Comparison of Plasma Clearance of Iohexol and Urinary Clearance of Inulin for Measurement of GFR in Children

Berg, Ulla; Bäck, Rune; Celsi, Gianni; Halling, Stella Edström; Homberg, Inger; Krmar, Rafael T.; Monemi, Kajsa Åsling; Öborn, Helena; Herthelius, Maria

doi:10.1053/j.ajkd.2010.07.013

Cited by 53 publications

(47 citation statements)

References 22 publications

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“…Urine creatinine was calculated based on the mean of two 24-hour urine collections. Renal function was estimated using creatinine clearance (CrCl) (9), which has recently been shown to be more accurate in children with GH than eGFR calculated by the Schwartz formula eGFR (10,11). GH was defined as CrCl Ն140 ml/min per 1.73 m 2 , which is the GH criteria used in diabetic children (12).…”

Section: Patient Selectionmentioning

confidence: 99%

Glomerular Hyperfiltration and Renal Progression in Children with Autosomal Dominant Polycystic Kidney Disease

Helal¹,

Reed²,

McFann³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The purpose of this study was to determine whether glomerular hyperfiltration (GH) occurring early in autosomal dominant polycystic kidney disease (ADPKD) is indicative of more rapid disease progression in children.Design, setting, participants, & measurements One hundred eighty children with ADPKD (ages 4 to 18 years) with normal renal function were examined by renal ultrasound. Renal volume was calculated using a standard formula for a modified ellipsoid. Creatinine clearance was calculated from serum creatinine and 24-hour urine creatinine. GH was defined as creatinine clearance Ն140 ml/min per 1.73 m 2 .Results Thirty-two children had GH (mean age 11.4 Ϯ 3.6 years) and 148 had normal renal function (mean age 10.8 Ϯ 3.9 years). Patients with GH at baseline demonstrated an increased rate of total renal volume growth (␤: rate of change ϭ ϩ19.3 Ϯ 10.8 cm 3 /year) over 5 years compared with those without GH at baseline (␤ ϭ Ϫ4.3 Ϯ 7.7 cm 3 /year), P ϭ 0.008. Those with GH at baseline experienced a faster decline in creatinine clearance in subsequent years (␤ ϭ Ϫ5.0 Ϯ 0.8 ml/min per 1.73 m 2 per year) compared with those without GH at baseline (␤ ϭ ϩ1.0 Ϯ 0.4 ml/min per 1.73 m 2 per year), P Ͻ 0.0001. ConclusionsThis study revealed that occurrence of GH in ADPKD children is associated with a significantly faster decline in renal function and higher rate of kidney enlargement over time. GH combined with the increased renal volume may therefore be used as an early marker for a more severe progression of ADPKD in children.

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Section: Patient Selectionmentioning

confidence: 99%

Glomerular Hyperfiltration and Renal Progression in Children with Autosomal Dominant Polycystic Kidney Disease

Helal¹,

Reed²,

McFann³

et al. 2011

Clinical Journal of the American Society of Nephrology

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“…Blood samples were collected before iohexol infusion for hematocrit, serum Cr, iohexol blank, and CysC. GFR was measured by a twopoint iohexol plasma disappearance analysis using a onecompartment model approximation validated in both children and adults (19,20). After a time-zero blood sample was obtained, patients received a 5-ml intravenous injection of iohexol from a preweighed syringe (Omnipaque 300 GE Healthcare Amersham Division, Princeton, NJ).…”

Section: Iohexol Determination Of Gfrmentioning

confidence: 99%

“…In three participants, a finger-prick method was used to place blood on filter paper. GFR was computed from the iohexol dose divided by the area under the disappearance curve and scaled for body surface area of 1.73 m 2 (19,20). All blood samples were collected in serum separator tubes, inverted 5-10 times, and allowed to clot before being centrifuged at 3000 rpm (11873g) for 10 minutes.…”

Section: Iohexol Determination Of Gfrmentioning

confidence: 99%

Estimating GFR in Adult Patients with Hematopoietic Cell Transplant

Hingorani

Pao

Schoch

et al. 2015

Clinical Journal of the American Society of Nephrology

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Background and objectives Formal evaluation of kidney function before and after hematopoietic cell transplant is important to determine conditioning regimens, type of transplant, and medication dosing. Serum creatinine and estimating equations may not accurately assess kidney function.Design, study, participants, & measurements Existing estimating equations for GFR were compared with an iohexol measure of GFR in a prospective cohort study of 50 patients undergoing hematopoietic cell transplant and subsequent care at the Fred Hutchinson Cancer Research Institute from 2009 to 2013. Patients underwent iohexol GFR, serum creatinine, and cystatin C determination at baseline and day 100 posthematopoietic cell transplant. Iohexol GFR measurements were compared with the CKD Epidemiology Collaboration, Inker CKD Epidemiology Collaboration cystatin C with and without serum creatinine, Modification of Diet in Renal Disease, and Cockcroft-Gault estimating equations using Bland-Altman analysis and McNemar's test. The iohexol measurements were also compared with blood samples collected simultaneously on filter paper.Results Mean differences between iohexol GFR and eGFR on the basis of Bland-Altman analyses ranged from 220.6 to +15.4 ml/min per 1.73 m 2 at baseline and 212.7 to +12.9 ml/min per 1.73 m 2 at day 100. The CKD Epidemiology Collaboration and Modification of Diet in Renal Disease estimating equations classified 64% of patients with a GFR,90 at baseline compared with 38% by iohexol GFR (P=0.003 and P,0.01, respectively). No statistically significant differences were seen at day 100. The filter paper GFR had a mean difference of 0 at baseline and 5.9 at day 100. Additionally, 21%-37% and 57%-89% of eGFRs were within 10% and 30%, respectively, of the iohexol GFR at baseline, and 16%-34% and 72%-84% were within 10% and 30%, respectively, of the iohexol GFR at day 100; 98% of the filter paper estimates at baseline were within 30%, and 46% were within 10% of iohexol GFR.Conclusions The estimating equations are neither accurate nor precise in the hematopoietic cell transplant population, and clinical decision may require measurement of GFR.

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“…Az iohexol ígéretesebb, bár vannak hátrányai (jódaller-giában nem használható, lehetséges tubularis reabszorpció, fehérjekötődés). Ezek ellenére alkalmasak a klinikum számára és a GFR nyomon követésére [7,19,20]. Az "arany standardokkal" mért GFR-hez viszonyítva is eltérőek voltak a vélemények.…”

Section: Megbeszélésunclassified

Comparison of seven estimated glomerular filtration rate equations in kidney patients

Kovács

Sárváry

Remport³

2013

Orvosi Hetilap

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Bevezetés: Krónikus vesebetegségben elengedhetetlen a glomerulusfi ltrációs ráta ismerete, mivel annak mértéke határozza meg a stádiumokat, és iránymutató a kezelés szempontjából. Célkitűzés: A szerzők két, a standardizált kreatininen, valamint öt immunturbidimetriás cisztatin-C-meghatározáson alapuló becsült glomerulusfi ltrációs ráta egyenletét vizsgálták. Módszer: Az analitok és az egyenletek eloszlását, kapcsolataikat, a becsült glomerulusfi ltrációs ráták közötti különbségeket és stádiumbesorolásaikat tanulmányozták. Eredmények: A cisztatin-C-képletek több beteget soroltak az 1-es stádiumba, míg a kreatinines képletek a 2-es, 3-as és 4-esbe. Az 5. stádiumba a Grubb1-, Grubb2-és Larsson-képletek több, míg a Tan-és Sjöström-képletek kevesebb beteget soroltak, mint a kreatinines képletek. Legjobban a Grubb1-és Grubb2-egyenletek stádiumbesorolásai hasonlítottak egymásra. A 3-5. stádiumok legritkábban a Sjöström-képlet esetében fordultak elő. Következtetések: A különböző képletekkel számolt becsült glomerulusfi ltrációs ráták szignifi kánsan befolyásolhatják a stádiumbeosztást, így a betegek kezelését és kilátásaik becslését is. Orv. Hetil., 2013, 154, 415-425. Kulcsszavak: kreatinin, cisztatin-C, becsült glomerulusfi ltrációs ráta, krónikus vesebetegség Comparison of seven estimated glomerular fi ltration rate equations in kidney patientsIntroduction: The degree of glomerular fi ltration rate determines the stages of chronic renal disease and, therefore, knowledge on its estimation is essential. Aims: Two standardized creatinine based estimated glomerular fi ltration rate equations and fi ve equations based on the immunoturbidimetric determination of cystatin C were compared. Methods: The distribution of the analytes and the equations, their relations, as well as the differences among the estimated glomerular fi ltration rates and their chronic kidney disease stages assignments were studied. Results: The equations based on cystatin C classifi ed more patient into stage 1, while the creatinine based ones more into stages 2, 3 and 4. The equations published as Grubb1, Grubb2 and Larsson classifi ed more patients while the equations created by Tan and Sjöström classifi ed fewer into stage 5 compared to the creatinine based equations. The equations of Grubb1 and Grubb2 resulted in the most similar stage assignment. The occurence of stages between 3 and 5 was the lowest using the equation of Sjöström. Conclusions: The different equations for the estimation of glomerular fi ltration rate modify signifi cantly the chronic kidney disease stage assignment which may have an infl uence on the treatment and outcome measures of the patients. Orv. Hetil., 2013, 154, 415-425.

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Comparison of Plasma Clearance of Iohexol and Urinary Clearance of Inulin for Measurement of GFR in Children

Cited by 53 publications

References 22 publications

Glomerular Hyperfiltration and Renal Progression in Children with Autosomal Dominant Polycystic Kidney Disease

Glomerular Hyperfiltration and Renal Progression in Children with Autosomal Dominant Polycystic Kidney Disease

Estimating GFR in Adult Patients with Hematopoietic Cell Transplant

Comparison of seven estimated glomerular filtration rate equations in kidney patients

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