Determination of Glomerular Filtration Rate in Advanced Renal Insufficiency

Jagenburg, Rudolf; Po, Attman; Aurell, Mattias; Bucht, H

doi:10.3109/00365597809179980

Cited by 83 publications

(51 citation statements)

References 10 publications

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“…The GFR was determined as the plasma or renal clearance of 51 Cr-EDTA [19]. The renal clearance method was used when the GFR was below 20 ml/min/1.73 m 2 BSA.…”

Section: Methodsmentioning

confidence: 99%

The Plasma Levels of Homocysteine Are Elevated in Moderate Renal Insufficiency but Do Not Predict the Rate of Progression

Samuelsson¹,

Lee²,

Attman³

et al. 1999

Nephron

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Background: Chronic renal failure is characterized by specific alterations of the lipoprotein metabolism. It is also characterized by elevated plasma levels of total homocysteine (tHcy). Hyperhomocysteinemia has been shown to be a risk factor for atherosclerosis in both the general population and in patients with end-stage renal disease. Aim: To analyze whether elevated tHcy levels also may contribute to a higher rate of progression of renal insufficiency in patients with moderately advanced renal failure. Methods: To investigate whether tHcy concentrations are associated with an accelerated rate of progression of renal insufficiency, we have correlated baseline plasma concentrations of tHcy with the progressive decline of renal function in an observational study of human chronic renal disease. Results: Sixty-three nondiabetic patients (49 men, 14 women) were studied as part of an observational study of patients with moderately advanced renal insufficiency. The average follow-up time of the patient population was 3.0 years, and the mean rate of decline in glomerular filtration rate (⁵¹Cr- EDTA clearance) was –3.2 ± (SD) 3.9 ml/min × 1.73 m² body surface area. The mean plasma concentration of tHcy at the beginning of the study was 28.3 ± 12.0 µmol/l. Plasma tHcy concentrations correlated significantly with the glomerular filtration rate (r = –0.32, p < 0.01). However, there was no association between the initial plasma level of tHcy and the rate of progression as assessed by linear regression analysis (r = 0.02; NS). In contrast, increased levels of apolipoprotein B, low-density lipoprotein cholesterol, and proteinuria were all significantly associated with a more rapid decline in renal function. Conclusions: Patients with moderately advanced chronic renal insufficiency have elevated plasma levels of homocysteine. The tHcy plasma levels increase in parallel with the degree of reduction in renal function. However, the hyperhomocysteinemia is not prospectively associated with a higher rate of progression of the renal functional impairment. Hence, there is no indication that elevated homocysteine levels play a contributing role for an accelerated glomerulosclerotic process.

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“…The GFR was determined as the plasma or renal clearance of 51 Cr-EDTA [19]. The renal clearance method was used when the GFR was below 20 ml/min/1.73 m 2 BSA.…”

Section: Methodsmentioning

confidence: 99%

The Plasma Levels of Homocysteine Are Elevated in Moderate Renal Insufficiency but Do Not Predict the Rate of Progression

Samuelsson¹,

Lee²,

Attman³

et al. 1999

Nephron

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show abstract

“…51 Cr-EDTA: For the 51 Cr-EDTA analysis, blood samples drawn at 5 and 24 hours were used, as previously reported (6,12,13). Dialysate collection ended at the last exchange of dialysate before blood sampling at 24 hours; in most patients, this collection occurred in the morning.…”

Section: Endogenous Substancesmentioning

confidence: 99%

Endogenous Markers for Estimation of Renal Function in Peritoneal Dialysis Patients

et al. 2013

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♦ Objective: This method comparison study, conducted at the peritoneal dialysis (PD) outpatient clinic of the Department of Renal Medicine, Aarhus University Hospital, Denmark, set out to evaluate the accuracy and reproducibility of methods for estimating glomerular filtration rate (GFR) based on endogenous markers in PD patients. ♦ Patients: The 12 consecutive patients included in the study were examined twice while in a stable condition. All patients finished the study. Inclusion criteria were age 18 years or older, ability to collect 24-hour urine, and urine production greater than 300 mL in 24 hours.

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“…A number of labelled chelates as well as labelled and unlabelled contrast media, for example iohexol, are used as GFR markers [3, 10, 11, 12, 13, 14, 16, 17, 18, 19, 20, 21]. Determination of GFR as body clearance overestimates renal clearance because all GFR markers have some extrarenal excretion and an accompanying extrarenal clearance [4, 5, 6, 7]. If this extrarenal clearance of GFR-markers at different levels of renal function were known, its value could be subtracted from body clearance to get closer to the ‘true GFR’.…”

Section: Introductionmentioning

confidence: 99%

“…Previous reports are contradictory. In patients with GFR varying from severely reduced to normal, extrarenal clearance calculated as body clearance minus renal clearance, was independent of the level of renal function in several studies [4, 6, 7], but was in one study [5]decreased at low GFR. In studies from our group in pigs with normal, reduced and absent GFR, extrarenal clearance varied with the level of GFR and was lowest in subjects without renal function [10, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

Biliary and Total Extrarenal Clearance of Inulin and Iohexol in Pigs

Westen

Almén

Chai³

et al. 2002

Nephron

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Biliary clearance, total extrarenal clearance, body and renal clearance of inulin and iohexol were determined in 11 normal and 11 nephrectomized pigs. The biliary clearance of inulin, calculated as biliary excretion divided by the plasma concentration, was 0.04 and 0.01 ml min^–1 10 kg^–1 and of iohexol 0.21 and 0.1 ml min^–1 10 kg^–1 , in normal, respectively, nephrectomized pigs (p < 0.05). The extrarenal clearance of inulin, calculated as body minus renal clearance, was 2.7 and 0.7 ml min^–1 10 kg^–1 and of iohexol 3.7 and 0.7 ml min^–1 10 kg^–1 in normal, respectively, nephrectomized pigs (p < 0.05). Some hours after injection of the markers their plasma concentrations were much higher in the nephrectomized pigs. This higher plasma concentration was not matched by an equally higher biliary excretion and therefore biliary clearance decreased. The smaller total extrarenal clearance in nephrectomized pigs, i.e. the overestimation of GFR when calculated as body clearance, indicates that this source of error decreases with decreasing renal function.

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Determination of Glomerular Filtration Rate in Advanced Renal Insufficiency

Cited by 83 publications

References 10 publications

The Plasma Levels of Homocysteine Are Elevated in Moderate Renal Insufficiency but Do Not Predict the Rate of Progression

The Plasma Levels of Homocysteine Are Elevated in Moderate Renal Insufficiency but Do Not Predict the Rate of Progression

Endogenous Markers for Estimation of Renal Function in Peritoneal Dialysis Patients

Biliary and Total Extrarenal Clearance of Inulin and Iohexol in Pigs

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