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1 Radiometer Medical ApS, Åkandevej 21, DK-2700 Brønshøj, Tel: +45 38 27 38 27, www.radiometer.com Physiology and clinical application RTC, October 2006.

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Presentation on theme: "1 Radiometer Medical ApS, Åkandevej 21, DK-2700 Brønshøj, Tel: +45 38 27 38 27, www.radiometer.com Physiology and clinical application RTC, October 2006."— Presentation transcript:

1 1 Radiometer Medical ApS, Åkandevej 21, DK-2700 Brønshøj, Tel: , Physiology and clinical application RTC, October 2006

2 2 Current clinical state for Radiometer What is creatinine? The kidneys Assessment of kidney function Creatinine in the hospital Future clinical state for Radiometer Read more Agenda

3 3 Current clinical state of ABL Blood gas Electrolytes Metabolites Full oximetry ER NICU OR PICU LAB ICU

4 4 Our customers want more.... Blood gas Electrolytes Metabolites Full oximetry Creatinine

5 5 Current clinical state for Radiometer What is creatinine? ­ Metabolism ­ Levels of creatinine The kidneys Assessment of kidney function Creatinine in the hospital Future clinical state for Radiometer Read more Agenda

6 6 Creatinine is.. A product of normal muscle metabolism Produced from creatine in the muscles Serves no metabolic purpose – a waste component Removed from the blood by the kidneys Diagnostic value: kidney functionality

7 7 Levels of creatinine Relatively constant within each individual Due to turnover of skeletal muscle it is higher in weightlifters, lower in children and adults, especially elderly ­ Changes in dietary intake causes only minor fluctuations Creatinine tends to decrease with age Conflicting information about levels in neonates African-American race higher muscle mass, higher Crea levels NB! The levels are highly method specific

8 8 Normal range of creatinine µmol/Lmg/dL Male Female Neonate week - 1 week-1 month months

9 9 Current clinical state for Radiometer What is creatinine? The kidneys ­ Anatomy and function ­ Pathology of kidneys Assessment of kidney function Creatinine in the hospital Future clinical state for Radiometer Read more Agenda

10 10 The kidneys Two kidneys Essentially a sophisticated blood filter 180 L blood are filtered daily and 1-1,5 L of urine is formed Important excretory and metabolic functions ­ Excretion of waste products, e.g. Crea ­ Regulation of fluid ­ Regulation of electrolytes ­ Regulation of acid-base balance ­ Etc

11 11 Anatomy of kidneys

12 12 Functionality of kidneys

13 13 Pathology of kidneys Most kidney diseases affect the nephrons ­ Acute, as a result of critical illness, injury or poisoning ­ Chronic, as a result of slow destruction by diabetes and/or high blood pressure Loss of filtering capacity ­ Impaired kidneys fail to separate albumin from the urine ­ Symptoms include protein, blood, glucose in the urine Decreased kidney function ­ 50 % of normal: possible to live a normal life ­ Less than 25 %: Serious health problems ­ Less than 15 %: Need dialysis or transplantation to survive Blood and urine flow pattern

14 14 Filtration system pathology Pre-renal ­ Low blood volume being presented to the glomerulus for filtration. ­ Causes: hypovolemia due to shock, hemorrhage, burns, salt and water depletion. Renal: ­ Damage of filter ­ Causes: inflammatory damage Post-renal: ­ Blockage on distal side of the glomerulus opposing filtration pressure. ­ Causes: any cause of urine retention e.g. stone in the ureter, tumor growth (prostatic carcinoma)

15 15 Current clinical state for Radiometer What is creatinine? The Kidneys Assessment of kidney function ­ Creatinine, urea, blood gases, electrolytes ­ Glomerular filtration rate, GFR ­ Standardization of Crea and GFR Creatinine in the hospital Future clinical state for Radiometer Read more Agenda

16 16 Assessment of kidney function Glomerular Filtration Rate - GFR - is the best estimate of kidney function ­ Requires creatinine measurement Creatinine is the most important marker of kidney damage – but not the only one ­ Relation to urea/BUN important for more in depth diagnosis ­ Calculation of GFR Urea/Crea ratio reported to give higher specificity in diagnosis ­ Often no strict critical values for therapy Na and K are often included to provide a full picture of the patient status Crea with full blood gas picture relevant for ICU patients ­ Risk of MOF, multi organ failure

17 17 Glomerular Filtration Rate - GFR GFR calculation is more accurate for determining whether a person has reduced kidney function Calculation of the efficiency with which the kidneys filter waste from the blood Traditionally: Measurement of excretion and plasma level of a substance that is freely filtered by the kidneys New equation allows for calculation from cCrea and age ­ Promoted by NKDEP, National Kidney Disease Education Program (USA) ­ Implemented on ABL8x7 FLEX GFR = k1  (cCrea) k2  (Age) k2  (0.741 if female)  (1.210 if African-American)

18 18 The kidneys and GFR Inverse proportionality between cCrea and GFR A high GFR reflects a high filtration rate and therefore a low cCrea Different GFRs exist Renewed focus on GFR

19 19 Current clinical state for Radiometer What is creatinine? The kidneys Assessment of kidney function Creatinine in the hospital ­ Where, why, when, STAT and together with what? ­ Acute renal failure ­ Chronic renal failure Future clinical state for Radiometer Read more Agenda

20 20 Current state – who wants creatinine? WHEREWHY ERFor selected critical patients ICURenal function, ARF, hydration status NICU/PICURenal function, ARF, hydration status ORRenal function, hydration status DialysisRenal function, monitor therapy General wardsRenal function, hydration status CT scanTo control possible kidney damage Creatinine is a marker of kidney function Patient groups found at both critical and general wards

21 21 Creatinine – Where, when, STAT and with what? WHERE?WHEN?STAT?With WHAT? ERAs neededYesSome always order creatinine and urea/BUN together, some don’t. Other creatinine partners: Na, K, Cl, HCO 3 -, tHb, iCa ICU1-2/daysSometimes ORBefore surgery Sometimes NICU/PICU1-2/daysSometimes Dialysis1/week to 1/month No General wards1/dayNo CT scanBefore a scanYesTypically only creatinine

22 22 At the Hospital – Acute Acute renal failure - ARF ­ Many patients in the ICU develop ARF (20-50%) ­ Very often surgery or shock patients ­ It is “sudden” - develops over 1-3 days Characterized by ­ Rapid increase of both creatinine and urea, with creatinine as the most important marker ­ Also changes in other parameters e.g. electrolytes parameters Therapy ­ Dialysis Outcome ­ Some are reversible ­ ARF mortality rate is % WHERE ? ER ICU NICU/PICU OR

23 23 At the Hospital – Chronic Chronic kidney disease - CKD ­ Progressive and irreversible destruction of kidney tissue ­ May develop over several years Cornerstone in diagnosis: GFR Therapy ­ Change in diet ­ Special care for diabetics etc ­ Dialysis Focus area of NKDEP WHERE All departments

24 24 Treatment of renal patients Dialysis or kidney transplantation Life saving therapy for people with acute or chronic kidney failure Dialysis is a method of removing toxic substances (impurities or wastes) from the blood when the kidneys are unable to do so Each treatment has advantages and disadvantages The patient needs to make some changes in his life, including cutting down on calories and salt in the diet

25 25 Treatment – kidney transplantation Kidney transplantation surgically places a healthy kidney from another person into the patient’s body The artery and vein of the new kidney is connected to the patient’s artery and vein so the blood flows through the donated kidney The new kidney may start working right away or may take up to a few weeks to make urine Unless the “old” kidneys are causing infection or high blood pressure, they are left in place

26 26 Treatment - hemodialysis Blood is diverted from the venous access via dialysis catheters to a dialysis machine Filtration through special filters along with toxin- removing solutions (dialysate) The chemical imbalances and impurities of the blood are corrected and the blood is returned to the body Most patients undergo hemodialysis for three sessions of three to four hours every week

27 27 Two challenges for us The lack of urea/BUN ­ Will be added to the ABL later Some do not perceive creatinine as s STAT parameter ­ Is true for the majority of the creatinine measurements in the hospital ­ Some are STAT – therefore requested by some customers ­ Very strong synergy to the other ABL parameters Electrolytes Blood gas Metabolites Full oximetry Creatinine

28 28 Future state - creatinine Creatinine on a BG analyzer makes perfect sense ­ Increased therapeutic value of each measurement ­ Evaluated together with the other parameters on the BG analyzer, including the recommended GFR ­ Critically ill patients carry a high risk of acute renal failure

29 29 Read more Lawson N, Lang T, Broughton A, Prinsloo P, Turner C, Marenah C. Creatinine assays: time for action? Ann Clin Biochem 39, Miller W, Myers G, Ashwood E, Killeen A, Wang E, Thienpont L, et al. Creatinine measurement: state of the art in accuracy and interlaboratory harmonization. Arch Pathol Lab Med 2005; 129 (3): Myers GL, Miller WG, Coresh J et al. Recommendations for improving serum creatinine measurement: a report from the laboratory working group of the national kidney disease education program. Clin Chem 2005; 52, 1: Rowe D, Omar H, Barratt S, Biggs P. An evaluation of blood creatinine measurement by creatinase on the NOVA M7 blood gas analyzer. Clinica Chimica Acta 307, Papadea C, Foster J, Grant S, Ballard S, Cate J, Southgate W, et al. Evaluation of the i-STAT Portable Clinical Analyzer for point-of-care blood testing in the intensive care units of a university children's hospital. Ann Clin Lab Sci 2002;32(3):

30 30 Radiometer Medical ApS, Åkandevej 21, DK-2700 Brønshøj, Tel: , RTC, October 2006


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