Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease
Abstract Background Interstitial fibrosis (IF) on kidney biopsy is one of the most potent risk factors for kidney disease progression. The furosemide stress test (FST) is a validated tool that predicts the severity of acute kidney injury (especially at 2 h) in critically ill patients. Since furosemi...
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| Format: | Article |
| Language: | English |
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BMC
2020-03-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-020-01721-z |
| _version_ | 1818368904607563776 |
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| author | Jesús Rivero Francisco Rodríguez Virgilia Soto Etienne Macedo Lakhmir S. Chawla Ravindra L. Mehta Sucheta Vaingankar Pranav S. Garimella Carlos Garza Magdalena Madero |
| author_facet | Jesús Rivero Francisco Rodríguez Virgilia Soto Etienne Macedo Lakhmir S. Chawla Ravindra L. Mehta Sucheta Vaingankar Pranav S. Garimella Carlos Garza Magdalena Madero |
| author_sort | Jesús Rivero |
| collection | DOAJ |
| description | Abstract Background Interstitial fibrosis (IF) on kidney biopsy is one of the most potent risk factors for kidney disease progression. The furosemide stress test (FST) is a validated tool that predicts the severity of acute kidney injury (especially at 2 h) in critically ill patients. Since furosemide is secreted through the kidney tubules, the response to FST represents the tubular secretory capacity. To our knowledge there is no data on the correlation between functional tubular capacity assessed by the FST with IF on kidney biopsies from patients with chronic kidney disease (CKD). The aim of this study was to determine the association between urine output (UO), Furosemide Excreted Mass (FEM) and IF on kidney biopsies after a FST. Methods This study included 84 patients who underwent kidney biopsy for clinical indications and a FST. The percentage of fibrosis was determined by morphometry technique and reviewed by a nephropathologist. All patients underwent a FST prior to the biopsy. Urine volume and urinary sodium were measured in addition to urine concentrations of furosemide at different times (2, 4 and 6 h). We used an established equation to determine the FEM. Values were expressed as mean, standard deviation or percentage and Pearson Correlation. Results The mean age of the participants was 38 years and 44% were male. The prevalence of diabetes mellitus, hypertension and diuretic use was significantly higher with more advanced degree of fibrosis. Nephrotic syndrome and acute kidney graft dysfunction were the most frequent indications for biopsy. eGFR was inversely related to the degree of fibrosis. Subjects with the highest degree of fibrosis (grade 3) showed a significant lower UO at first hour of the FST when compared to lower degrees of fibrosis (p = 0.015). Likewise, the total UO and the FEM was progressively lower with higher degrees of fibrosis. An inversely linear correlation between FEM and the degree of fibrosis (r = − 0.245, p = 0.02) was observed. Conclusions Our findings indicate that interstitial fibrosis correlates with total urine output and FEM. Further studies are needed to determine if UO and FST could be a non-invasive tool to evaluate interstitial fibrosis. Trial registration ClinicalTrials.gov NCT02417883 . |
| first_indexed | 2024-12-13T23:15:22Z |
| format | Article |
| id | doaj.art-d9aac1da605c42e6a02433f28349374f |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-13T23:15:22Z |
| publishDate | 2020-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-d9aac1da605c42e6a02433f28349374f2022-12-21T23:27:58ZengBMCBMC Nephrology1471-23692020-03-012111910.1186/s12882-020-01721-zFurosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney diseaseJesús Rivero0Francisco Rodríguez1Virgilia Soto2Etienne Macedo3Lakhmir S. Chawla4Ravindra L. Mehta5Sucheta Vaingankar6Pranav S. Garimella7Carlos Garza8Magdalena Madero9Nephrology Department, National Institute of Lung Disease Ismael Cosio VillegasNephrology Department, National Institute Cardiology Ignacio ChávezNephrology Department, National Institute Cardiology Ignacio ChávezDivision of Nephrology, University of CaliforniaDivision of Nephrology, University of CaliforniaDivision of Nephrology, University of CaliforniaNephrology Department, National Institute Cardiology Ignacio ChávezDivision of Nephrology, University of CaliforniaNephrology Department, National Institute Cardiology Ignacio ChávezNephrology Department, National Institute Cardiology Ignacio ChávezAbstract Background Interstitial fibrosis (IF) on kidney biopsy is one of the most potent risk factors for kidney disease progression. The furosemide stress test (FST) is a validated tool that predicts the severity of acute kidney injury (especially at 2 h) in critically ill patients. Since furosemide is secreted through the kidney tubules, the response to FST represents the tubular secretory capacity. To our knowledge there is no data on the correlation between functional tubular capacity assessed by the FST with IF on kidney biopsies from patients with chronic kidney disease (CKD). The aim of this study was to determine the association between urine output (UO), Furosemide Excreted Mass (FEM) and IF on kidney biopsies after a FST. Methods This study included 84 patients who underwent kidney biopsy for clinical indications and a FST. The percentage of fibrosis was determined by morphometry technique and reviewed by a nephropathologist. All patients underwent a FST prior to the biopsy. Urine volume and urinary sodium were measured in addition to urine concentrations of furosemide at different times (2, 4 and 6 h). We used an established equation to determine the FEM. Values were expressed as mean, standard deviation or percentage and Pearson Correlation. Results The mean age of the participants was 38 years and 44% were male. The prevalence of diabetes mellitus, hypertension and diuretic use was significantly higher with more advanced degree of fibrosis. Nephrotic syndrome and acute kidney graft dysfunction were the most frequent indications for biopsy. eGFR was inversely related to the degree of fibrosis. Subjects with the highest degree of fibrosis (grade 3) showed a significant lower UO at first hour of the FST when compared to lower degrees of fibrosis (p = 0.015). Likewise, the total UO and the FEM was progressively lower with higher degrees of fibrosis. An inversely linear correlation between FEM and the degree of fibrosis (r = − 0.245, p = 0.02) was observed. Conclusions Our findings indicate that interstitial fibrosis correlates with total urine output and FEM. Further studies are needed to determine if UO and FST could be a non-invasive tool to evaluate interstitial fibrosis. Trial registration ClinicalTrials.gov NCT02417883 .http://link.springer.com/article/10.1186/s12882-020-01721-zInterstitial fibrosisUresisKidney biopsyFurosemide stress test |
| spellingShingle | Jesús Rivero Francisco Rodríguez Virgilia Soto Etienne Macedo Lakhmir S. Chawla Ravindra L. Mehta Sucheta Vaingankar Pranav S. Garimella Carlos Garza Magdalena Madero Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease BMC Nephrology Interstitial fibrosis Uresis Kidney biopsy Furosemide stress test |
| title | Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| title_full | Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| title_fullStr | Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| title_full_unstemmed | Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| title_short | Furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| title_sort | furosemide stress test and interstitial fibrosis in kidney biopsies in chronic kidney disease |
| topic | Interstitial fibrosis Uresis Kidney biopsy Furosemide stress test |
| url | http://link.springer.com/article/10.1186/s12882-020-01721-z |
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