division of Nephrology Fellowship Training Program Curriculum Consult/Transplant Servic Patient Care Take medical history Perform physical examination Urinalysis and sediment eval Interpret

More information

Proteinuria in Pregnancy 2010

Proteinuria in Pregnancy 2010 Poupak Rahmani PGY 5 General Internal Medicine 30 year old female, 15 weeks pregnant RFR: proteinuria PMHx: DM1 diagnosed at age 15 Poor diabetic control in early years of diagnosis Single admission with

More information

Best Practice Guide: Myeloma kidney disease

Best Practice Guide: Myeloma kidney disease Best Practice Guide: Myeloma kidney disease This document is one of the Myeloma UK Nursing Best Practice Guides for the Management of Myeloma series. The purpose of this Guide is to enhance knowledge and

More information

cystatin C cystatin C

cystatin C cystatin C [1,2] 1991 2000 (USRDS) 2005 ( 2004 2005 ) 2001 (National Kidney Foundation, NKF) K-DOQI (1) (glomerular filtration rate, GFR) 3 (2) 60 ml/min/1.73m 2 3 [3-5] ( 1) 113 (serum creatinine) (Ketoacidosis)

More information

Nephrotic Syndrome in Pediatric Patients

Nephrotic Syndrome in Pediatric Patients EPIDEMIOLOGY In the United States, incidence of 2.7 cases per 100,000 children per year Cumulative prevalence of 16 per 100,000 children More common in boys than girls in younger age groups, but once adolescence

More information

Chronic kidney disease

Chronic kidney disease Chronic kidney disease Early identification and management of chronic kidney disease in adults in primary and secondary care Issued: September 2008 NICE clinical guideline 73 guidance.nice.org.uk/cg73

More information

PED1-4120/F & PED1-4120/H PEDIATRIC NEPHROLOGY Course Policies and Procedures. Location Le Bonheur Outpatient Center, 51 N.

PED1-4120/F & PED1-4120/H PEDIATRIC NEPHROLOGY Course Policies and Procedures. Location Le Bonheur Outpatient Center, 51 N. PED1-4120/F & PED1-4120/H PEDIATRIC NEPHROLOGY Course Policies and Procedures Co-Course Director Name: Coordinator Name: David Hains Office Location: Office Location: Le Bonheur, CFRC, Room 275R Phone

More information

Chapter 2. best? Paul E. de Jong Nynke Halbesma Ron T. Gansevoort. Nephrology Dialysis Transplantation 2006; 21:

Chapter 2. best? Paul E. de Jong Nynke Halbesma Ron T. Gansevoort. Nephrology Dialysis Transplantation 2006; 21: Chapter 2 Screening for early chronic kidney disease what method fits best? Paul E. de Jong Nynke Halbesma Ron T. Gansevoort Nephrology Dialysis Transplantation 2006; 21:2358-2361 Chapter 2 Introduction

More information

Type 2 Diabetes Media Fact Sheet

Type 2 Diabetes Media Fact Sheet Type 2 Diabetes Media Fact Sheet 1. Type 2 diabetes: Facts & figures 2. What is type 2 diabetes? 3. Risk factors for type 2 diabetes 4. Complications associated with type 2 diabetes 5. The socio-economic

More information

Chronic Kidney Disease (CKD) Getting it right from the start

Chronic Kidney Disease (CKD) Getting it right from the start Chronic Kidney Disease (CKD) Getting it right from the start Increased demand for ESRF Treatment 2007 NZ No of patients on dialysis - 2064 New Patients 461 41% - Type II Diabetes 20% were late referrals

More information

GLOMERULAR DISEASE: What You Need To Know.

GLOMERULAR DISEASE: What You Need To Know. GLOMERULAR DISEASE: What You Need To Know www.kidney.org National Kidney Foundation s Kidney Disease Outcomes Quality Initiative The National Kidney Foundation s Kidney Disease Outcomes Quality Initiative

More information