Assessment of kidney function in children by enzymatic determination of 2- or 24-h creatinine clearance: comparison with inulin clearance

Uemura, Osamu; Nagai, Takuhito; Yamakawa, Satoshi; Kaneko, Tetsuji; Hibi, Yoshiko; Yamasaki, Yasuhito; Yamamoto, Masaki; Nakano, Masaru; Iwata, Naoyuki; Hibino, Satoshi

doi:10.1007/s10157-015-1166-3

Cited by 9 publications

(10 citation statements)

References 25 publications

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“…Generally, because pediatric nephrologists perform the Cin test using the standard method, in this study, we measured the Cin in pediatric patients (aged < 18 years) with CKD stage 2 or 3 using a similar method. In addition, with reference to the previous study [ 11 ], we verified that 2-h Ccr overestimated Cin by at least 1.2-fold, and confirmed the safety of inulin in pediatric patients.…”

Section: Introductionsupporting

confidence: 86%

“…The following secondary endpoints were set: 2-h Ccr measured at the same time as Cin and eGFR calculated from sCre, sCys-C, and sBMG measured at the same time as Cin. The sCre, sCys-C and sBMG-based eGFR were calculated using the formulas shown below [9,[12][13][14] According to the result of the previous study [11], the 2.5th percentile value of Ccr/Cin in pediatric patients with CKD stage 2 was 1.19. Therefore, the primary endpoint criterion for this study was set to 1.2 to confirm that the 2.5th percentile value of Ccr/Cin for this study was higher than 1.19.…”

Section: Efficacy Endpointsmentioning

confidence: 99%

“…Members of the Japanese Society for Pediatric Nephrology conducted a clinical study to investigate any discrepancies between Cin measured by the standard method and 2-hour Ccr (2-h Ccr) measured at the same time [ 11 ]. They reported that the median 2-h Ccr and Cin in pediatric patients with renal disease was 121.6 and 74.0 mL/min/1.73 m 2 , respectively, and found that 2-h Ccr may overestimate Cin by approximately 1.5-fold, regardless of the GFR value.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of inulin clearance with 2-h creatinine clearance in Japanese pediatric patients with renal disease: open-label phase 3 study of inulin

et al. 2021

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Background There is no approved dosage and administration of inulin for children. Therefore, we measured inulin clearance (Cin) in pediatric patients with renal disease using the pediatric dosage and administration formulated by the Japanese Society for Pediatric Nephrology, and compared Cin with creatinine clearance (Ccr) measured at the same time. We examined to what degree Ccr overestimates Cin, using the clearance ratio (Ccr/Cin), and confirmed the safety of inulin in pediatric patients. Methods Pediatric renal disease patients aged 18 years or younger were enrolled. Inulin (1.0 g/dL) was administered intravenously at a priming rate of 8 mL/kg/hr (max 300 mL/hr) for 30 min. Next, patients received inulin at a maintenance rate of 0.7 × eGFR mL/min/1.73 m2 × body surface area (max 100 mL/hr) for 120 min. With the time the maintenance rate was initiated as a starting point, blood was collected at 30 and 90 min, while urine was collected twice at 60-min intervals. The primary endpoint was the ratio of Ccr to Cin (Ccr/Cin). Results Inulin was administered to 60 pediatric patients with renal disease; 1 patient was discontinued and 59 completed. The primary endpoint, Ccr/Cin, was 1.78 ± 0.52 (mean ± standard deviation). Regarding safety, five adverse events were observed in four patients (6.7%); all were non-serious. No adverse reactions were observed in this study. Conclusions The results in this study on the dosage and administration of inulin showed that inulin can safely and accurately determine GFR in pediatric patients with renal disease. ClinicalTrials.gov identifier NCT03345316.

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Section: Introductionsupporting

confidence: 86%

Section: Efficacy Endpointsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comparison of inulin clearance with 2-h creatinine clearance in Japanese pediatric patients with renal disease: open-label phase 3 study of inulin

et al. 2021

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“…In addition, 24‐h creatinine clearance (24hCcr) was calculated from plasma samples and 24‐h urinary Cr within 3 days of the iGFR measurement. The eGFR‐24hCcr was calculated as 24hCcr multiplied by 0.76 33 . Serum CysC values were evaluated through a particle‐enhanced immunonephelometric analysis (Nittobo Medical Co. Ltd., Fukushima, Japan) using BioMajesty automated analyzer just before the iGFR measurement.…”

Section: Methodsmentioning

confidence: 99%

Assessment of kidney function using inulin‐based and estimated glomerular filtration rates before and after allogeneic hematopoietic stem cell transplantation in pediatric patients

Matsuoka

Hirabayashi

Murase

et al. 2020

Pediatric Blood & Cancer

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Background: Accurate evaluation of kidney function before and after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is important for both informed decision making and detection of chronic kidney disease. However, to the best of our knowledge, no report has evaluated the glomerular filtration rate (GFR) in pediatric patients who underwent HSCT using the gold standard GFR measurement, as well as inulin-based GFR (iGFR). Methods: We assessed iGFR before and after allo-HSCT to evaluate the impact of allo-HSCT on GFR in a prospective cohort study of 17 pediatric patients. We also assessed the accuracy and bias of the values of estimated GFR (eGFR) calculated using serum creatinine (Cr), cystatin C (CysC), beta-2 microglobulin (β 2 MG), 24-h creatinine clearance (24hCcr), and the full chronic kidney disease in children (CKiD) index that combines Cr, CysC, and blood urea nitrogen-based equations with iGFR as a reference to identify the most reliable equation for GFR. Results: There was no significant difference between the values before and after allo-HSCT. CKiD CysC-, 24hCcr-, and full CKiD-based values showed good within 30% (P30) accuracy (80.6%, 79.3%, and 80.6%, respectively), but only 24hCcr and full CKiD had good mean bias (8.5% and 8.9%, respectively) and narrow 95% limits of agreement (−32.2 to 52.7 mL/min/1.73 m 2 and −29.3 to 47.4 mL/min/1.73 m 2 , respectively) compared with the corresponding iGFR. Conclusion: There was no significant impact of allo-HSCT on GFR in our cohort. The most reliable equations for pediatric patients with allo-HSCT were eGFR-24hCcr and eGFR-full CKiD.

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“…Cin was performed using the method standardized for Japanese pediatric patients [1]. Ccr-based eGFR was calculated based on 24-h Ccr, using the formula 24-h Ccr-based eGFR = 0.764 × 24-h Ccr [15]. Cr-based eGFR, cysC-based eGFR, and β2MG-based eGFR were calculated as described [1,3,4].…”

Section: Evaluation Of Kidney Functionmentioning

confidence: 99%

Influence of thyroid function on glomerular filtration rate and other estimates of kidney function in two pediatric patients

Uemura

Iwata²,

Nagai³

et al. 2018

CEN Case Rep

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To determine the optimal method of evaluating kidney function in patients with thyroid dysfunction, this study compared the estimated glomerular filtration rate derived from serum creatinine, cystatin C, or β2-microglobulin with inulin or creatinine clearance in two pediatric patients, one with hypothyroidism and the other with hyperthyroidism. It was observed that the kidney function decreased in a hypothyroid child and enhanced in a hyperthyroid child, with their kidney function becoming normalized by treatment with drugs, which normalized their thyroid function. Kidney function cannot be accurately evaluated using cystatin C-based or β2-microglobulin-based estimated glomerular filtration rate in patients with thyroid dysfunction, as these tests overestimated glomerular filtration rate in a patient with hypothyroidism and underestimated glomerular filtration rate in a patient with hyperthyroidism, perhaps through a metabolic rate-mediated mechanism. In both our patients, 24-h urinary creatinine secretion was identical before and after treatment, suggesting that creatinine production is not altered in patients with thyroid dysfunction. Therefore, kidney function in patients with thyroid dysfunction should be evaluated using creatinine-based estimated glomerular filtration rate.

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Assessment of kidney function in children by enzymatic determination of 2- or 24-h creatinine clearance: comparison with inulin clearance

Cited by 9 publications

References 25 publications

Comparison of inulin clearance with 2-h creatinine clearance in Japanese pediatric patients with renal disease: open-label phase 3 study of inulin

Comparison of inulin clearance with 2-h creatinine clearance in Japanese pediatric patients with renal disease: open-label phase 3 study of inulin

Assessment of kidney function using inulin‐based and estimated glomerular filtration rates before and after allogeneic hematopoietic stem cell transplantation in pediatric patients

Influence of thyroid function on glomerular filtration rate and other estimates of kidney function in two pediatric patients

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