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Assessment of renal function: selected developments.

F V Flynn1

  • 1Department of Chemical Pathology, University College Hospital, London, England.

Clinical Biochemistry
|February 1, 1990
PubMed
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Reliable kidney function tests are crucial. For glomerular filtration rate (GFR), 51Cr-EDTA clearance is recommended over creatinine clearance. For tubular damage, retinol-binding protein and N-acetyl-beta-D-glucosaminidase are suggested.

Area of Science:

  • Nephrology
  • Clinical Chemistry
  • Biomarker Discovery

Background:

  • Accurate assessment of kidney function, including glomerular filtration rate (GFR) and renal tubular damage, is vital for patient management.
  • Current methods for GFR assessment, such as creatinine clearance, have limitations and are prone to errors.
  • Detecting tubular damage often relies on measuring urinary biomarkers, but their reliability varies.

Purpose of the Study:

  • To critically review established and novel tests for assessing GFR.
  • To evaluate biomarkers for detecting acute and chronic renal tubular damage.
  • To recommend reliable methods for clinical use in nephrology.

Main Methods:

  • Review of existing literature on GFR and renal tubular damage assessment methods.

Related Experiment Videos

  • Analysis of the accuracy and limitations of creatinine clearance and plasma creatinine for GFR estimation.
  • Evaluation of urinary biomarkers including low molecular weight proteins (beta-2-microglobulin, retinol-binding protein, alpha-1-microglobulin), enzymes (N-acetyl-beta-D-glucosaminidase, alanine aminopeptidase), and tissue proteins (adenosine-deaminase-binding protein).

    • Main Results:

    • Creatinine clearance is unreliable for GFR assessment; plasma creatinine offers a rough estimate.
    • 51Cr-EDTA clearance is recommended as a reliable method for measuring GFR.
    • For chronic tubular malfunction, retinol-binding protein or alpha-1-microglobulin are preferred over unstable beta-2-microglobulin.
    • Urinary N-acetyl-beta-D-glucosaminidase or alanine aminopeptidase are most useful for early detection of acute tubular damage.
    • Adenosine-deaminase-binding protein shows potential for early detection of renal allograft rejection.

    Conclusions:

    • Specific biomarkers offer improved accuracy for assessing GFR and detecting renal tubular damage compared to traditional methods.
    • Recommended tests include 51Cr-EDTA clearance for GFR, retinol-binding protein/alpha-1-microglobulin for chronic tubular issues, and N-acetyl-beta-D-glucosaminidase/alanine aminopeptidase for acute tubular damage.
    • Adenosine-deaminase-binding protein is a promising marker for monitoring renal allograft status.