PMID- 31195248
OWN - NLM
STAT- MEDLINE
DCOM- 20190729
LR  - 20190729
IS  - 1872-6283 (Electronic)
IS  - 0379-0738 (Linking)
VI  - 301
DP  - 2019 Aug
TI  - Post-mortem diagnosis of kidney impairment: An experimental study.
PG  - 271-277
LID - S0379-0738(18)30946-0 [pii]
LID - 10.1016/j.forsciint.2019.05.034 [doi]
AB  - The determination of the role that drugs may have played in a death is an 
      important part of the investigation into unexplained deaths. Renal impairment may 
      lead to a reduction in drug excretion rate and therefore an accumulation of drugs 
      or metabolites, leading to possible toxic or lethal effects. Creatinine levels 
      are known to be stable in the post mortem period and in life can give an 
      indication of kidney function. There are however widely reported limitations when 
      using creatinine in isolation and so we investigated the usefulness of using 
      estimated glomerular filtration rate (eGFR) for scoring an individual as having 
      renal impairment using the Chronic Kidney Disease Epidemiology Collaboration 
      (CKD-EPI) formula. We analysed unpreserved vitreous for creatinine in 812 
      individuals using an isotope dilution mass spectrometry (ID-MS) traceable 
      enzymatic. We found that the biochemical analysis of post mortem vitreous 
      creatinine and subsequent calculation of eGFR is a useful adjunct to the standard 
      testing that takes place during a post-mortem examination and can assist in death 
      investigation. Using an eGFR of <60 mL/min/1.73 m(2) gave a sensitivity of 94.3% 
      and specificity of 97.3% when scoring an individual as having renal impairment. 
      We therefore recommend the calculation of eGFR for the determination of possible 
      renal impairment in post mortem investigations. It is, of course, always 
      pertinent to interpret any results using a wealth of case information. Extreme 
      caution should be exercised in cases where insufficient clinical 
      information/history is available, particularly in cases in which there is 
      suspected diabetic ketoacidosis, dehydration or hospitalisation prior to death.
CI  - Copyright (c) 2019 Elsevier B.V. All rights reserved.
FAU - Maskell, Peter D
AU  - Maskell PD
AD  - School of Science, Engineering and Technology, Abertay University, Dundee, DD1 
      1HG, UK. Electronic address: p.maskell@abertay.ac.uk.
FAU - Penney, Elizabeth
AU  - Penney E
AD  - School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK.
FAU - Smith, Paul R
AU  - Smith PR
AD  - Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, 
      Leicester, LE1 5WW, UK.
FAU - Hikin, Laura J
AU  - Hikin LJ
AD  - Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, 
      Leicester, LE1 5WW, UK.
FAU - Morley, Stephen R
AU  - Morley SR
AD  - Forensic Toxicology Service, University Hospitals of Leicester NHS Trust, 
      Leicester, LE1 5WW, UK.
LA  - eng
PT  - Journal Article
DEP - 20190524
PL  - Ireland
TA  - Forensic Sci Int
JT  - Forensic science international
JID - 7902034
RN  - 0 (Biomarkers)
RN  - AYI8EX34EU (Creatinine)
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Biomarkers/metabolism
MH  - Creatinine/*metabolism
MH  - Female
MH  - Forensic Toxicology
MH  - *Glomerular Filtration Rate
MH  - Humans
MH  - Male
MH  - Mass Spectrometry/methods
MH  - Middle Aged
MH  - Renal Insufficiency/*diagnosis
MH  - Sensitivity and Specificity
MH  - Vitreous Body/*metabolism
MH  - Young Adult
OTO - NOTNLM
OT  - Creatinine
OT  - Death investigation
OT  - Renal impairment
OT  - eGFR
EDAT- 2019/06/14 06:00
MHDA- 2019/07/30 06:00
CRDT- 2019/06/14 06:00
PHST- 2018/10/23 00:00 [received]
PHST- 2019/04/04 00:00 [revised]
PHST- 2019/05/17 00:00 [accepted]
PHST- 2019/06/14 06:00 [pubmed]
PHST- 2019/07/30 06:00 [medline]
PHST- 2019/06/14 06:00 [entrez]
AID - S0379-0738(18)30946-0 [pii]
AID - 10.1016/j.forsciint.2019.05.034 [doi]
PST - ppublish
SO  - Forensic Sci Int. 2019 Aug;301:271-277. doi: 10.1016/j.forsciint.2019.05.034. 
      Epub 2019 May 24.