Clinical Appraisal of Creatinine Clearance as a Measurement of Glomerular Filtration Rate

Bauer, John H.; Brooks, Charles S.; Burch, Rebecca N.

doi:10.1016/s0272-6386(82)80091-7

Cited by 238 publications

(99 citation statements)

References 15 publications

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“…Second, the study did not include information on the concomitant use of drugs, such as trimethoprim or cimetidine (43,44), which can inhibit the tubular secretion of creatinine, although the use of these medications is likely to be rare at the time period of CRIC enrollment. Our results are consistent with prior studies which have reported that CrCl is approximately 10%-30% higher than simultaneously measured GFR (16)(17)(18)(19)45). Third, since there was only one measurement of baseline iGFR and CrCl, we were not able to generate data on within-person CV from CRIC data and had to rely on data from previously published studies.…”

Section: Discussionsupporting

confidence: 86%

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Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Zhang

McCulloch

Lin

et al. 2016

CJASN

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Background and objectives Overestimation of GFR by urinary creatinine clearance (CrCl) at lower levels of GFR has long been attributed to enhanced creatinine secretion. However, this does not take into consideration the contribution of errors in measured GFR (and CrCl) due to short-term biologic variability or test imprecision.Design, setting, participants, & measurements We analyzed cross-sectional data among 1342 participants from the Chronic Renal Insufficiency Cohort study with baseline measurement of GFR by iothalamate clearance (iGFR) and CrCl by 24-hour urine collection. We examined the CrCl/iGFR ratio classified by categories of iGFR and also by categories of CrCl.Results Overall, mean CrCl/iGFR ratio was 1.13. CrCl/iGFR ratio was higher at lower iGFR categories. In contrast, this ratio was lower at lower CrCl levels. We hypothesize these relationships could be due to measurement error, which is bolstered by replicating these trends in a simulation and modeling exercise in which there was no variation in the ratio of CrCl/iGFR with true kidney function but taking into account the effect of measurement error in both CrCl and iGFR (of magnitudes previously described in the literature). In our simulated data, the observed CrCl/iGFR ratio was higher at lower observed iGFR levels when patients were classified by categories of observed iGFR. When the same patients were classified by categories of observed CrCl, the observed CrCl/iGFR ratio was lower at lower observed CrCl levels. ConclusionsThe combined empirical and modeling results suggest that measurement errors (in both CrCl and iGFR) should be considered as an alternative explanation for the longstanding observation that the ratio of CrCl to iGFR gets larger as iGFR decreases.

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Section: Discussionsupporting

confidence: 86%

“…However, available empirical data supporting this notion primarily consist of studies showing that the CrCl/GFR ratio is higher in patients with lower measured GFR than in patients with higher measured GFR (Supplemental Table 1) (16)(17)(18)(19)(20).…”

mentioning

confidence: 99%

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Zhang

McCulloch

Lin

et al. 2016

CJASN

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“…To determine the individual prognosis of a patient with a renal disease, physicians currently make use of functional parameters such as serum creatinine, GFR, proteinuria, and the histologic information obtained from the renal biopsy. Several studies have shown that the current functional measurements are inaccurate as measures of progression in chronic renal failure (1,2). An extensive number of studies have shown that certain histologic changes in the biopsy are associated with an adverse outcome.…”

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confidence: 99%

Renal mRNA Levels as Prognostic Tools in Kidney Diseases

Eikmans¹,

Baelde²,

Hagen

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Molecular biologic techniques are currently considered as new diagnostic and prognostic parameters with a sensitivity and specificity exceeding those of histologic and functional data currently used in clinical practice. The results in various clinical settings have been of limited value up to now. This study is an investigation of the use of tissue levels of RNA determined in routine clinical kidney biopsies as prognostic tools. The focus was on RNA encoding for molecules known to be involved in the pathogenesis of renal disorders. Fresh kidney biopsy tissue was obtained from 52 patients with various renal diseases. The GFR was followed for 12 mo. The extent of glomerulosclerosis and interstitial fibrosis in the biopsies was determined with quantitative digital image analysis. Glomerular and tubulointerstitial compartments from each biopsy specimen were separated, and mRNA levels of TGF-␤, collagen I, collagen IV, and fibronectin were quantitated by real-time PCR. Correlations, along with 95% confidence intervals (CI), between all variables tested at time biopsy were determined. To assess their prognostic value, these variables were correlated with the slope of GFR within several time intervals after biopsy. In addition, to evaluate the predictive value of the variables for outcome in individual patients, differences for each variable were tested between patients showing progressive decline in renal function (slope GFR Ͻ 0) and patients showing stable or improving renal function over time (slope GFR Ն 0). In chronic renal diseases, the extent of histologic damage correlated with the GFR at the time of biopsy (r ϭ Ϫ0.44; CI Ϫ0.68 to Ϫ0.11), but it did not correlate with the slope expressing a change in GFR after the biopsy. Tubulointerstitial TGF-␤ mRNA levels correlated with the rate of change in GFR between time of biopsy and 1 mo later (r ϭ 0.41; CI, 0.07 to 0.67). The GFR at the time of biopsy correlated with the slope of change in GFR between time of biopsy and 12 mo later (r ϭ Ϫ0.50; CI, Ϫ0.73 to Ϫ0.18). In chronic renal diseases, glomerular fibronectin mRNA levels, in comparison with the GFR at time of biopsy, correlated relatively strongly with the slope of change in GFR between 3 and 12 mo (r ϭ 0.50; CI, 0.16 to 0.74). Patients with favorable renal outcome after 12 mo showed significantly higher TGF-␤ mRNA levels and lower proteinuria levels at time of biopsy (P Ͻ 0.05) than patients with a progressive decline in renal function. This study shows that mRNA levels measured in kidney biopsies can function as prognostic tools in human renal diseases. In particular, relatively high levels of tubulointerstitial TGF-␤ mRNA and glomerular fibronectin mRNA are associated with less deterioration in renal function.

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“…This hyperbolic relationship implies that at a GFR close to normal, large changes in GFR correspond with only small changes in cystatin C. Therefore, mild elevation of serum cystatin C as typically seen in renal transplant recipients, may already reflect marked impairment of renal function, leading to overestimation of GFR. Using creatinine clearance as reference method to assess the performance of serum cystatin C and serum creatinine, we are aware that creatinine clearance can result in an inaccurate estimate of GFR [2,22,261. However, good agreement between creatinine clearance and "true" markers of GFR as inulin [3], 1251-iothalamate [16] and 99mTc-DTPA clearance [17,20] at all levels of renal function was reported.…”

Section: Discussionmentioning

confidence: 99%

Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

Herget–Rosenthal¹,

Trabold²,

Huesing³

et al. 2000

Transplant International

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The performance of serum cystatin C as a screening marker of reduced creatinine clearance in renal transplantation was evaluated and compared to serum creatinine. In addition we studied whether cystatin C accurately reflects creatinine clearance over the entire range of transplant function. Serum cystatin C, serum creatinine, and creatinine clearance were measured in 110 adult renal transplant recipients. Cystatin C detected reduced creatinine clearance with the high sensitivity of 95 YO. Serum cystatin C and serum creatinine did not differ regarding 90 and 95 YO sensitivity, derived from the receiver-operating characteristics plot. We demonstrated a strong correlation and linear association between l/cystatin C and creatinine clearance over the entire range of transplant function,

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Clinical Appraisal of Creatinine Clearance as a Measurement of Glomerular Filtration Rate

Cited by 238 publications

References 15 publications

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Measurement Error as Alternative Explanation for the Observation that CrCl/GFR Ratio is Higher at Lower GFR

Renal mRNA Levels as Prognostic Tools in Kidney Diseases

Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

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