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Published on: May 10, 2013
Estimating and measuring glomerular filtration rate in children
Dana F Work1, George J Schwartz
1Department of Pediatrics, University of Rochester School of Medicine, Rochester, New York 14618, USA.
Insights
Accurately measuring glomerular filtration rate (GFR) in children is crucial for kidney function assessment. Iohexol plasma clearance is recommended for precise GFR measurement, while new formulas improve estimations for clinical use.
Area of Science:
- Pediatric Nephrology
- Renal Function Assessment
- Biomarker Discovery
Background:
- Glomerular filtration rate (GFR) is the primary indicator of kidney function in children.
- Declining GFR can be an early sign of renal disease, necessitating timely intervention.
- Accurate GFR measurement guides medication dosing, fluid management, and prevention of end-stage renal failure.
Purpose of the Study:
- To review current methods for determining GFR in pediatric populations.
- To discuss recent advancements in GFR measurement and estimation techniques.
- To highlight the clinical importance of accurate GFR assessment in children.
Main Methods:
- Discusses iohexol plasma disappearance as a practical method for GFR measurement.
- Compares iohexol clearance with traditional creatinine-based estimations (e.g., Schwartz formula).
- Explores the development of new GFR estimating equations using multiple endogenous markers.
Main Results:
- Iohexol plasma clearance offers a practical and accurate alternative to inulin for GFR measurement in children.
- Creatinine-based formulas remain useful for bedside estimations but have limitations.
- Newer formulas incorporating cystatin C, albumin, and blood urea nitrogen aim to enhance GFR estimation precision.
Conclusions:
- Iohexol plasma clearance is the preferred method for accurate GFR measurement in children.
- Advanced estimating equations utilizing multiple biomarkers are emerging for routine clinical application.
- Accurate GFR determination is indispensable, especially in pediatric patients with altered body composition.
Purpose Of Review:
Glomerular filtration rate is the best determinant of kidney function in children. A decline in glomerular filtration rate may be the only sign of renal disease. A knowledge of glomerular filtration rate allows the clinician to appropriately dose medications, administer fluids, and intervene early to prevent end-stage renal failure. The aim of this review is to discuss the current options for determining glomerular filtration rate in children and the latest advances in research on this topic.
Recent Findings:
Owing to the limited availability of inulin, the gold standard for measuring glomerular filtration rate, and the concern for using radioactivity, the plasma disappearance of iohexol has been utilized to measure glomerular filtration rate in children, and this represents a practical option for glomerular filtration rate determination in both clinical and research studies. By contrast, creatinine-based estimates of glomerular filtration rate (e.g. Schwartz formula) are more practical for bedside use. To improve their precision, recent formulas have incorporated the use of additional endogenous markers, such as cystatin C, albumin, and blood urea nitrogen.
Summary:
Iohexol plasma clearances should be used to accurately measure glomerular filtration rate in children. New estimating equations with multiple endogenous markers are being developed for everyday clinical use. However, at present, there is no substitute for an accurate glomerular filtration rate determination, particularly in children with conditions affecting muscle mass or body habitus.
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