The patient is dying
Wesley C. Finegan, Angela McGurk, Wilma O’Donnell, Jan Pederson, Elizabeth Rogerson in Care of the Cancer Patient, 2018
Many families will have some prior experience of death either as individuals or as a group. These experiences may colour their expectations and prompt specific anxieties and fears depending on whether they have good or bad memories of the previous death. The family may be seeking advice, comfort, company and regular visits for reassurance, or they may wish to be alone during those last few days or hours. The patient approaches death, he or she is making an unfamiliar journey. The family often has no clear idea of what may happen or what role to play. The appropriate prognostic indicators such as rising urea and creatinine levels and low serum albumin levels should be monitored if necessary and appropriate, but it is inappropriate to carry out investigations if no action will be taken. When the team is agreed that death is inevitable, the end-of-life care package that is normally used by the team should be implemented.
Functions of the Kidneys and Functional Anatomy
Peter Kam, Ian Power, Michael J. Cousins, Philip J. Siddal in Principles of Physiology for the Anaesthetist, 2020
The primary function of the kidneys is the regulation of fluid and electrolyte composition of the body. The kidneys have an integral role in the long-term regulation of body water and electrolyte composition, and therefore renal function is an important determinant of the long-term regulation of blood volume and arterial blood pressure. Urea (from protein metabolism), creatinine (from muscle), uric acid (from nucleic acids) and bilirubin (from haemoglobin) are all excreted from the body in the urine. Within each kidney, there are one-million nephrons. A protein-free filtrate of plasma is formed at the beginning of the nephron by the renal corpuscle, and the fluid then passes along the lumen, through the proximal convoluted tubule, loop of Henle and distal convoluted tubule to the collecting ducts. The nephron is made up of a single layer of epithelial cells separated from the peritubular capillaries by a basement membrane.
Osteoporosis
Jane Higgs, Gill Wakley, Ruth Chambers, Clare Gerada in Demonstrating your Clinical Competence in Depression, Dementia, Alcoholism, Palliative Care and Osteoporosis, 2018
Osteoporosis is a disorder characterised by compromised bone strength. This bone disease is very common and many nurses, particularly those working with older people, are likely to encounter patients with it. The main consequence of osteoporosis is the increased tendency to fracture with minor trauma and the subsequent loss of function and quality of life. Dual energy x-ray absorptiometry (DXA) is the most widely used method of measuring bone mineral density. Using DXA confirms the diagnosis of osteoporosis, contributes to the assessment of risk of future fractures, and allows the most appropriate targeting of treatments. If osteoporosis or osteopenia is found, one should screen for underlying causes with other investigations: serum calcium, phosphate, alkaline phosphatase, and creatinine; serum protein electrophoresis; thyroid function tests; serum testosterone in men; and urinary Bence-Jones protein. The National Osteoporosis Society produces relevant material as well as a patient helpline and an email address for nursing queries.
A novel method for creatinine adjustment makes the revised Lund–Malmö GFR estimating equation applicable in children
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2020
Jonas Björk, Ulf Nyman, Pierre Delanaye, Anders Grubb, Anders Larsson, Laura Vranken, Anna Åkesson, Hans Pottel
The aim of this study was to establish creatinine growth curves separately for males and females that can be used to adjust childhood levels of serum creatinine to corresponding adult levels. Linear regression with fractional polynomials of age as independent variable was used to construct creatinine growth curves for a reference cohort (n = 83,157 samples from Belgium and Sweden, age 2–40 years). Adjusted creatinine obtained from the growth curves was used to improve accuracy of estimated glomerular filtration rate (eGFR) based on the Lund–Malmö revised (LMR) equation in children. The LMR equation based on creatinine values adjusted to age 18 years was validated against measured GFR (mGFR) in a separate cohort of 4005 children from four different European countries. Validation metrics included median bias, precision, and accuracy expressed as percentage of estimates within ±30% (P30) of mGFR. Remarkable improvements in bias and accuracy were observed; P30 increased from 56% to 74% after creatinine adjustments in children with mGFR
Importance of creatinine clearance for drug dosing in nursing home residents
Published in Renal Failure, 2014
Jignesh Shah, Joshua Fogel, Leah Balsam
Serum creatinine is often not an adequate measure of renal function, especially in advanced age or in physically debilitated patients. Estimated creatinine clearance is necessary to decide on usage of drugs such as Metformin. This study included 64 nursing home residents with diabetes treated with Metformin. Creatinine clearance (CrCl) was calculated by the Cockcroft–Gault equation modified for ideal body weight. CrCl more than or equal to 60/mL min was used as a cut-off for appropriate use of Metformin. In our sample, 20.3% had renal failure when measured by serum creatinine while 56.3% had renal failure when measured by CrCl. Age >65 years and women were more likely to be classified as normal for serum creatinine but have abnormal creatinine clearance. Use of estimated creatinine clearance should be advocated instead of serum creatinine when prescribing Metformin, especially for those of older age and among women.
Challenges in the measurement of plasma creatinine on the Roche cobas c702
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2018
Erland Jørn Erlandsen, Else Randers
The aim of this study was to document the differences between two Roche creatinine measurement methods, the CREP2 test on the cobas c702 and the CREA PLUS test on the Modular P. Samples with creatinine isotope dilution mass spectrometry (IDMS) values were analyzed on both instruments. Method comparison using the remaining plasma samples was performed twice, using two different lot numbers of reagents and two different lot numbers of calibrators on both instruments. Medians and percentiles of the plasma creatinine values produced on the Modular P and cobas c702 from 2012 to 2017 were compared. The recovery of samples with IDMS creatinine values (SRM 967a level 1, SRM 967a level 2, serum X and five serum pools from Roche) was 101.7%–110.2% on the cobas c702 and 98.9%–102.6% on the Modular P. Comparison of the two methods showed that the slope was close to 1.0 using linear, Deming and Passing Bablok regressions, but all equations showed a negative intercept, indicating that the cobas c702 overestimates plasma creatinine in relation to the Modular P by 4–6 µmol/L. The median value for routine plasma creatinine lies between 74 and 77 µmol/L for the Modular P and 81 µmol/L for the cobas c702. After the cobas c702 was factorized in September 2016, the median plasma creatinine value decreased to 75 µmol/L. In conclusion, the CREP2 method on the cobas c702 overestimates creatinine by 4–6 μmol/L, which has a significant influence on the estimated glomerular filtration rate (eGFR) in children.
Related Knowledge Centers
- Muscle
- Renal Function
- Pyrazoles
- Imidazolines
- Imidazolidines
- Imidazoles
- Kidney