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      Renal Functional Reserve Evolution in Children with a Previous Episode of Hemolytic Uremic Syndrome

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          Abstract

          Introduction: Glomerular filtration rate (GFR) is the most widely used indicator of kidney function in patients with renal disease, although it does not invariably reflect functional status after renal injury. The concept of renal functional reserve (RFR) as the ability of the kidney to increase GFR following a protein load was introduced in the 1980s. In this study we evaluated the RFR test in 26 children who had developed hemolytic-uremic syndrome (HUS) at least 2 years before the first evaluation, then 8 years later. At the beginning of the study they had no signs of proteinuria, hypertension or renal insufficiency. RFR was also evaluated in 15 healthy control children. Methods: Proteinuria and creatinine in serum and urine were tested. Functional reserve index (FRI) was defined in order to evaluate RFR. Patients with FRI level >1.36 were considered as responders (R) and with FRI <1.36 as non-responders (NR). Results: R and NR groups failed to show any significant differences when basal creatinine clearance (C<sub>Cr</sub>) was evaluated. The NR group presented a significant low initial FRI that persisted unchanged at the end of the study. These patients developed proteinuria and a renal protector treatment with protein restriction was indicated. Although the proteinuria diminished, it remained within pathological range. The lack of RFR response in the NR group was significantly related to the presence of oliguria lasting longer than 8 days during the acute phase of disease. Conclusions: Those patients with a previous history of HUS with normal basal C<sub>Cr</sub> should be evaluated by the RFR test to detect those at risk of developing glomerular hyperfiltration.

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          Renal functional reserve in humans

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            Short-term protein loading in assessment of patients with renal disease.

            The effect of short-term protein loading on the glomerular filtration rate in normal persons and patients with renal disease was evaluated. Previous studies have demonstrated that in healthy subjects, protein loading results in an increased glomerular filtration rate. By determining the glomerular filtration rate preceding (baseline glomerular filtration rate) and following (test glomerular filtration rate) oral protein loading, it was possible to define (1) the filtration capacity (test glomerular filtration rate) and (2) the renal reserve (test glomerular filtration rate - baseline glomerular filtration rate) of the kidney. In normal persons, filtration capacity averaged 157 +/- 13 ml per minute and renal reserve 34 ml per minute. The test glomerular filtration rate was reproducible and independent of protein intake, whereas baseline glomerular filtration rate was significantly influenced by diet. Patients with renal disease were found to have a reduced renal reserve and/or a diminished filtration capacity. The reduction in filtration capacity appears to correlate with the damage sustained by the organ. It is suggested that an abnormal response to protein loading in renal disease may herald the fall in the baseline glomerular filtration rate and the rise in plasma creatinine level.
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              Author and article information

              Journal
              NEC
              Nephron Clin Pract
              10.1159/issn.1660-2110
              Nephron Clinical Practice
              S. Karger AG
              1660-2110
              2004
              July 2004
              17 November 2004
              : 97
              : 3
              : c118-c122
              Affiliations
              aDepartment of Nephrology and bDivision of Laboratory, Children’s Hospital Dr Ricardo Gutierrez, Buenos Aires, Argentina
              Article
              78640 Nephron Clin Pract 2004;97:c118–c122
              10.1159/000078640
              15292689
              © 2004 S. Karger AG, Basel

              Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

              Page count
              Figures: 4, Tables: 2, References: 21, Pages: 1
              Product
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/78640
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