Glomerular filtration rate (GFR) in children can be estimated by the formula GFR=k x BH/Pcr (where BH is body height in centimetres and Pcr is the plasma creatinine concentration in micromoles per litre). For k, several values have been reported: k=38 (Counahan), k=40 (Morris) and k=48.7 (Schwartz). In this study the predictive performance of these formulae was compared with that of newly developed formulae. GFR measurements based on inulin concentration time curves were divided into an index (n=58) and a validation data set (n=48). In the index data set a value for k was derived by application of nonlinear mixed-effect modelling. This approach was also used to develop a formula that better explained the relationship between patient factors and GFR. Bias and precision of all formulae were calculated for the validation data set. In the index data set a value of 41.2 was found for k, which was close to the value k=40 (Morris). Both formulae estimated GFR well (bias <5%; precision 25%). Further modelling of the relationship between patient factors and GFR did not improve the predictive performance. In our hospital GFR was best estimated by the formula with k=40 and k=41.2. It is recommended that the optimal value for k be assessed locally.
The reference method to determine the glomerular filtration rate (GFR) in children is the urinary clearance of inulin during a continuous intravenous infusion. Alternatively, the plasma clearance of inulin can be determined, which does not require urine collection. This study compared the determination of the inulin plasma clearance in 24 pediatric patients by two methods: the single injection and the continuous infusion method. In the single injection method 5000 mg/m(2) inulin was administered as bolus injection, and blood samples were drawn 10, 30, 90, and 240 min after administration. For the continuous infusion method inulin was started overnight and blood samples were collected the next day. The inulin plasma clearance determined by the single injection method was on average 9.7 ml min(-1) 1.73 m(-2) higher than the clearance determined with the continuous infusion method (95% CI: 5.3-14.2). The difference between the two methods was smaller at lower GFRs. The difference in results generated by the two methods in children is small and is considered acceptable in clinical practice. For practical reasons, the single injection method with minimum sampling is preferred.
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