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Renal function studies in man with advanced renal insufficiency

J H Bauer, C S Brooks, R N Burch

    American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation
    |July 1, 1982
    PubMed
    Summary

    The average of creatinine and urea clearances is a useful clinical indicator of glomerular filtration rate (GFR) in patients with advanced renal insufficiency. This method proved more accurate than individual clearance measurements for assessing GFR.

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    Area of Science:

    • Nephrology
    • Renal Physiology

    Background:

    • Advanced renal insufficiency necessitates accurate assessment of glomerular filtration rate (GFR).
    • The combined average of creatinine and urea clearances is commonly used as a surrogate for GFR in clinical practice.

    Purpose of the Study:

    • To evaluate the accuracy of using the average of creatinine and urea clearances ((Ccr + Cur)/2) as an indicator of GFR.
    • To compare the reliability of individual creatinine clearance (Ccr) and urea clearance (Cur) with inulin clearance (Cin) in subjects with impaired renal function.

    Main Methods:

    • Simultaneous timed measurements of inulin clearance (Cin), creatinine clearance (Ccr), and urea clearance (Cur) were performed.
    • The study included 31 subjects with an inulin clearance (Cin) below 20 ml/min/1.73 m2.

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    Main Results:

    • Creatinine clearance (Ccr) and urea clearance (Cur) both showed positive correlations with inulin clearance (Cin).
    • The fractional excretion of urea (Cur/Cin) demonstrated a negative correlation with Cin, and in some cases, exceeded 1, suggesting tubular secretion.
    • The average of creatinine and urea clearances ((Ccr + Cur)/2) exhibited the strongest positive correlation with Cin, identifying it as the best clinical indicator of GFR.

    Conclusions:

    • The average of creatinine and urea clearances is a reliable and the best available clinical indicator for estimating glomerular filtration rate (GFR) in patients with advanced renal insufficiency.
    • Individual measurements of creatinine and urea clearance may be less accurate due to factors like tubular secretion, particularly at very low GFR levels.