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Biomedical subjects

S Vítko

Publications and source records attributed to S Vítko.

At least 37 records · Page 2Linked to original sources
PubMed2001

Effect of daclizumab on inflammatory infiltrate in fine needle aspiration biopsy in patients after liver transplantation.

OBJECTIVES: FNAB is a cytological procedure enabling the monitoring of inflammatory cells in the graft, morphological modification of parenchymal cells, and expression of antigens on aspirated cells. The aim of the study was to evaluate whether Daclizumab influences the composition of inflammatory infiltrate and expression of HLA-DR antigens and intercellular adhesive molecule ICAM-1 on parenchymal cells. METHODS: Two groups of liver allograft recipients were included and they were treated with two different immunosuppressive protocols. The first group with quadruple immunosuppression therapy (Cyclosporine A, Mycophenolate mofetil, steroids, and Daclizumab). The second group with quadruple combination immunosuppression (Cyclosporine A, Azathioprine, steroids and ATG-Fresenius). FNAB and blood samples were collected simultaneously. Corrected increments of inflammatory cells were statistically evaluated as well as expression of HLA-DR antigens and ICAM-1 on parenchymal cells. RESULTS: FNAB specimens from the Daclizumab group demonstrated significantly lower values of the total corrected increment, the corrected increment of monocytes, number of blast cells per slide, and a lower number of ICAM-1 expressing parenchymal cells. CONCLUSION: We summarise that Daclizumab significantly reduces inflammatory cells in liver graft, as well as expression of ICAM-1 on parenchymal cells.

Adult↗
PubMed2001

Correlation of FNAB with histology in human liver allografts. Regional experience.

OBJECTIVES: A total of 43 FNABs, corresponding blood specimens and conventional biopsies from 39 adult liver allograft recipients were analysed. The purpose of the present study was to determine whether results obtained by cytological and histological examination were concordant at the monitoring of liver allograft rejection within the first 5 weeks of the posttransplant period. RESULTS: When histology in 14 cases showed rejection, rejection was diagnosed in 12 out of 14 FNAB specimens. When in other 14 cases the rejection was absent histologically, FNAB was negative in 10 out of those 14 specimens (sensitivity 85.7%, specificity 71.4%). Cholestasis was demonstrated in biopsy and FNAB specimens with sensitivity 83% and specificity 86%. CONCLUSION: FNAB is a useful method for diagnosis of acute rejection in liver allograft during the early posttransplant period, as well as for evaluation of cholestasis. Results obtained by FNAB correlated well with results obtained by core-needle biopsy.

Biopsy, Needle↗
PubMed2001

MRP 8/14 and procalcitonin serum levels in organ transplantations.

OBJECTIVES: MRP8/14 is a heterodimer of two myeloid calcium-binding proteins associated with different types of acute inflammatory processes. We studied MRP8/14 together with procalcitonin (PCT) serum levels in order to diagnose infectious complications or the rejection process affecting kidney or heart allograft. METHODS: A total of 419 serum samples was evaluated. MRP8/14 levels were measured by ELISA (BMA Biomed), PCT by a sensitive immunoluminiscent assay ILMA (Brahms Diagn.) RESULTS: Both parameters showed very low basal levels in healthy subjects (range 303-1,660 ng/ml of MRP8/14; less than 0.08 ng/ml of PCT). A rapid increase in serum levels occurred in response to bacterial infections (MRP8/14 up to 6,230 ng/ml; PCT up to 297 ng/ml). Serum PCT concentration remained low in the presence of kidney allograft rejection, where MRP8/14 levels were increased. An uncomplicated outcome of kidney or heart transplantation did not change basal serum MRP8/14 and PCT levels. CONCLUSIONS: We conclude that 1) both MRP8/14 and PCT are very sensitive markers of complications in organ transplant recipients (normal values in uncomplicated outcome) 2) combination of both parameters is useful to discriminate between rejection (increased MRP8/14 with normal PCT) and systemic bacterial infection (both parameters increased).

Aged↗
PubMed2000

[Withdrawal of prednisone from a triple combination of immunosuppressive agents after kidney transplantation].

BACKGROUND: Triple-drug immunosuppression may not be necessary in a majority of stabilized patients over 1 year after kidney transplantation. In contrary steroid withdrawal may be beneficial for the patient by elimination of side-effects. The primary aim of this study was assessment of the risk of rejection after the prednisone withdrawal. METHODS AND RESULTS: 88 patients 1 year after the first renal transplantation with stable graft function and serum creatinine < 160 mumol/l treated with cyclosporine-A, azathioprine and prednisone were randomized into group A (n = 46) with a prednisone withdrawal and group B (n = 42) on triple-drug therapy without change. At the time of randomization, fine-needle biopsy was carried out in all of the patients. In group A, the dose of prednisone was gradually reduced to zero in the course of six months and the patients were followed up for the next 12 months. In the group B, patients on triple-drug therapy were followed for the corresponding period of time. 3 patients (6.6%) in group A, and 2 (4.8%) in group B experienced rejection (NS). Mean values of serum creatinine were in the course of follow-up in both groups without any statistical difference. Suspect immunological activity or proved immunological activity in aspiration biopsy was present in 4 patients in each group, but one of them rejected the graft. In comparison with group B, a significant decrease of cholesterol and leukocytes was observed in group A. Prednisone withdrawal had no influence on hypertension and triglyceride. CONCLUSIONS: Gradual withdrawal of steroids is not associated with higher risks of rejection and has a beneficial effect on cholesterol levels. Aspiration biopsy was of no use for the prediction of rejection.

Azathioprine↗
PubMed2000

Proportion of glomerulosclerosis in procurement wedge renal biopsy cannot alone discriminate for acceptance of marginal donors.

BACKGROUND: The shortage of available kidneys for renal transplantation could be addressed, to some extent, by expanding the criteria for acceptance of marginal donors. The study of these criteria is limited by the selection of grafts actually retrieved and transplanted, therefore reduced to a study of risk factors. We have evaluated the potential of procurement renal biopies as an instrument for acceptance or refusal of donor kidneys for transplantation. METHODS: This was a prospective study of a consecutive series of 200 donors. Biopsies were performed by wedge technique at the donor operation and were evaluated for proportion of glomerulosclerosis, vascular and tubular changes, and interstitial fibrosis. The study included 387 renal grafts with a representative biopsy, transplanted, and followed-up for survival and functional evaluation; 24 hr creatinine clearance at 1 and 3 weeks, and 3, 6, 12, 18, and 24 months. RESULTS: Factors associated with initial graft function included cold ischemia time, number of DR mismatches, tubular changes, although donor age showed the strongest correlation with short- and long-term level of graft function. DR mismatches and retransplantation appeared to be the only significant risk factors for graft loss. The proportion of glomerulosclerosis (mean 8%, range 0-48%) correlated with graft function in the simple regression analysis. However, when age was taken into account glomerulosclerosis did not correlate significantly with graft function. Furthermore, glomerulosclerosis as high as 25% or more had an acceptable 3-year graft survival rate of 74.7%. CONCLUSION: Procurement biopsy provides only limited information for the decision whether or not to accept a kidney donor.

Adolescent↗
PubMed2000

LF 08-0299 in the prophylaxis and treatment of chronic rejection in a rat aortic allograft model.

Chronic rejection is the major cause of late kidney allograft failure. We evaluated the efficacy of LF 08-299 (LF), an analogue of 15-deoxyspergualin, in a rat aortic allograft model of chronic rejection. BN aortic allografts were transplanted to Lew recipients. LF was administered at a dose of 6 mg/kg and 2.5 mg/kg on days 0-20 and 6 mg/kg on days 60-90. CyA was used at a dose of 5 mg/kg on days 0-20. Untreated isografts and allografts were used as controls. Histological changes and immunohistochemistry were monitored sequentially at 8, 12, 16 and 20 weeks. There were no differences in intimal proliferation between LF-treated allografts and untreated or CyA-treated controls. Only a tendency in adventitial infiltration reduction was seen in LF-treated animals. We found a significantly less pronounced reduction in media diameter in LF-treated animals. We concluded that LF 08-0299 is only able to reverse reduction in media thickness in aortic allografts, but not intimal proliferation in this model of chronic rejection.

Animals↗
PubMed2000

Liver transplantation in Eastern Europe.

The aim of this report is to evaluate the development of liver transplantation in eastern Europe until mid-1998. Representatives of gastroenterological and hepatological societies of the respective countries answered a questionnaire about the most descriptive items of the issue of liver transplantation. The Baltic countries, together with 6 southern Balkan countries, Moldovia, and Belarus, have not developed a program of liver transplantation. In Ukraine, 7 transplantations were performed, with 3 early deaths. In Russia, 31 liver transplantations were performed, with 8 of the last 12 patients surviving short term. In Slovenia, 1 of 2 patients, and in Yugoslavia, 8 of 9 patients survived. In Croatia and Slovakia, 2 patients each died immediately after surgery. The number of liver transplantations is increasing in both Hungary and Poland. In Hungary, 63 transplantations were performed, with a 1-year survival rate reaching 85%; in Poland, 55 adults and 29 children underwent transplantation, with an actuarial 1-year survival rate of 70%. In former East Germany, 4 centers developed their programs since 1992. A total of 196 transplantations were performed, with 1-year survival rates varying from 80% to 89%. The total spectrum of indications for transplantation was standard, with a greater proportion of hepatocellular cancer compared with Eurotransplant statistics. In the Czech Republic, the first liver transplantation was performed in 1983, but it was not until 1994 that the number of procedures increased steeply. Until mid-1998, a total of 182 transplantations were performed. At the Prague Institute for Clinical and Experimental Medicine, we performed 94 transplantations, with a 1-year patient survival rate of 90.6%. There has been rapid development over the last 3 years in the 3 countries of Central Europe. The progress is influenced by the sweeping political and economic changes.

Adult↗
PubMed2000

Adverse effect of donor arteriolosclerosis on graft outcome after renal transplantation.

INTRODUCTION: In recent years less strict criteria for renal graft donors have been applied. Our study was designed to investigate whether the histological picture, with special reference to vascular changes of the donor kidney, has an effect on the development and level of graft function, and on 48-month graft survival. METHODS: Three morphologically distinct groups were formed from 150 consecutive cadaveric kidneys donors transplanted into 290 recipients. A control group (C) consisted of kidneys with a completely normal histological picture. Group M1 included kidneys with mild arteriolosclerosis and group M2 (n=122) was comprised of kidneys showing significant arteriolosclerosis. The onset of graft function was assessed by the need for dialysis treatment post-transplantation and the levels of serum creatinine and creatinine clearance at 6, 12, 24 and 36 months post transplant. RESULTS: The proportion of sclerotic glomeruli (P<0.001) and the incidence and severity of interstitial fibrosis was greater in groups M1 and M2 than in the control group (M1, P<0.01; M2, P<0.001). The incidence of vascular fibrinoid necrosis in M2 was greater than in controls (P<0.001). The onset of graft function did not differ significantly between the groups. Group M2 showed a significantly lower level of graft function (P<0.001). The 4-year graft survival rate of group M2 was 74.2%, significantly lower than in the combined group C+M1 (P=0.03). CONCLUSION: Significant vascular lesions in the donor kidney should be taken into account when predicting graft function and survival.

Acute Disease↗
PubMed2000

Withdrawal of steroids from triple-drug therapy in kidney transplant patients.

BACKGROUND: In renal transplant patients with stable graft function, triple-drug immunosuppression may not be necessary, while withdrawal of steroids may eliminate side effects. The primary aim of this study was to assess the risk of rejection after steroid withdrawal. METHODS: A total of 88 patients with stable graft function and serum creatinine <160 micromol/l, treated with cyclosporin A, azathioprine and prednisone were randomized into group A (n=46) with a gradual prednisone reduction to zero in the course of 6 months, and group B (n=42) on triple-drug therapy without change. At the time of randomization, fine-needle aspiration biopsy (FNAB) was carried out in all of the patients. After stopping steroids, the patients were followed up for a period of 12 months. RESULTS: Four patients failed to complete steroid withdrawal, three due to rejection, and one due to leukopenia. The proportion of rejection in three patients in group A (6.6%) was not significantly different from rejection in two patients in group B (4.8%). The mean value of serum creatinine was not significantly different in both groups in the course of follow-up. A finding of some degree of immunological activity in FNAB was made in four patients in each group, but none of these patients developed rejection. Compared with group B, significant decreases in serum cholesterol and blood leukocytes were observed in group A. Prednisone withdrawal did not have any influence on hypertension and serum triglycerides. CONCLUSIONS: Gradual withdrawal of steroids is not associated with a higher risk for rejection and has a beneficial effect on serum total cholesterol levels. FNAB was not a useful tool for predicting rejection.

Adult↗
PubMed1999

Serum procalcitonin concentrations in transplant patients with acute rejection and bacterial infections.

Procalcitonin (PCT) represents a new marker of systemic inflammatory reactions of the body to infections. PCT is selectively induced by severe bacterial infections leading to sepsis or multiorgan dysfunction syndrome. The aim of our study was to test PCT as a postoperative infection marker in heart and kidney transplant patients compared with healthy subjects and patients with localized lung-inflammatory processes without a manifest systemic response. PCT concentrations were measured by an immunoluminometric assay (ILMA) in a total of 419 serum samples. Normal serum levels were in the range of 0.08-0.6 ng/ml. Operative trauma associated with heart (not kidney) transplantation induced a transient increase in PCT levels to 7-10 ng/ml with a decline to normal levels within 2-3 days in most patients. Severe bacterial infections dramatically augmented serum PCT concentrations reaching values of 46-297 ng/ml in the most critical periods. Good response to antibiotic therapy was associated with a decline in serum PCT concentrations. Acute rejection or cytomegalovirus infections did not significantly increase the serum PCT levels. Localized pulmonary infections showed either no, or only a limited increase, in the serum PCT levels (max. 7 ng/ml). We conclude from our data that PCT can be used as a sensitive marker to differentiate systemic bacterial infections from other complications in organ transplantation.

Bacterial Infections↗
PubMed1999

[Age and changes in dietary habits affect hyperlipoproteinemia after kidney transplantation].

BACKGROUND: Atherosclerosis of the blood vessels is the most frequent cause of morbidity and mortality of patients after transplantation of the kidneys with a long-term function of the graft. It is assumed that the most significant risk factor for its development is secondary hyperlipoproteinaemia (HLP). In the development of HLP a number of factors may participate (chronic renal insufficiency, proteinuria, immunosuppressive treatment, diet, increment of body weight, age, genetic factors). The objective of the investigation was to follow changes of the lipid spectrum after renal transplantation and evaluate the impact of different factors which participate in these changes. METHODS AND RESULTS: The authors investigated in a retrospective metabolic study for a period of 18 months a total of 348 patients after the first cadaverous kidney transplantation. They compared the findings in 34 patients (group I) who had throughout the investigation period a total cholesterol of < or = 5.2 and triacylglycerols < or = 2.3 and group II (314 patients) who had elevated values of these factors. The mean values of different parameters differed highly significantly (group I vs. group II): cholesterol 4.6 +/- 0.4 vs 6.8 +/- 1.5 (p < 0.001), triacylglycerols 1.8 +/- 0.8 vs 3.6 +/- 1.6 (p < 0.001), LDL-cholesterol 2.6 +/- 0.6 vs 4.0 +/- 1.1 (p < 0.001), (all in mmol/l) and HDL/total cholesterol 0.28 +/- 0.07 vs 0.20 +/- 0.09 (p < 0.01). The authors did not detect a difference in the incidence of isoforms of apo E. There were no differences in the mean cyclosporin A levels: 394 +/- 114 vs. 489 +/- 202 (ng/ml) and renal function CCr 1.0 +/- 0.6 vs 0.9 +/- 0.3 (ml/s). In group I there was a significantly higher intake of energy 150 +/- 20 vs. 125 +/- 25 (kJ), of fat 1.6 +/- 0.3 vs. 1.0 +/- 0.2 (g/kg) and disaccharides (by 50%). With this corresponded also a significantly higher increment of BMI 27.4 +/- 4.6 vs. 23.8 +/- 3.3 (p < 0.01). Patients in group II were also significantly older (44.5 +/- 14.1 vs 49.4 +/- 12.5, p < 0.01). CONCLUSIONS: It is assumed that one of the main causes of the development of HLP after transplantation are poor dietary habits of the patients associated with an excessive intake of energy, fats and disaccharides and an increase of body weight. The patient's age is significantly higher. Standard lower doses of immunosuppressive drugs have obviously only a supportive effect.

Adult↗
PubMed1999

[Conversion from Consupren sol. to Consupren S capsules in kidney transplant patients].

In a group of patients after transplantation of the kidney with stabilized graft function treated by Consupren sol. combined with prednisone and azathioprin in 20 patients (group A) Consupren sol. was replaced by Consupren S capsules, in 17 patients (group B) Consupren sol. therapy proceeded without any change. To maintain the cyclosporin blood concentration within the therapeutic range it was necessary after the change of drug form in group A to adjust the dosage of the drug in 12 patients of group A while in group B only in one patient (p<0.01). The mean doses and levels of Cy-A however did not change significantly during the three-month investigation period in the two groups and and the bioequivalence of the two preparations was evident. Conversion from Consupren sol. to Consupren S capsules is not associated with the risk of rejection or undesirable effects. It can be implemented at a ratio of 1:1 or 1: the closest dose divisible by 25 (the smallest capsules are 25 mg) and after conversion a check-up or possible modification of the dose is necessary.

Administration, Oral↗
PubMed1998

[Repeat kidney transplantation].

BACKGROUND: The objective of the study was an analysis of results of repeated kidney transplantations (Tx2, Tx3) implemented during the first 29 years of activities of the Transplantation Centre of the Institute of the Clinical and Experimental Medicine in subjects with a different maintenance immunosuppression. METHODS AND RESULTS: The retrospective study pertains to 134 Tx2 and 17 Tx3 in 134 non-diabetic subjects: 43 of them had during Tx1 and Tx2 (1966-1981 and 1966-1985 resp.) immunosuppression on the basis of azathioprin (Aza, sub-group AA), 42 during Tx1 (1972-85), Aza, while during Tx2 (1984-85) immunosuppression on the basis of cyclosporin (CyA, subgroup AC) and 49 both during Tx1 and Tx2 (1985-93 and 1986-95 resp.) CyA (subgroup CC). Compared was survival of grafts by the actuarial method (with regard to all losses regardless of cause) by the end of the 4th year inside the subgroups (Tx2, vs. Tx1 and Tx3 vs. Tx2 in the same subjects) and between subgroups (Tx1 vs. Tx1 and Tx2 vs. Tx2 in different subjects). Moreover in paired investigations the survival of recipients and grafts after Tx2 was compared after immunosuppression on the basis of CyA with the same parameters after Tx1 in different subjects with the same immunosuppression, operated at approximately the same time (n = 81) and survival of subjects with Tx1 + Tx2 on the CC regime regardless whether the second grafts functioned at the time of the last examination, with survival of subjects after Tx1 where after graft failure Tx2 was not performed (n = 34). Prophylaxis with antilymphocyte globulins was not used. Survival of second and first grafts did not differ in any of the subgroups, third grafts survived at the end of the third year more frequently than second grafts (66 vs. 18%, p < 0.01). Second grafts in CC survived more than in AA (55 vs. 28%, p < 0.01). In the paired study Tx2 vs. Tx1 the survival of grafts and recipients was the same (88 vs. 89%, N.S. and 47 vs. 62% resp.), in the paired study Tx1 + Tx2 vs. Tx1 more subjects with Tx1 + Tx2 survived 10 years after Tx1 than subjects who did not have Tx2 (82 vs. 49%, p < 0.05). CONCLUSIONS: A further transplantation of the kidney after functional loss of the first graft is the method of choice: the mortality is low, the probability of several years' function is considerable and the prognosis as regards quality and length of life better than with regular dialysis treatment.

Adult↗
PubMed1998

[Evaluation of long-term monitoring of glomerular filtration in individuals with kidney transplantation].

BACKGROUND: Long-term follow-up of the glomerular filtration rate (GFR) in subjects with a transplanted kidney revealed that changes of this function in the course of time are frequently irregular and cannot be expressed by a simple mathematical function. This fact causes problems when evaluating the rate of progression of chronic transplant nephropathy. Characterization of changes of the GFR of the graft by values of this function at the beginning and at the end of the follow-up period does not take into account transient changes and the predominating level of GFR during the entire follow-up period. The authors tried to elaborate a method which would render it possible to evaluate in a simple manner the level of the GFR during the entire investigation period. The method is based on assessment of the area under the curve (AUC) of GFR. METHODS AND RESULTS: This method was used to investigate the time course of GFR in 22 subjects after transplantation of the kidney from a cadaverous donor. The investigated group included nine women and 13 men aged 30-65 years (mean 50 years). The time interval after transplantation was 1-84 months (mean 22 months). The GFR was assessed after 3-months intervals for a period of 9-21 months (mean 13.5 months). GFR was assessed on the basis of renal clearance of polyfructosan. The time course and level of GFR was evaluated in the common way based on GFR values at the beginning and end of the investigation period and according to the new method based on calculation of AUC. It was found that the two methods of evaluation of graft function do not provide the same results. In one third of the examined subjects the differences were higher than 20%. CONCLUSIONS: The results of this study provide evidence that evaluation of changes and the level of the GFR of the graft throughout the follow-up period based on AUC provides more detailed information then evaluation of the GFR only at the beginning and end of the follow-up period. The authors assume that this method of evaluation of the GFR of the graft could be helpful in a more accurate assessment of the effect of different therapeutic procedures.

Adult↗
PubMed1998

Long-term follow-up of the tubular secretion of creatinine in renal graft recipients.

The differences in glomerular filtration rate (GFR) based on creatinine clearance (Ccr) or obtained by the more exact methods are caused mainly by tubular creatinine secretion. In this study, we monitored creatinine clearance (Ccr), GFR on the basis of polyfructosan renal clearance (C(PF)) and parameters characterizing tubular creatinine secretion (Ccr/C(PF), Ccr - C(PF), Tcr/C(PF) x 100) in 12 individuals with renal grafts (Group A), 12 kidney graft donors for related transplantation (Group B), and in 27 individuals undergoing nephrectomy for a pathological process in one kidney (Group C). In the monitored groups, C(PF) and Ccr values were within the limits consistent with the normal function of a single kidney in a healthy individual. The values characterizing tubular creatinine secretion in Group A did not differ significantly from those obtained in Groups B and C. However, the parameters showed a wide range in all groups. In seven individuals with a renal graft, all the above functional parameters were monitored at three-month intervals for a period of 24 months. Significant differences in the time courses of Ccr and C(PF) due to marked intra-individual fluctuations were found in tubular creatinine secretion. The findings suggest that the rate of tubular creatinine secretion in the renal graft does not differ significantly from that in individuals with a single native (normally functioning) kidney. However, there are large inter-individual differences. The large intra-individual fluctuations in tubular creatinine secretion in the kidney graft result in significant differences in the time courses of Ccr and C(PF) and a possibility of erroneous evaluation of graft function if based exclusively on Ccr.

Adolescent↗
PubMed1998

[Renal excretion of potassium in individuals with stabilized function of a transplanted kidney].

From previous work it is known that in subjects with a transplanted kidney treated with cyclosporin A hyperkalaemia may develop even if the glomerular filtration rate is within the normal range or only slightly reduced. The mechanism of this defect was not elucidated so far. In the present work the authors try to study the question whether and how renal potassium excretion by the transplanted kidney is influenced by the intensity of sodium excretion. Focused on renal excretion of potassium, sodium, chlorides, all osmotically active substances, glomerular filtration rate (polyfructosan clearance) and renal plasma flow (paraaminohippuric acid clearance) the authors examined 12 patients after transplantation of the kidney from a cadaverous donor (group A), 11 subjects after unilateral nephrectomy for the purpose of donorship for transplantation (group B) and 27 subjects after nephrectomy on account of a pathological process in one kidney (group C). The glomerular filtration rate in the investigated groups was greater than 1.0 ml/s/1.73 m2. The mean value of the fractional potassium excretion (FEK) in group A was 15.2 (+/- 6.3)%, in group B 18.4 (+/- 6.6)% and in group C 20.1 (+/- 8.6)%. The value of FEK in group A was significantly lower than in group C (p < 0.01). Groups B and C did not differ significantly in the mean value of FEK. Between values of FEK and FENA a significant direct correlation was found (r = 0.621, p < 0.001) in the group of subjects with a single kidney of their own (B + C). On the other hand, this correlation was not found in subjects with a transplanted kidney (A). The achieved results support the idea that in subjects with a transplanted kidney treated with cyclosporin A there are deviations in tubular potassium transport even when its serum level is not elevated. This deviation is manifested by lower FEK values and also by and inadequate response of the distal tubule to an increased sodium supply by increased tubular potassium secretion. The authors assume that when drugs with a potential potassium retaining effect are administered to subjects with a transplanted kidney it is important to check carefully the serum potassium level even when the glomerular filtration rate is within normal limits or only slightly reduced.

Adult↗