A Comparison of GFR Estimation Formulae in Pediatric Oncology

Rechenauer, Tobias; Zierk, Jakob; Gräfe, Daniel; Rascher, Wolfgang; Rauh, Manfred; Metzler, Markus

doi:10.1055/a-0587-5753

Cited by 4 publications

(6 citation statements)

References 30 publications

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“…Some meta-analyses have reported that CysC is superior to creatinine as a marker of renal function (34,35) . Cystatin C is eliminated mainly by glomerular filtration, correlates with GFR, and it is very sensitive even in mildly impaired kidney function so some studies have suggested it as an ideal GFR marker in pediatric oncology (36) . The validation of the Schwartz formula and the calculations based on serum CysC was done in several studies by comparing them to nuclear scanning methods, which suggest that they are closely correlated to GFR (37)(38)(39) .…”

Section: Discussionmentioning

confidence: 99%

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

Erdem¹,

Emir²,

Çakar³

et al. 2021

BUCH

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Objective: Increased survival rates in childhood cancers have led the researchers to focus on long-term side effects and possible risk factors for late nephrotoxicity related to the treatment regimens applied. Our aim is to evaluate drug-induced nephrotoxicity in survivors of childhood cancer and to investigate the compatibility of creatinine clearance with the estimated glomerular filtration rate. Methods: The presence of glomerular and tubular dysfunction has been screened among 59 childhood cancer survivors who had completed their treatment regimens with cisplatin, carboplatin, ifosfamide, and /or high dose methotrexate. Results: The mean age of patients was 10.7±5.5 years (2.5-23), and mean follow-up time was 2.6±2.1 years (0.5-8). Renal dysfunction was detected in 65% of the patients. The most prevalent manifestation of renal dysfunction was decreased glomerular filtration rate (n: 19, 32.2%), and increased urinary β2-microglobulin excretion (n: 12, 20.4%), followed by microalbuminuria (n: 6, 10.1%). Survivors treated with combined chemotherapy regimens (cisplatin, carboplatin, ifosfamide) had significantly lower tubular reabsorption of phosphate than those treated with high dose of methotrexate. The glomerular filtration rate analysis was performed using different methods, and a moderate correlation (r=0.563, p=0.00) was found between estimated glomerular filtration rates calculated according to cystatin-C-based equations and Schwartz formula. Conclusion: Childhood cancer survivors demonstrated a high frequency of renal complications in the current study. We have shown that the calculation of the estimated glomerular filtration rate using the Schwartz formula or cystatin-C-based equations is compatible with the creatinine clearance in this specific patient group. In survivors of childhood cancer who cannot perform 24-hour urine collection, determination of estimated glomerular filtration rate is a more practical approach.

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Section: Discussionmentioning

confidence: 99%

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

Erdem¹,

Emir²,

Çakar³

et al. 2021

BUCH

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“…Likewise the CysC-based GFR calculation using Chronic Kidney Disease Epidemiology Collaboration GFR calculation with age 2012 (CKD-EPI) GFR Eq. ( 2012), which is an excellent and reliable way to assess renal function in pediatric patients [23,[25][26][27].…”

Section: Biological Parametersmentioning

confidence: 99%

The role of urinary N-acetyl-β-D-glucosaminidase in early detection of acute kidney injury among pediatric patients with neoplastic disorders in a retrospective study

et al. 2022

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Background The 1-year cumulative incidence of AKI reportedly is high (52%) in pediatric neoplastic disorders. About half of these events occur within 2 weeks. However, subclinical AKI episodes may remain unrecognized by the conventional creatinine-based approaches. We investigated the diagnostic value of urinary N-acetyl-β-D-glucosaminidase (uNAG) as an early marker of acute kidney injury (AKI). Methods In our retrospective study, 33 children with neoplastic disorders were inculded who had serial uNAG tests (at least 5 samples/patient) with a total of 367 uNAG measurements. Renal function was determined by cystatin-C and creatinine based GFR, and relative increase of uNAG index (uNAGRI). We focused on detecting both clinical and subclinical AKI episodes (according to Biomarker-Guided Risk Assessment using pRIFLE criteria and /or elevated uNAG levels) and the incidence of chronic kidney damage. Results Sixty episodes in 26 patients, with positivity at least in one parameter of kidney panel, were identified during the observation period. We detected 18/60 clinical and 12/60 subclinical renal episodes. In 27/60 episodes only uNAG values was elevated with no therapeutic consequence at presentation. Two patients were detected with decreased initial creatinine levels with 3 „silent” AKI. In 13 patients, modest elevation of uNAG persisted suggesting mild, reversible tubular damage, while chronic tubuloglomerular injury occurred in 5 patients. Based on ROC analysis for the occurence of AKI, uNAGRI significantly indicated the presence of AKI, the sensitivity and specificity are higher than the changes of GFRCreat. Serial uNAG measurements are recommended for the reduction of the great amount of false positive uNAG results, often due to overhydratation. Conclusion Use of Biomarker-guided Risk Assessment for AKI identified 1.5 × more clinical and subclinical AKI episodes than with creatinine alone in our pediatric cancer patients. Based on the ROC curve for the occurence of AKI, uNAGRI has relatively high sensitivity and specificity comparable to changes of GFRCysC. The advantage of serial uNAG measurements is to decrease the number of false positive results. Trial registration The consent to participate is not applicable because it was not reqired for ethical approval and it is a retrospectiv study.

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“…2,7 Glomerular filtration rate (GFR) is best marker for assessment of renal function and its decrease correlate with loss of function of nephrons and degree of kidney failure. 8,9 For measurement of GFR commonly used methods are inulin clearance, EDTA clearance and iohexol and 24hour creatinine clearance (Ccrl). 10 Glomerular filtration rate assessment by inulin, EDTA clearance and iohexol is cumbersome and is not routinely done in clinical settings.…”

Section: Introductionmentioning

confidence: 99%

“…24hours Crcl requires 24hours urine collection which is also not feasible especially in young children for routine use of GFR measurement. 8 Glomerular filtration rate estimation (eGFR) formulae have been developed for assessment of kidney function and there are variety of GFR formulas available for clinical use. eGFR formulas based on serum creatinine have been used since long and are most commonly employed for GFR monitoring at bed side among which most commonly used is Schwartz formula.…”

Section: Introductionmentioning

confidence: 99%

“…eGFR formulas based on serum creatinine have been used since long and are most commonly employed for GFR monitoring at bed side among which most commonly used is Schwartz formula. 7,8,11 In 2012, KDIGO (kidney disease: Improving Global Outcomes) also recommended use of Updated Schwartz formula for estimation of GFR in children. 12 Though there are new reports of more efficacy by using cystatin C (CysC) based equations, but in oncology patients, it has limitation as corticosteroid therapy affects CysC levels in dose dependant manner and in children using steroids, eGFR may be underestimated.…”

Section: Introductionmentioning

confidence: 99%

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Correlation of Glomerular Filtration Rate (Gfr) Estimation Formulae With Measured GFR in Pediatric Oncology Patients

Pervez

Anjum²,

Bibi³

et al. 2022

J Ayub Med Coll Abbottabad

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Background: In patients with malignancy accurate assessment of renal function is important for administration of chemotherapeutic medicines. Measurement of GFR by inulin, EDTA clearance, iohexol and 24 hrs urinary creatinine clearance (Crcl) is cumbersome so creatinine based GFR formulas have been developed for assessment of kidney function and there are variety of GFR formulas available for clinical use. Objective was to determine the correlation of estimated GFR by creatinine-based estimation formulae with measured GFR by 24-hours creatinine clearance. Methods: A cross sectional study was conducted in which all patients who underwent measured GFR (mGFR) assessment at Oncology Unit of NICH between 1st January to 31st December 2019 were enrolled in the study. Estimated Glomerular filtration rate (eGFR) of all these patients was calculated by three formulae Original Schwartz (OS), Updated Schwartz (US) and simple height independent equation (SHID). Correlation was made with mGFR by Crcl taken as gold standard using Pearson’s correlation and Linear regression analysis. Bland Altman analysis was also done to see the agreement between eGFR with mGFR. Results: Total sixty (60) patients were enrolled with mean age of 8.2±3.6 years. All three eGFR formulae exhibited a statistically significant positive correlation with mGFR (p-value <0.01). Linear regression analysis also showed a statistically significant relation between mGFR and eGFRs however, the developed regression models for all three formulae showed a low R2 values. Bland-altman analysis revealed that useful level of agreement does not exist between mGFR and eGFR by OS however, SHID and US were found to be in agreement with mGFR by Crcl. Conclusion: SHID and US equations give a good estimate of GFR and may be used in children with malignancies to estimate GFR.

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A Comparison of GFR Estimation Formulae in Pediatric Oncology

Cited by 4 publications

References 30 publications

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

Examination of Nephrotoxicity in Survivors of Childhood Cancer and Comparison of Methods for Estimating Glomerular Filtration Rate

The role of urinary N-acetyl-β-D-glucosaminidase in early detection of acute kidney injury among pediatric patients with neoplastic disorders in a retrospective study

Correlation of Glomerular Filtration Rate (Gfr) Estimation Formulae With Measured GFR in Pediatric Oncology Patients

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