Early detection of chronic kidney disease

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Early identification of patients with chronic kidney disease is considered important for implementing therapeutic interventions aimed at slowing further progression of the disease. This chapter describes the diagnostic techniques including historical findings, the clinical examination, laboratory diagnosis and imaging. Measurement of glomerular filtration rate is discussed in detail.

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10.1 Exponential relationship between creatinine concentration and glomerular filtration rate (GFR) in cats, indicating that a large decrease in GFR results in only a small corresponding increase in creatinine concentration. (Adapted from )
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10.2 Creatinine concentration bodyweight in 567 dogs of various sizes. (Courtesy of R Heiene, J Aasen, C Trangerud and E Teske)
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10.3 Analytical values and reference ranges in plasma/serum creatinine in 10 healthy dogs (plotted on x-axis). Three aliquots from each of the dogs were analysed at 10 European referral laboratories. While the analytical variability was low, the percentage of samples classified as abnormal varied from 0 to 37%, based upon the variability in reference ranges between laboratories. (Reproduced from with permission from )
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10.5 Structure of the glomerulus. (Reproduced from with permission from the )
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10.6 Structure of the nephron. (Reproduced from with permission from the )
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10.8 Pharmacokinetic models used to determine the area under the plasma concentration time curve. (a) One-compartment; minimum number of samples = 2. (b) Two-compartment; minimum number of samples = 4. (c) Non-compartment; minimum number of samples is unknown, however, the use of three gives inaccurate glomerular filtration rate estimation.
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10.9 Plasma concentration time curve indicating the missing area under the curve (AUC) associated with the slope–intercept method. The slope–intercept method of determining plasma clearance relies on a limited number of samples (generally three) collected during the elimination phase of the clearance curve (usually starting 60 minutes after administration of the filtration marker). As the initial distribution exponential is ignored, this creates a ‘missing area under the curve’ (blue circle), leading to an underestimation in the calculated AUC and hence overestimation of the glomerular filtration rate (GFR) (because GFR is calculated as dose/AUC).

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