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Educational review: measurement of GFR in special populations
Guido Filler1,2,3,4, Misan Lee5
1Department of Pediatrics, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, N6A 5W9, Canada. guido.filler@lhsc.on.ca.
Insights
Estimating kidney function using standard formulas can be misleading in special pediatric populations. Alternative methods are recommended for accurate glomerular filtration rate (GFR) assessment in these groups.
Area of Science:
- Nephrology
- Pediatric Medicine
- Clinical Chemistry
Background:
- Glomerular filtration rate (GFR) estimation is crucial for monitoring kidney function.
- Conventional GFR estimation formulas (e.g., creatinine-based) are population-based and have limitations.
- Special pediatric populations present unique challenges for accurate GFR assessment.
Purpose of the Study:
- To review existing literature on estimating GFR in special pediatric populations.
- To provide recommendations for accurate GFR measurement in these groups.
Main Methods:
- Literature review of studies on GFR estimation in pediatric populations.
- Analysis of factors affecting the reliability of creatinine and cystatin C assays.
- Identification of special populations requiring alternative GFR estimation methods.
Main Results:
- Creatinine-based eGFR is unreliable due to variations in muscle mass, diet, and physiological states.
- Cystatin C is affected by inflammation and protein catabolism, and its availability is limited.
- Neonates, children with wasting disease, obesity, or those undergoing chemotherapy require specialized GFR assessment.
- Bodybuilders and oncology patients may have inaccurately estimated GFR (eGFR) using standard formulas.
Conclusions:
- Clinicians must recognize the limitations of conventional eGFR formulas in special pediatric populations.
- Alternative GFR estimation methods are necessary for accurate assessment in these groups.
- Awareness of these limitations improves patient management and clinical decision-making.
Importance:
Changes in kidney function are typically followed by the sequential estimation of glomerular filtration rate (eGFR). Formulae for eGFR work well on a population basis, but there are well-known conditions where they do not work.
Objective:
The purpose of this review is to summarize the existing literature on special populations in the pediatric age range and provide recommendations on how to estimate GFR in these populations.
Findings:
The reliability of creatinine depends on muscle mass, while cystatin C (not widely available) is limited by inflammation and changes in protein catabolism. Various dietary factors can alter eGFR. Renal function in neonates changes drastically every day, and there are currently no satisfactory reference intervals for routine pediatric use. Gender effects and conditions such as wasting disease and obesity require alternative ways to obtain eGFR. In oncology patients, chemotherapy may negatively affect renal function, and nuclear GFR measurements may be necessary. For body builders, high muscle mass may lead to underestimation of eGFR using creatinine.
Conclusions And Relevance:
Clinicians should be aware of special populations that may yield misleading eGFRs with conventional creatinine-based formulae, and that the alternative methods may be more appropriate for some populations.
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