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Area of Science:

  • Nephrology
  • Biomarker analysis
  • Diagnostic methods

Background:

  • Kidney function assessment is crucial for diagnosing and treating chronic kidney disease (CKD).
  • Estimated glomerular filtration rate (eGFR) using creatinine or cystatin C is widely used but can be inaccurate due to patient-specific factors like body composition and inflammation.
  • Inaccurate eGFR necessitates consideration of measured glomerular filtration rate (mGFR) for reliable kidney function assessment.

Purpose of the Study:

  • To highlight the limitations of eGFR in specific patient populations.
  • To introduce measured glomerular filtration rate (mGFR) as a more accurate alternative.
  • To discuss various mGFR methods and their current standing in clinical practice.

Main Methods:

  • Review of existing literature on kidney function assessment methods.
  • Comparison of endogenous biomarkers (creatinine, cystatin C) used in eGFR with exogenous biomarkers used in mGFR.
  • Discussion of plasma iohexol clearance as a standardized mGFR method and other techniques like iothalamate clearance and transdermal measurements.

Main Results:

  • eGFR estimations are frequently compromised by individual patient characteristics, leading to potential diagnostic and treatment errors.
  • Measured GFR (mGFR) methods, particularly plasma iohexol clearance, provide more accurate kidney function assessment by utilizing exogenous biomarkers.
  • While plasma iohexol clearance is internationally standardized, other mGFR methods exist with varying degrees of validation and clinical acceptance.

Conclusions:

  • For patients susceptible to inaccurate eGFR, mGFR is essential for precise kidney function evaluation.
  • Plasma iohexol clearance represents the most accepted and standardized mGFR method currently available.
  • Ongoing development of novel GFR measurement techniques, such as transdermal methods, requires further validation before widespread clinical adoption.