Methods for assessing the functional reserve of the kidneys
https://doi.org/10.36485/1561-6274-2022-26-4-127-131
Abstract
The problem of studying the functional reserve of the kidneys attracted the attention of nephrologists about 40 years ago. However, to date, a single protocol for performing functional load tests has not been developed. When assessing the excretory function of the kidneys, nephrologists, as before, are guided by the value of the glomerular filtration rate. However, in two patients of the same age and gender, the same value of this indicator cannot be interpreted unambiguously. In this article, we consider the technical features of performing load tests using egg white, "red meat", a mixture of amino acids, 0.5 % sodium chloride solution. All of them require time and labor resources. This limits the possibilities of their use in outpatient settings. We believe that it is necessary to determine the functional reserve in patients without primary kidney pathology, that is, persons with an established diagnosis of diabetes mellitus or hypertension with a disease duration of at least 5 years. Serious nephroprotective measures in them are recommended to begin only at the stage of chronic kidney disease C3a. It is possible that such a late start of secondary prevention partly explains the increase in the proportion of such patients in hemodialysis centers.
About the Authors
A. Sh. Rumyantsev
Department of Faculty Therapy, St. Petersburg State University; Department of propaedeutic of internal diseases Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Rumyantsev Aleksandr Shalikovich, Prof., MD, PhD, DMedSci
199106
21st line V.O., 8a
St. Petersburg
tel.: +7 (812) 326-03-26;
197022
L'va Tolstogo str. 6-8
St. Petersburg
tel.: +7 (911) 2677413
A. G. Kucher
Department of propaedeutic of internal diseases Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Anatoly G. Kucher, Prof., MD, PhD, DMedSci, Vice-Director
Research Institute of Nephrology, Research and Сlinical Research Center
197022
L.Tolstoy st., 17, build 54
Saint Petersburg
tel.: +7(921)421-18-17
M. Kh. Khasun
Department of propaedeutic of internal diseases Pavlov First Saint Petersburg State Medical University
Russian Federation
Russian Federation
Associate Prof. Khasun H. Mohamad, MD, PhD
197022
L. Tolstoy st., 17, build. 54
St-Petersburg
tel.: (812) 346-39-26
References
1. Клинические Практические Рекомендации KDIGO 2012 по Диагностике и Лечению Хронической Болезни Почек. Нефрология и диализ 2017;19(1):22–206. doi: 10.28996/1680-4422-2017-1-22-206
2. Pitts R. Physiology of the kidney and body fluids. Chicago: Yearbook Medical Publishers, 1966; 70
3. Doolan PD, Alpen EL, Theil GB: A clinical appraisal of the plasma concentration and endogenous clearance of creatinine. Am J Med 1962; 32:65–79
4. Wesson L: Physiology of the human kidney. New York: Grune & Stratton, 1969; 100, 101-128, 634-636, 640-644
5. Rifkin DE, Shlipak MG, Katz R et al. Rapid Kidney Function Decline and Mortality Risk in Older Adults. Arch Intern Med 2008;168(20):2212–2218. doi:10.1001/archinte.168.20.2212
6. Lewis ME, Volpert-Esmond HI, Deen JF et al. Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan. Int J Environ Res Public Health 2021 Feb 13;18(4):1821. doi: 10.3390/ijerph18041821; Sangla A, Kandasamy Y. Effects of prematurity on long-term renal health: a systematic review. BMJ Open 2021 Aug 6;11(8):e047770. doi: 10.1136/bmjopen-2020-047770
7. Helal I, Fick-Brosnahan GM, Reed-Gitomer B, Schrier RW. Glomerular hyperfiltration: definitions, mechanisms and clinical implications. Nat Rev Nephrol 2012 Feb 21;8(5):293–300. doi: 10.1038/nrneph.2012.19
8. Bosch JP, Saccaggi A, Lauer A et al. Renal functional reserve in humans. Effect of protein intake on glomerular filtration rate. Am J Med 75: 943–950, 1983. doi:10.1016/0002-9343(83)90873-2
9. Wada L, Don BR, Schambelan M. Hormonal mediators of amino acid-induced glomerular hyperfiltration in humans. Am J Physiol 1991 Jun;260(6 Pt 2):F787-92. doi: 10.1152/ajprenal
10. Just A. Mechanisms of renal blood flow autoregulation: dynamics and contributions. Am J Physiol Regul Integr Comp Physiol 2007 Jan;292(1):R1–17. doi: 10.1152/ajpregu.00332.2006
11. Levey AS, Stevens LA, Schmid CH et al. CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med 2009 May 5;150(9):604–612. doi: 10.7326/0003-4819-150-9-200905050-00006
12. Mansy H, Patel D, Tapson JS et al. Four methods to recruit renal functional reserve. Nephrol Dial Transplant 1987;2(4):228–232. PMID: 3118262
13. Gaipov A, Solak Y, Zhampeissov N et al. Renal functional reserve and renal hemodynamics in hypertensive patients. Ren Fail 2016 Oct;38(9):1391–1397. doi: 10.1080/ 0886022X.2016.1214052
14. Mundodan JM, Saju CR, Joshy VM. Utility of Broca’s Index in Assessing Body Mass: Analysis of Anthropometric Measures from A Cross Sectional Study. Natl J Community Med 2019; 10(11): 600–604
15. Kucher AG, Essayan AM, Shishkina LI et al. The influence of vegetable and meat protein loads on the kidney functions in healthy persons. Nephrology (Saint-Petersburg) 1997;1(2):79–84. (In Russ.) https://doi.org/10.24884/1561-6274-1997-1-2-79-84
16. Livi R, Teghini L, Pignone A, Generini S, Matucci-Cerinic M, Cagnoni M. Renal functional reserve is impaired in patients with systemic sclerosis without clinical signs of kidney involvement. Ann Rheum Dis 2002 Aug;61(8):682–686. doi: 10.1136/ard.61.8.682
17. Gozhenko AI, Dolomatov SI, Shumilova PA et al. Topor E.A., Pyatenko V.A., Badiin I.Yu. Effects of osmotic loads on the functional state of the kidneys in healthy volunteers. Nephrology (Saint-Petersburg) 2004;8(2):44–48. (In Russ.) https://doi.org/10.24884/1561-6274-2004-8-2-44-48
18. Ivanov DD, Gozhenko AI, Savytska LM. Individualization of renoprotection in dependence from estimated glomerular filtration rate and renal functional reserve. Nephrology (Saint-Petersburg) 2019;23(1):9–14. (In Russ.) https://doi.org/10.24884/1561-6274-2019-23-1-9-14
19. Ananthasubramaniam G, Ananthasubramaniam K. Stress electrocardiography testing in coronary artery disease: Is it time for its swan song or to redefine its role in the modern era? Indian Heart J 2022 Mar-Apr;74(2):81–85. doi: 10.1016/j.ihj.2022.02.003
Review
For citations:
Rumyantsev A.Sh., Kucher A.G., Khasun M.Kh. Methods for assessing the functional reserve of the kidneys. Nephrology (Saint-Petersburg). 2022;26(4):127-131. (In Russ.) https://doi.org/10.36485/1561-6274-2022-26-4-127-131
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