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      Formula-Derived Prediction of the Glomerular Filtration Rate from Plasma Creatinine Concentration

      , ,

      Nephron

      S. Karger AG

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          Most cited references 5

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          Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis.

          Several studies carried out in a limited number of patients demonstrated a wide range of overestimation of glomerular filtration rate (GFR) by serum creatinine level and creatinine clearance (Ccr) in liver disease. We simultaneously evaluated Ccr, inulin clearance, and predicted GFR calculated from serum creatinine level in 56 cirrhotic patients. Inulin clearance was considered the gold standard for GFR evaluation. The sensitivity of serum creatinine level, predicted GFR, and Ccr in detecting renal failure was 18.5%, 51%, and 74%, respectively. On the basis of inulin clearance, patients were divided into two groups: those with normal GFR (mean, 106 +/- 34 mL/min per 1.73 m2) (group 1, 29 patients) and those with reduced GFR (mean, 56 +/- 19 mL/min per 1.73 m2) (group 2, 27 patients). Predicted GFR and Ccr were accurate markers of GFR in group 1 patients, while both overestimated GFR by about 50% in group 2 patients. An increased tubular secretion of creatinine accounted for the disparity between Ccr and inulin clearance in these patients. Our results indicate that renal failure is greatly underestimated on the basis of serum creatinine level and Ccr in cirrhotic patients. Clinical implications of this observation include excessive dosage of potentially nephrotoxic drugs and failure to recognize renal impairment induced by such medical treatments as diuretic therapy or paracentesis.
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            Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment.

            The aim of this study was to define cut-off values for serum creatinine as an indicator of several levels of renal impairment. To identify the suitable values, receiver operating characteristic curves were constructed based on the data of 984 laboratory assessments of renal function. The glomerular filtration rate was measured with inulin clearance. Three levels of renal impairment were analyzed. An index that gave the same weight to false positive and false negative results was used to determine the thresholds. Robustness of the results was tested using a "bootstrap" technique. Considering an inulin clearance of less than 80 ml/min/1.73 m2, the cut-off value for serum creatinine was 11.5 mumol/liter for men and 90 mumol/liter for women. The cut-off value for a clearance of less than 60 ml/min/1.73 m2 was 137 mumol/liter for men and 104 mumol/liter for women. For a clearance of less than 30 ml/min/1.73 m2, the cut-off value was 177 mumol/liter for men and 146 mumol/liter for women. This method is useful to determine a cut-off value for serum creatinine in epidemiological studies concerning early chronic renal failure screening. The value of the glomerular filtration rate of reference and the weight of false positive and false negative results have to be adapted to the aim of the individual study design.
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              Difficulties in estimating glomerular filtration rate in the elderly.

              Estimates of glomerular filtration rate are generally obtained by measuring or estimating endogenous creatinine clearance. However, it may sometimes be difficult to obtain the necessary urine collections. Most of 19 healthy, reliable elderly outpatients were found unable to provide satisfactory 24-hour urine collections. To judge whether formulas estimating creatinine clearance from serum creatinine levels are reliable, we also compared 24-hour creatinine clearances measured in 50 inpatients with values calculated by the Cockroft-Gault equation. Only a moderate correlation was found, which may be unacceptable in the clinical situations for which the equation is used, such as drug dosing. For reasons including uncertainties in the validity of predictive formulas and unreliability of urine collections, we conclude that no acceptable method now exists for bedside estimation of glomerular filtration rate and that drug levels should be measured whenever possible in elderly patients and in those with renal insufficiency.
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                Author and article information

                Journal
                NEF
                Nephron
                10.1159/issn.1660-8151
                Nephron
                S. Karger AG
                1660-8151
                2235-3186
                2002
                August 2002
                15 July 2002
                : 91
                : 4
                : 547-558
                Affiliations
                Department of Internal Medicine and Nephrology of the Academic Medical Center, University of Amsterdam, The Netherlands
                Article
                65012 Nephron 2002;91:547–558
                10.1159/000065012
                12138254
                © 2002 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                Page count
                Tables: 3, References: 145, Pages: 12
                Product
                Self URI (application/pdf): https://www.karger.com/Article/Pdf/65012
                Categories
                Editorial Review

                Cardiovascular Medicine, Nephrology

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