학술논문
A study of size-selective renal elimination using a novel human model.
Document Type
Academic Journal
Author
Sigurjonsson J; Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.; Grubb D; Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.; Grubb A; Department of Clinical Chemistry, Skåne University Hospital, Lund University, Lund, Sweden.; Christensson A; Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden.; Öberg CM; Department of Nephrology, Skåne University Hospital, Lund University, Malmö, Sweden.; Ederoth P; Department of Anaesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.; Koul S; Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.; Götberg M; Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.; Yndigegn T; Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.; Tödt T; Department of Cardiology, Skåne University Hospital, Lund University, Lund, Sweden.; Viterius B; Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.; Bjursten H; Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Source
Publisher: Informa Healthcare Country of Publication: England NLM ID: 0404375 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1502-7686 (Electronic) Linking ISSN: 00365513 NLM ISO Abbreviation: Scand J Clin Lab Invest Subsets: MEDLINE
Subject
Language
English
Abstract
The recently discovered selective glomerular hypofiltration syndromes have increased interest in the actual elimination of molecules in the human kidney. In the present study, a novel human model was introduced to directly measure the single-pass renal elimination of molecules of increasing size. Plasma concentrations of urea, creatinine, C-peptide, insulin, pro-BNP, β 2 -microglobulin, cystatin C, troponin-T, orosomucoid, albumin, and IgG were analysed in arterial and renal venous blood from 45 patients undergoing Transcatheter Aortic Valve Implantation (TAVI). The renal elimination ratio (RER) was calculated as the arteriovenous concentration difference divided by the arterial concentration. Estimated glomerular filtration rate (eGFR) was calculated by the CKD-EPI equations for both creatinine and cystatin C. Creatinine (0.11 kDa) showed the highest RER (21.0 ± 6.3%). With increasing molecular size, the RER gradually decreased, where the RER of cystatin C (13 kDa) was 14.4 ± 5.3% and troponin-T (36 kDa) was 11.3 ± 4.6%. The renal elimination threshold was found between 36 and 44 kDa as the RER of orosomucoid (44 kDa) was -0.2 ± 4.7%. The RER of creatinine and cystatin C showed a significant and moderate positive linear relationship with eGFR ( r = 0.48 and 0.40). In conclusion, a novel human model was employed to demonstrate a decline in renal elimination with increasing molecular size. Moreover, RERs of creatinine and cystatin C were found to correlate with eGFR, suggesting the potential of this model to study selective glomerular hypofiltration syndromes.