Renal Functional Reserve in Children with and without Renal Disease

DeSanto, Natale G.; Capasso, Giovambattista; Anastasio, Pietro; Coppola, Salvatore; Policastro, Mariangela; Bellini, Luigi; Siciliano, Antonio

doi:10.1159/000186508

Cited by 10 publications

(7 citation statements)

References 21 publications

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“…We found that our cyclosporine-treated children had a RFR of around 20%, which corresponds rather well to those values reported by DeSanto et al [20] (18% -34%) in healthy children. To our knowledge, a few studies on RFR in cyclosporine-treated children following renal Tx have been published [12,13].…”

Section: Discussionsupporting

confidence: 92%

“…The line of identity is drawn using creatinine clearance for measuring RFR are not reliable, and therefore it may be difficult to compare studies using different methods. This point has also been emphasized by DeSanto et al [20]. In a large study of RFR in healthy children, creatinine clearance was used and only one blood sample was taken, after an OPL [41].…”

Section: Discussionmentioning

confidence: 91%

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Renal functional reserve in transplanted and native single kidneys of children and adults

Englund

Berg

Arfwidson

1997

Pediatric Nephrology

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Renal functional reserve (RFR) after an oral protein load was evaluated in 36 cyclosporine-treated children following kidney transplantation (Tx), in 15 kidney donors (Don), and in 15 children with single kidneys (Nx/Ag). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by clearances of inulin (and creatinine) and para-aminohippurate during water diuresis. Baseline and stimulated GFR and ERPF were determined and RFR was calculated as the difference between stimulated and baseline values. Baseline GFR and ERPF in Tx were lower than in Don and Nx/Ag. Both GFR and ERPF increased significantly in all groups from baseline to stimulated values. RFR GFR was 23% + 3%, 20% + 3% and 15% + 3% in Tx, Don, and Nx/Ag and RFR ERPF 35% + 4% in Tx, which was significantly higher than 20%+4% and 15%+3% in the two other groups respectively. Stimulated GFR and ERPF in Tx correlated with kidney length. No differences were seen in recipient-donor pairs, except for higher fractional increases of ERPF in recipients. There was no correlation between RFR measured by clearance of creatinine and clearance of inulin. In conclusion, cyclosporine-treated children following renal Tx were found to have a renal reserve capacity.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 91%

Renal functional reserve in transplanted and native single kidneys of children and adults

Englund

Berg

Arfwidson

1997

Pediatric Nephrology

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“…The mean RFR in our study (17.10 + 12.08 ml/min/m 2 ) is almost comparable to the study reported by De Santo et al [9,10] (27 + 4 ml/min/m 2 , 39.7 + 5.2 ml/min/m 2 , 24 + 0.9 ml/min/m 2 and 20.1 + 1.13 ml/min/m 2 in four different studies). [7] In the study by Molina et al, [11] the mean value of RFR in school children (60.2 ml/min/m 2 ) was higher than the level of 34 ml/min/m 2 reported in adults by Bosch et al [4] The discrepancy in the study by Molina et al [11] may be due to overestimation of RFR because of the use of a single post-meal serum creatinine for both the pre-meal and post-meal creatinine clearance determination.…”

Section: Discussionsupporting

confidence: 91%

“…Filtration capacity (stimulated maximal GFR) has a high correlation with baseline GFR in the control group (r = 0.643, P = 0.002), and a strong correlation (r = 0.922, p = 0.001) with the study group. Similar results were observed by Anastasio et al [9] in the studies with creatinine clearance and inulin clearance.…”

Section: Figuresupporting

confidence: 90%

“…[7] In the study by Molina et al, [11] the mean value of RFR in school children (60.2 ml/min/m 2 ) was higher than the level of 34 ml/min/m 2 reported in adults by Bosch et al [4] The discrepancy in the study by Molina et al [11] may be due to overestimation of RFR because of the use of a single post-meal serum creatinine for both the pre-meal and post-meal creatinine clearance determination. It should be stressed that in the study by De Santo et al [9] there are many methodological problems that are related to sodium and protein intake as well as quantity and quality of protein load. Also, sodium intake, which is one of the determinants of renal hemodynamic response to meat meal, [12] has not been considered in most of their studies.…”

Section: Discussionmentioning

confidence: 99%

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The role of renal function reserve estimation in children with hydronephrosis

Jindal

Bal

Bhatnagar

2007

J Indian Assoc Pediatr Surg

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Background: Glomerular filtration rate (GFR) is the most widely used indicator of kidney function although it does not invariably reflect the functional status after renal injury. The concept of renal function reserve (RFR) as the ability of the kidney to increase GFR following a protein load was introduced in 1980s. In hydronephrotic children, the acute hemodynamic response to intravenous protein load can cause changes in renal function that are different from changes in normal controls. Materials and Methods: RFR was evaluated in 21 children with hydronephrosis (group I -study group) and in 20 healthy children (group II -control group) by subtracting the baseline GFR from the stimulated GFR following an intravenous protein load. GFR was determined by double compartment-2 plasma sample method using 99m Tc DTPA (diethylenetriamine pentaacetic acid) radioisotope as the filtration agent. Results: The baseline GFR, stimulated GFR and RFR of hydronephrotic children (group I) was found to be significantly lower (P = 0.01, P = 0.001 and P = 0.03 respectively) as compared with healthy normal children (group II). The stimulated GFR shows a strong correlation with the baseline GFR in both the groups, but the RFR shows a high inverse correlation to the baseline GFR in controls and a very low correlation in study group. Conclusion: RFR is preserved in children with hydronephrosis, but it is reduced in comparison to healthy children. However, its clinical utility to unmask the severity of hydronephrosis is limited by the various limiting factors.

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