GENERAL FINANCIAL RULES OF THE CENTRAL GOVERNMENT. VOLUME 1. CHAPTER 1 INTRODUCTORY. 1. The rules contained in this. General Financial Rules, came into force from 1st July replacing the General financial. Rules mentioned in the previous set (GFR, ) have. any, outside GeM, relevant GFRRules shallapply. (vi) TheMinistries/ Departmentsshallwork out their procurementrequirementsof. Goods and Serviceson either.
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General Financial Rules (GFRs) are a compendium of general provisions General Financial Rules, have evolved as a result of the wide. General Financial Rules, Language English. Subject: General Financial Rules, Upload English Pdf for table structure: PDF icon Download The file . 9, General Financial Rules, , Download ( KB) application/pdf, 7 Sep 10, Laying of the Table of the House Annual Report and Audited Accounts .
Based on information from references 3 and 12 through Consequently, detection and quantitation of proteinuria are essential to the diagnosis and treatment of chronic kidney disease. Reducing proteinuria with an angiotensin-converting enzyme ACE inhibitor or an angiotensin-II receptor blocker ARB slows the progression of chronic kidney disease in patients with or without diabetes. Albumin, the predominant protein excreted by the kidney in most types of renal disease, is detected readily by urine dip-stick testing. In some conditions, immunoglobulins also may be excreted in urine. The protein-creatinine ratio in an early-morning random urine sample correlates well with hour urine protein excretion and is much easier to obtain.
Early detection of renal damage may help to delay the process.
As these processes are slow, kidney damage rarely occurs in the first 10 years of diabetes, and 15 to 25 years will usually pass before kidney failure occurs. For people who live with diabetes for more than 25 years without any signs of kidney failure, the risk of ever developing it decreases. Tubular proteinuria results when glomerular function is normal but the proximal tubules have diminished absorbing capacity. Table 1 The various tests for chronic tubular dysfunction in diabetic nephropathy Test name Blood urea nitrogen serum or plasma Initial diagnosis of acute or chronic kidney disease Method: Spectrophotometry Initial diagnosis of acute or chronic kidney disease Method: Spectrophotometry May be used as a screening test Method: Immunoturbidimetric Useful in diabetic patients to assess baseline renal function Useful in monitoring diabetic nephropathy in insulin-dependent diabetes mellitus Creatinine based glomerular filtration rate estimated Estimate renal function and use as monitoring tool Method: Spectrophotometry Test reports serum creatinine reference intervals Cystatin-C based glomerular filtration rate estimated May be useful sensitive marker of renal disease; however, test lacks specificity due to reference range inavailability Method: Nephelometry May be used as a marker for early diabetic nephropathy.
These substances are normal metabolic waste products that are excreted by the kidneys. Urea is a byproduct of protein breakdown.
A test can be done to measure the amount of urea nitrogen in the blood. In kidney disease, these substances as well as numerous others are not excreted normally, and so they accumulate in the body thus causing an increase in blood levels of urea. Creatinine Serum creatinine is primarily a metabolite of creatine, almost all of which is located in skeletal muscle.
The normal level of creatinine is 0. Females usually have a lower creatinine 0. The amount of creatine per unit of skeletal muscle mass is consistent and the breakdown rate of creatine is also consistent. Thus, plasma creatinine concentration is very stable and a direct reflection of skeletal muscle mass[ 18 ]. Interestingly, Nobuko Harita et al[ 19 ], hypothesized that, lower serum creatinine is associated with an increased risk of type 2 diabetes, which might reflect a lower volume of skeletal muscle.
Skeletal muscle is a major target tissue of insulin and a lower volume of skeletal muscle would mean fewer target sites for insulin which causes increase in insulin resistance. This leads to the development of type 2 diabetes[ 20 ]. This may explain in part the pathogenesis of type 2 diabetes associated with lower serum creatinine.
GFR measures the rate at which the kidneys' two million glomeruli filter plasma in order to process it and remove waste products from it. If the kidneys are injured by chronic kidney disease, the GFR gradually declines, and the amount of remaining kidney function can be estimated by measuring or calculating the GFR. Creatinine clearance: Creatinine clearance requires a 24 h urine collection.
A blood sample is drawn at some point during the 24 h period, and creatinine clearance, can then be calculated. However, because a small amount of creatinine is released by the filtering tubes in the kidneys, creatinine clearance is not exactly the same as the GFR. In fact, creatinine clearance usually overestimates the GFR, particularly in patients with advanced kidney failure.
There are several factors that may interfere with the accuracy of the test. These include: 1 Incomplete urine collection; 2 Pregnancy; and 3 Vigorous exercise.
Creatinine clearance measurements can also be affected by drugs, such as: cimetidine, trimethoprim, and drugs that can damage the kidneys cephalosporins. The creatinine clearance test should only be done for patients who are medically stable.
Other patients may have a rapidly changing creatinine clearance, and therefore any result may be inaccurate. It is anticipated that this process will aid early identification and therefore improve longterm outcomes for those with diabetic nephropathy. The American Diabetes Association recommends estimation of glomerular filtration rate by eGFR in millilitres per min per 1. This is expressed as: 1.
However, despite validation in chronic kidney disease, eGFR has limitations in patients with preserved kidney function. These equations do have recognized limitations, including a tendency to significantly underestimate higher levels of GFR[ 29 ]. In obese patients with established kidney disease, the Cockcroft-Gault equation overestimates GFR while underestimating GFR in lean subjects, possibly due to increasing weight; while performance of the MDRD equation in such patients is consistent regardless of weight.
Bias of the Cockcroft-Gault formula was most pronounced in lean subjects, diminishing with increasing body weight. Conversely, bias of the MDRD equation increased with increasing body weight[ 31 ].
In obese patients, excess body weight is mainly adipose tissue, whereas creatinine is primarily generated by muscle. In the Cockcroft-Gault equation, body weight is proportional to GFR; therefore, increasing body weight without a proportional increase in creatinine generation will tend to increase the estimation of GFR.
An algorithm for detecting proteinuria and microalbuminuria is provided in Figure 1. Algorithm for proteinuria and microalbuminuria screening in the patient with risk factors for chronic kidney disease.
Adapted with permission from National Kidney Foundation. Am J Kidney Dis ;39 2 suppl 1 :S1— Evaluation for Proteinuria and Microalbuminuria Figure 1. The value of screening for microalbuminuria has been questioned in patients who already are receiving ACE-inhibitor therapy 26 on the basis that the results are unlikely to change management.
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Glomerular filtration rate GFR describes the flow rate of filtered fluid through the kidney. View or download all content the institution has subscribed to. Established in , J.
Last Update: Usage Frequency. The equation was re- expressed in. GfrFull description. Glory gfr user manual Download gfr manual.
In daily clinical practice creatinine clearance is used as marker of glomerular filtration rate GFR. Recommend Documents. Earned Leave can be ordinarily combined with the following. Rumus Menghitung GFR. Under the editorial leadership of Dr. This test measures how well your kidneys work to filter waste products from your body.
Conversely, the new edition of the GAAFR aims to facilitate easy access to specific topics through the use of shorter, more narrowly focused chapters.
Estimating GFR from plasma creatinine measurements. Pierre Ronco Paris, France , KI is one of the most cited journals in nephrology and widely regarded as the world' s premier journal on the. General Financial Rules, have evolved as a result of the wide. Biological relevance. Rele hubung tanah.