[Validity of routinely used methods of testing glomerular filtration in pediatric practice]
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J Stejskal1, J Nováková, V Reitschlägrová
1Dĕtská klinika ILF, Praha.
Insights
Polyfructosan S plasma clearance is a sensitive method for detecting reduced glomerular filtration rate (GFR) in children. Creatinine clearance and the Schwartz formula show good correlation with GFR, especially in advanced renal failure.
Area of Science:
- Pediatric Nephrology
- Renal Physiology
Background:
- Accurate assessment of glomerular filtration rate (GFR) is crucial in pediatric practice.
- Commonly used methods include creatinine clearance and the Schwartz formula.
Purpose of the Study:
- To compare the efficacy of different methods for assessing GFR in children.
- To evaluate polyfructosan S plasma clearance against creatinine clearance and the Schwartz formula.
Main Methods:
- Study included 108 children aged 4-16 years.
- GFR assessed using polyfructosan S plasma clearance, creatinine clearance, and Schwartz formula.
- Patients categorized into three groups based on polyfructosan S clearance levels.
Main Results:
- Creatinine clearance with a one-hour urine collection was most sensitive for detecting mild GFR reduction (50-100 ml/min/1.73 m2).
- Three-hour creatinine clearance and the Schwartz formula showed strong correlation with GFR in chronic renal failure (GFR < 50 ml/min/1.73 m2).
- Polyfructosan S plasma clearance demonstrated high sensitivity across GFR ranges.
Conclusions:
- Polyfructosan S plasma clearance offers advantages for GFR assessment in children.
- The choice of method for GFR assessment may depend on the severity of renal impairment.
- Commonly used methods have varying sensitivity in detecting reduced GFR.
Abstract:
The authors compare different methods used commonly in paediatric practice to assess glomerular filtration (GFR)--creatinine clearance and assessment of GFR by means of Schwartz formula with plasma clearance of polyfructosan S (corresponds to inulin plasma clearance). A group of 108 children aged 4-16 years (x = 10.95) was examined. The patients were divided into three groups by the magnitude of polyfructosan S clearance: greater than 100 ml/min/1.73 m2; 50-100 ml/min/1.73 m2 and less than 50 ml/min/1.73 m2. The authors correlated the clearance of polyfructosan S with creatinine clearance and assessment of GFR according to Schwartz. The method which proved to be most sensitive for detection of reduced GFR in the area of 50-100 ml/min/1.73 m2 was creatinine clearance with urine collection one hour after a previous water load (r = 0.748). In the stage of chronic renal failure with GFR less than 50 ml/min/1.73 m2 the correlation was close with the three-hour creatinine clearance (r = 0.957) and equally close was the correlation with GFR according to Schwartz (r = 0.885). The authors discuss the probability of detection of impaired GFR by commonly used methods and draw attention to the advantages of examination of plasma clearance by polyfructosan S.