title: Do clinical symptoms and signs predict reduced renal function among hospitalized adults?
abstract: BACKGROUND
  Reduced renal function manifests as reduced glomerular filtration rate (GFR), which is estimated using the serum creatinine levels. This condition is frequently encountered among hospitalized adults. Renal dysfunction remains clinically asymptomatic, until late in the course of disease, and its symptoms and screening strategies are poorly defined.
  
  
  OBJECTIVE
  We conducted this study to understand if the presence of renal dysfunction related clinical symptom and signs (either alone or in combination) can predict reduced GFR. Further, we aimed to determine if the combination of symptoms and signs are useful for prediction of different levels of reduced GFR.
  
  
  METHODS
  We performed a cross-sectional clinical prediction study and included all consecutive patients admitted to the medical wards of the hospital. We used a renal dysfunction related clinical predictors as index tests and low estimated GFR ([eGFR] < 60 ml/min/1.73 m(2)) as a reference standard. We identified symptoms with a high likelihood ratio (LR) for prediction of low eGFR and constructed different risk score models. We plotted receiver operating curves for each score and used area under the curve (AUC) for comparison. The score with the highest AUC was considered as most discriminant. All statistical analysis was performed using the statistical software STATA (version 11.0, lake drive, Texas, USA).
  
  
  RESULTS
  A total of 341 patients participated in the study. None of the predictor variables had statistically significant LRs for eGFR less than 60 ml/min or eGFR less than 30 ml/min. Positive LRs were significant for prediction of eGFR < 15 ml/min for the presence of hypertension, vomiting pruritis, peripheral edema, hyperpigmentation, peripheral neuropathy and severe anemia. The best predictive model for eGFR less than 15 ml/min/1.73 m(2), included Age > 45 years, the presence of hypertension, vomiting, peripheral edema, hyperpigmentation, and severe anemia and had AUC of 0.82.
  
  
  CONCLUSIONS
  Clinical symptoms and signs are poorly predictive of reduced renal function, except for very low eGFR of less than 15 ml/min/1.73 m(2).
authors.affiliation: Department of Medicine, Jawahar Lal Nehru Medical College, DMIMS, Sawangi, Wardha, Maharashtra, India.
authors.forename: S
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Medicine, All India Institute of Medical Sciences Bhopal, Sewagram, Wardha, Maharashtra, India.
authors.forename: R
authors.initials: R
authors.lastname: Joshi
authors.affiliation: Medical Student, Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha, Maharashtra, India.
authors.forename: V
authors.initials: V
authors.lastname: Joge
keywords: Clinical predictor; Glomerular filtration rate; Renal dysfunction