Precision of Estimating Equations for GFR in Children with a Solitary Functioning Kidney

Westland, Rik; Abraham, Yael; Bökenkamp, Arend; Stoffel‐Wagner, Birgit; Schreuder, Michiel F.; Wijk, J. A. E. van

doi:10.2215/cjn.07870812

Cited by 38 publications

(33 citation statements)

References 44 publications

(43 reference statements)

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“…In a study focused on children with a solitary functioning kidney, the authors employed six eGFR equations based on Scr, Scys, and a combination of both variables, and found the combined formula, Schwartz et al (2012), had superior precision. 23 For clinical practice, we need to identify the most accurate eGFR equation that can be applied to a diverse pediatric patient population. In adults, there are several, large studies capable of validating the accuracy of eGFR equations.…”

Section: Discussionmentioning

confidence: 99%

Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance

Deng

Finer

Haymond

et al. 2015

Translational Research

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Estimates of glomerular filtration rate (eGFR) have become popular in clinical medicine as an alternative to measuring GFR (mGFR) but there are few studies comparing them in clinical practice. We determined mGFR by iohexol clearance in 81 consecutive children in routine practice and calculated eGFR from 14 standard equations using serum creatinine, cystatin C, and urea nitrogen that were collected at the time of the mGFR procedure. Non-parametric Wilcoxon test, Spearman Correlation, Bland–Altman analysis, bias (median difference) and accuracy (P15, P30) were used to compare mGFR to eGFR. For the entire study group, the mGFR was 77.9±38.8mL/min/1.73 m2. Eight of the 14 estimating equations demonstrated values without a significant difference from the mGFR value and demonstrated a lower bias in Bland–Altman analysis. Three of these eight equations based on a combination of creatinine and cystatin C, (Schwartz et al. 2009, 2012; Chehade et al.), had the highest accuracy with approximately 60% of P15 and 80% of P30. In 10 patients with a single kidney, seven with kidney transplant, and 11 additional children with short stature, values of the three equations had low bias and no significant difference when compared with mGFR. In conclusion, the three equations that employed cystatin C, creatinine, and growth parameters performed in a superior manner over univariate equations based on either creatinine or cystatin C, and also had good applicability in specific pediatric patients with single kidneys, those with a kidney transplant, and/or short stature. Thus, we suggest that eGFR calculations in pediatric clinical practice employ only a multivariate equation.

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Section: Discussionmentioning

confidence: 99%

Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance

Deng

Finer

Haymond

et al. 2015

Translational Research

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“…Ambulatory BP measurement to monitor for hypertension is the preferred method in children and adults (55), whereas microalbuminuria should be measured in a first morning void (56). GFR in children can be estimated by the commonly used Schwartz equation, which has been shown to be precise in children with a solitary functioning kidney (57). The follow-up of children with a solitary functioning kidney, but without signs of renal injury, can be performed by the general pediatrician, whereas patients with renal injury and early CKD may require clinical visits by a pediatric nephrologist.…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of the Solitary Functioning Kidney

Westland

Schreuder

Goudoever

et al. 2014

Clinical Journal of the American Society of Nephrology

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Congenital anomalies of the kidney and urinary tract are the major cause of ESRD in childhood. Children with a solitary functioning kidney form an important subgroup of congenital anomalies of the kidney and urinary tract patients, and a significant fraction of these children is at risk for progression to CKD. However, challenges remain in distinguishing patients with a high risk for disease progression from those patients without a high risk of disease progression. Although it is hypothesized that glomerular hyperfiltration in the lowered number of nephrons underlies the impaired renal prognosis in the solitary functioning kidney, the high proportion of ipsilateral congenital anomalies of the kidney and urinary tract in these patients may further influence clinical outcome. Pathogenic genetic and environmental factors in renal development have increasingly been identified and may play a crucial role in establishing a correct diagnosis and prognosis for these patients. With fetal ultrasound now enabling prenatal identification of individuals with a solitary functioning kidney, an early evaluation of risk factors for renal injury would allow for differentiation between patients with and without an increased risk for CKD. This review describes the underlying causes and consequences of the solitary functioning kidney from childhood together with its clinical implications. Finally, guidelines for follow-up of solitary functioning kidney patients are recommended.

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“…As the accuracy of the creatinine-based equations is limited when GFR decreases, follow-up using a combined serum cystatin C/creatinine-based equation is recommended, if available [35,36]. Investigation of SFK in deceased individuals is advised in order to allow a retrospective classification of SFK patients into groups according to the number of nephrons per kidney.…”

Section: Discussionmentioning

confidence: 99%

Solitary Functioning Kidney in Children - A Follow-Up Study

Kolvek

Podracká

Rosenberger

et al. 2014

Kidney Blood Press Res

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Background/Aims: This study aims to assess the cumulative incidence of elevated albuminuria, hypertension and decreased estimated glomerular filtration rate (eGFR) to identify possible renal injury in children with SFK. Methods: Forty-two children with SFK (23 boys; 27 congenital) were included in a prospective follow-up study. Blood pressure, albuminuria and eGFR were assessed repeatedly and the cumulative incidence rate of various forms of renal injury, overall and by type of etiology, were evaluated. Finally, renal injury-free survival was analyzed. Results: Mean follow-up was until age 11.3 years (SD 6.3 years). During follow-up, 16 (38.1%) patients met the criteria for renal injury, defined as hypertension (10; 23.8%), severely increased albuminuria (3; 7.1%) and a significantly impaired eGFR (<60ml/min/1.73m²) (5; 11.9%) and/or use of antihypertensive or antiproteinuric medication (11; 26.2%). Children with CAKUT in SFK had a significantly higher incidence of renal injury. The median time to develop renal injury was 12.8 years. Conclusion: A substantial proportion of children with SFK develop renal injury during childhood, especially those with CAKUT in the SFK. Therefore, close follow-up of albuminuria, blood pressure and eGFR are warranted to identify chronic kidney disease in its early stages.

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Precision of Estimating Equations for GFR in Children with a Solitary Functioning Kidney

Cited by 38 publications

References 44 publications

Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance

Applicability of estimating glomerular filtration rate equations in pediatric patients: comparison with a measured glomerular filtration rate by iohexol clearance

Clinical Implications of the Solitary Functioning Kidney

Solitary Functioning Kidney in Children - A Follow-Up Study

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