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Feasibility of estimating glomerular filtration rate in children using single-sample adult technique
1Department of Nuclear Medicine, Saint Pierre Hospital, Free University of Brussels, Belgium.
Insights
Adult methods for estimating pediatric 51Cr-EDTA renal clearance are unreliable, even with body surface correction. Specific pediatric methods are necessary for accurate measurements in children.
Area of Science:
- Pediatric Nephrology
- Pharmacokinetics
- Biomedical Measurement
Background:
- Accurate estimation of renal clearance is crucial for pediatric patient management.
- Specific pediatric methods for estimating 51Cr-EDTA renal clearance are established.
- Adult methods may offer a simpler alternative if validated for pediatric use.
Purpose of the Study:
- To evaluate the efficacy of adult single-sample methods in estimating pediatric 51Cr-EDTA renal clearance.
- To determine if body surface area correction improves the accuracy of adult methods in children.
- To compare adult method performance against established pediatric methods.
Main Methods:
- 90 children (0.1-15 years) underwent 51Cr-EDTA clearance measurement.
- Four approaches were used: specific pediatric methods (120-min plasma) and adult methods (240-min plasma).
- Methods were applied with and without body surface area (BSA) correction (1.73 m2).
Main Results:
- Specific pediatric methods showed high correlation irrespective of BSA correction.
- Adult methods yielded erroneous values, with some improvement after BSA correction.
- BSA-corrected adult method results showed only fair correlation with pediatric methods.
Conclusions:
- Adult single-sample techniques, even with BSA correction, are not interchangeable with pediatric methods for 51Cr-EDTA clearance.
- Specific pediatric methods remain essential for accurate pediatric renal clearance estimation.
Unlabelled:
This work was undertaken to verify whether a single-sample adult technique, when applied using body surface-corrected plasma concentration, can be used in place of specific pediatric method to estimate 51Cr-EDTA renal clearance in children.
Methods:
In a series of 90 children (aged 0.1 to 15 yr). 51Cr-EDTA renal clearance was calculated using for different approaches. The first approach used specific pediatric single-sample methods; three techniques were chosen and they all used 120-min plasma concentration. The second approach used the same three specific pediatric methods, but they were applied using 120-min plasma concentration prescaled for 1.73 m2 body surface area. The third approach used single-sample methods designed for adults; three methods were again chosen. They all used 240-min plasma concentration. The fourth approach used the same adults algorithms, but they were applied using 240-min plasma concentration prescaled for 1.73 m2 body surface area.
Results:
Clearances calculated using the three specific pediatric methods were all closely cross-correlated regardless of whether or not the plasma concentration was prescaled. The use of classical adult methods produced in some cases obviously erroneous clearance values. Improvements were observed when the same adult methods were applied using prescaled plasma concentration. Nonetheless, the clearance values obtained only fairly correlated with those obtained using specific pediatric methods.
Conclusion:
The single-sample adult technique using plasma concentration prescaled for 1.73 m2 body surface area cannot be used in place of a specific pediatric single-sample method to estimate 51Cr-EDTA renal clearance in children.