How Measuring Glomerular Filtration Rate? Comparison of Reference Methods

Delanaye, Pierre

doi:10.5772/25770

Cited by 10 publications

(7 citation statements)

References 187 publications

(151 reference statements)

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“…We identified 13 different methods to evaluate GFR. Against the gold standard evaluation, which is inulin clearance, precision and accuracy of creatinine clearance, isotope clearance, and formulas greatly vary (17). This is especially true with high GFR values or high filtration fraction (18).…”

Section: Discussionmentioning

confidence: 99%

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Cachat

Combescure

Cauderay³

et al. 2015

Clinical Journal of the American Society of Nephrology

158

138

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Background and objectives Evaluation of glomerular hyperfiltration (GH) is difficult; the variable reported definitions impede comparisons between studies. A clear and universal definition of GH would help in comparing results of trials aimed at reducing GH. This study assessed how GH is measured and defined in the literature.Design, setting, participants, & measurements Three databases (Embase, MEDLINE, CINAHL) were systematically searched using the terms "hyperfiltration" or "glomerular hyperfiltration". All studies reporting a GH threshold or studying the effect of a high GFR in a continuous manner against another outcome of interest were included.Results The literature search was performed from November 2012 to February 2013 and updated in August 2014. From 2013 retrieved studies, 405 studies were included. Threshold use to define GH was reported in 55.6% of studies. Of these, 88.4% used a single threshold and 11.6% used numerous thresholds adapted to participant sex or age. In 29.8% of the studies, the choice of a GH threshold was not based on a control group or literature references. After 2004, the use of GH threshold use increased (P,0.001), but the use of a control group to precisely define that GH threshold decreased significantly (P,0.001); the threshold did not differ among pediatric, adult, or mixedage studies. The GH threshold ranged from 90.7 to 175 ml/min per 1.73 m 2 (median, 135 ml/min per 1.73 m 2 ).Conclusion Thirty percent of studies did not justify the choice of threshold values. The decrease of GFR in the elderly was rarely considered in defining GH. From a methodologic point of view, an age-and sex-matched control group should be used to define a GH threshold.

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Section: Discussionmentioning

confidence: 99%

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Cachat

Combescure

Cauderay³

et al. 2015

Clinical Journal of the American Society of Nephrology

158

138

View full text Add to dashboard Cite

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“…A detailed overview of all exogenous GFR markers that have been studied is also out of scope for this manuscript and have been reviewed elsewhere. 1,37,38 A recent review specifically surveyed the literature and presented the validity of different markers for kidney clearance and/or plasma disappearance. 39 Two common clinical X-ray contrast media iothalamate and iohexol are currently the most commonly used filtration markers to measure GFR, we will direct most attention to these markers below.…”

Section: Exogenous Gfr Markersmentioning

confidence: 99%

Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective

Seegmiller

Eckfeldt

Lieske

2018

Advances in Chronic Kidney Disease

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The assessment of kidney function is a cornerstone in the clinical management and health of the patient. Although the kidneys perform many physiologic functions and are essential for maintaining homeostasis, kidney function is typically evaluated, quantitated, and understood using the glomerular filtration rate (GFR). Although GFR can be directly measured using a variety of externally administered glomerular filtration markers, in general practice, the GFR is usually estimated (eGFR) using endogenous markers that are cleared primarily by kidney filtration. Common situations exist where the GFR needs to be measured (mGFR) in order to proceed with care. This manuscript will review laboratory challenges in the assessment of GFR. Key points to consider when implementing a mGFR testing protocol are the following: marker selection, clearance methodology (urinary vs solely plasma measurements of filtration marker), sample collection, number of samples to collect, staff required, and analytical measurement technology for the filtration marker selected. We suggest those wanting to implement mGFR testing examine site-specific institutional resources along with patient population and proceed with the approaches best suited for their clinical needs and laboratory resources available.

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“…8 Recent reviews have identified chromium 51 ( 51 Cr)–EDTA, iothalamate, or iohexol as reasonably accurate methods for measuring GFR, if inulin clearance is not possible, and have delineated some of their limitations. 9–11 Unfortunately, these techniques and the adaptations that followed remain cumbersome and expensive and require a prolonged time for sample processing, and thus are not clinically practical. Therefore, physicians base diagnostic and therapeutic decisions in millions of patients daily primarily using a surrogate marker of GFR, the patient’s serum creatinine (Scr) concentration.…”

Section: Understanding and Quantifiying Gfr As A Measure Of Kidney Fumentioning

confidence: 99%

Rethinking CKD Evaluation: Should We Be Quantifying Basal or Stimulated GFR to Maximize Precision and Sensitivity?

Molitoris

2017

American Journal of Kidney Diseases

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Chronic kidney disease (CKD) remains an increasing clinical problem. Although clinical risk factors and biomarkers for development and progression of CKD have been identified, there is no commercial surveillance technology to definitively diagnose and quantify the severity and progressive loss of glomerular filtration rate (GFR) in CKD. This has limited the study of potential therapies to late stages of CKD when FDA-registerable events are more likely. Since patient outcomes, including the rate of CKD progression, correlate with disease severity, and effective therapy may require early intervention, being able to diagnose and stratify patients by their level of decreased kidney function early on is key for translational progress. In addition, renal reserve, defined as the increase in GFR following stimulation, may improve the quantification of GFR based solely on basal levels. Various groups are developing and characterizing optical measurement techniques utilizing new minimally invasive or non-invasive approaches for quantifying basal and stimulated kidney function. This development has the potential to allow widespread individualization of therapy at an earlier disease stage. Therefore, the purposes of this review are to suggest why quantifying stimulated GFR, by activating renal reserve, may be advantageous in patients and review fluorescent technologies to deliver patient-specific GFR.

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How Measuring Glomerular Filtration Rate? Comparison of Reference Methods

Cited by 10 publications

References 187 publications

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

A Systematic Review of Glomerular Hyperfiltration Assessment and Definition in the Medical Literature

Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective

Rethinking CKD Evaluation: Should We Be Quantifying Basal or Stimulated GFR to Maximize Precision and Sensitivity?

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