An easy to calculate equation to estimate GFR based on inulin clearance

Background. For the estimation of renal function on the basis of serum creatinine, either the Cockcroft-Gault (CG) equation or the MDRD formula is commonly used. Compared to MDRD (using power functions), CG has the advantage of easy calculability at the bedside. MDRD, however, approaches glomerular filtration rate (GFR) more precisely than CG and gives values corrected for a body surface area (BSA) of 1.73 m2. We wondered whether CG could be adapted to estimate GFR rather than creatinine clearance without losing the advantage of easy calculability. In this prospective study, inulin clearance under well-defined conditions was taken as the gold standard for GFR. Methods. In 182 living kidney donors, inulin clearance was measured under standardized conditions (protein, salt and water intake, overnight stay) before and after nephrectomy. Together with the serum creatinine level, and demographic and clinical data, 281 measurements of inulin clearance were used to compare the accuracy of different estimation equations. Using stepwise multiple regression, a new set of constants was defined for a CG-like equation in order to estimate GFR. Results. The MDRD equation underestimated GFR by 9%, and the quadratic equation suggested by Rule overestimated GFR by 12.4%. The new CG-like equation, even when calculated with ‘mental arithmetic-friendly' rounded parameters, showed significantly less bias (1.2%). The adapted equation is Conclusions. We propose the CG-like equation called IB-eGFR (Inulinclearance Based eGFR) to estimate GFR more reliably than MDRD, Rule's equation or the original Cockcroft-Gault equation. As our data represent a Caucasian population, the adapted equation is still to be validated for patients of other ethnicit

Cytomegalovirus (CMV)—Specific T Cell Immunity after Renal Transplantation Mediates Protection from CMV Disease by Limiting the Systemic Virus Load

The role of cytomegalovirus (CMV)—specific cytotoxic T lymphocytes (CTLs) and T helper cells (Th) in controlling CMV infection, as detected by antigenemia assay and polymerase chain reaction (PCR) in blood leukocytes, and CMV disease was investigated in 20 renal transplant recipients. Within 3 months after transplant, CMV-specific CTL and Th responses were demonstrable in 11 (55%) and 15 (75%) patients, respectively; CMV infection was detected by antigenemia and PCR in 19 (95%) patients each. During the month of first CMV detection, there was an inverse correlation between CTL response and antigenemia at ⩾20 positive cells/105 leukocytes (P =.007) but no association with lower antigenemia levels or PCR positivity. CMV disease developed in 7 (35%) patients and was associated with high-level antigenemia but was inversely correlated with detection of CTLs (P = .04). After renal transplantation, CMV-specific CTLs limit the systemic virus load as reflected by antigenemia levels and thereby mediate protection from CMV diseas

Cryostratigraphy, sedimentology, and the late Quaternary evolution of the Zackenberg River delta, northeast Greenland

The Zackenberg River delta is located in northeast Greenland (74°30′ N, 20°30′ E) at the outlet of the Zackenberg fjord valley. The fjord-valley fill consists of a series of terraced deltaic deposits (ca. 2 km2) formed during relative sea-level (RSL) fall. We investigated the deposits using sedimentological and cryostratigraphic techniques together with optically stimulated luminescence (OSL) dating. We identify four facies associations in sections (4 to 22 m in height) exposed along the modern Zackenberg River and coast. Facies associations relate to (I) overriding glaciers, (II) retreating glaciers and quiescent glaciomarine conditions, (III) delta progradation in a fjord valley, and (IV) fluvial activity and niveo-aeolian processes. Pore, layered, and suspended cryofacies are identified in two 20 m deep ice-bonded sediment cores. The cryofacies distribution, together with low overall ground-ice content, indicates that permafrost is predominately epigenetic in these deposits. Fourteen OSL ages constrain the deposition of the cored deposits to between approximately 13 and 11 ka, immediately following deglaciation. The timing of permafrost aggradation was closely related to delta progradation and began following the subaerial exposure of the delta plain (ca. 11 ka). Our results reveal information concerning the interplay between deglaciation, RSL change, sedimentation, permafrost aggradation, and the timing of these events. These findings have implications for the timing and mode of permafrost aggradation in other fjord valleys in northeast Greenland

Cryostratigraphy, sedimentology, and the late Quaternary evolution of the Zackenberg River delta, northeast Greenland

The Zackenberg River delta is located in northeast Greenland (74°30′ N, 20°30′ E) at the outlet of the Zackenberg fjord valley. The fjord-valley fill consists of a series of terraced deltaic deposits (ca. 2 km2) formed during relative sea-level (RSL) fall. We investigated the deposits using sedimentological and cryostratigraphic techniques together with optically stimulated luminescence (OSL) dating. We identify four facies associations in sections (4 to 22 m in height) exposed along the modern Zackenberg River and coast. Facies associations relate to (I) overriding glaciers, (II) retreating glaciers and quiescent glaciomarine conditions, (III) delta progradation in a fjord valley, and (IV) fluvial activity and niveo-aeolian processes. Pore, layered, and suspended cryofacies are identified in two 20 m deep ice-bonded sediment cores. The cryofacies distribution, together with low overall ground-ice content, indicates that permafrost is predominately epigenetic in these deposits. Fourteen OSL ages constrain the deposition of the cored deposits to between approximately 13 and 11 ka, immediately following deglaciation. The timing of permafrost aggradation was closely related to delta progradation and began following the subaerial exposure of the delta plain (ca. 11 ka). Our results reveal information concerning the interplay between deglaciation, RSL change, sedimentation, permafrost aggradation, and the timing of these events. These findings have implications for the timing and mode of permafrost aggradation in other fjord valleys in northeast Greenland

Antipyrine kinetics in liver disease and liver transplantation

Antipyrine kinetics were studied in seven normal subjects, 10 patients with liver disease, and 13 clinically stable patients who received a liver transplant. Five patients were studied both before and after liver transplantation. Antipyrine concentrations in saliva after oral dosing were measured by HPLC. The antipyrine t(1/2) was significantly longer (P < 0.05) in patients with liver disease than in patients undergoing liver transplantation and normal subjects. Antipyrine clearance was not significantly different between patients undergoing liver transplantation and normal subjects, but it was significantly reduced (P < 0.05) in patients with liver disease. In five patients who were studied before and after liver transplantation, there was a significant (P < 0.05) increase in the antipyrine clearance and a marked reduction in its t(1/2) after liver transplantation. These results indicate that liver transplantation improves the drug metabolizing ability of patients with liver disease and that the oxidative metabolizing capacity of the liver in clinically stable patients after liver transplantation is similar to that of normal subjects

Open and laparoscopic living donor nephrectomy in Switzerland: a retrospective assessment of clinical outcomes and the motivation to donate

Background. Laparoscopic living kidney nephrectomy is thought to be associated with reduced morbidity, when compared to open nephrectomy. The purpose of this study was to explore the impact of these techniques on donors' clinical outcomes, satisfaction and motivation to donate. Methods. Clinical outcomes were retrospectively compared in 152 open (n = 71) or laparoscopic (n = 81) donor procedures. Donor satisfaction and motivation were assessed with a self-administered questionnaire. Results. The complication rate was the same with both procedures and the majority of complications were mild. Laparoscopy was significantly less painful and resulted in an insignificantly faster return to active life. More than 80% of the donors volunteered to donate without pressure. Worries about future health status, pain or scars were not important in the decision to donate. Similarly, only 15% considered the surgical procedure as instrumental for their decision. Few donors currently worried about their health with one kidney and more than 95% of the donors in both groups stated that they would give their kidney again. Conclusions. Living donor nephrectomy is safe, regardless of the procedure used. Although the laparoscopic nephrectomy offers clear short-term benefits over the open nephrectomy, donors' satisfaction was excellent with both surgical approaches. Moreover, the type of procedure did not seem to influence their decision to donat

Do Meio- and Macrobenthic Nematodes Differ in Community Composition and Body Weight Trends with Depth?

Nematodes occur regularly in macrobenthic samples but are rarely identified from them and are thus considered exclusively a part of the meiobenthos. Our study compares the generic composition of nematode communities and their individual body weight trends with water depth in macrobenthic (>250/300 µm) samples from the deep Arctic (Canada Basin), Gulf of Mexico (GOM) and the Bermuda slope with meiobenthic samples (<45 µm) from GOM. The dry weight per individual (µg) of all macrobenthic nematodes combined showed an increasing trend with increasing water depth, while the dry weight per individual of the meiobenthic GOM nematodes showed a trend to decrease with increasing depth. Multivariate analyses showed that the macrobenthic nematode community in the GOM was more similar to the macrobenthic nematodes of the Canada Basin than to the GOM meiobenthic nematodes. In particular, the genera Enoploides, Crenopharynx, Micoletzkyia, Phanodermella were dominant in the macrobenthos and accounted for most of the difference. Relative abundance of non-selective deposit feeders (1B) significantly decreased with depth in macrobenthos but remained dominant in the meiobenthic community. The occurrence of a distinct assemblage of bigger nematodes of high dry weight per individual in the macrobenthos suggests the need to include nematodes in macrobenthic studies