Measurement of renal functional reserve in children

Hellerstein, Stanley; Berenbom, Max; Erwin, Pat; Wilson, Nancy; DiMaggio, Sylvia

doi:10.1007/s00467-004-1550-9

Cited by 17 publications

(9 citation statements)

References 12 publications

(14 reference statements)

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“…Comparison of RFR with other children examined during a hypotonic saline perfusion test and dopamine infusion is lacking. All previous studies used a protein load to stimulate GFR [25]. Because the degree of increase in GFR and RPF is comparable with the reports in healthy adults [10], our MCNS population seems suitable as a control population for RFR, in contrast with the findings of Gamero et al [26].…”

Section: Discussionsupporting

confidence: 65%

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

et al. 2007

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Increased glomerular filtration rate (GFR) has been implicated in the development of diabetic nephropathy. Large normal interindividual variations of GFR hamper the diagnosis of renal hemodynamic alterations. We examined renal functional reserve (RFR) in children with type 1 diabetes mellitus to assess whether hyperfiltration occurs. The renal hemodynamic response following dopamine infusion was examined in 51 normoalbuminuric diabetic children (7.7 +/- 3.6 years) with a mean duration of diabetes of 6.2 years and compared them with 34 controls. Mean baseline GFR in diabetic children did not differ from the control population (130.7 +/- 22.9 vs. 124.8 +/- 25 ml/min per 1.73 m(2)), whereas renal plasma flow was significantly lower (463.7 +/- 103.9 vs. 587.2 +/- 105 ml/min per 1.73 m(2), p < 0.001), and filtration fraction was increased (29 +/- 8 vs. 21 +/- 2%, p < 0.001), compared with controls. The mean RFR was lower (p < 0.001) than in control subjects (-0.77 +/- 23 vs. 21 +/- 8 ml/min per 1.73 m(2)). This study documents an increased filtration fraction and reduced or absent RFR in children with type 1 diabetes mellitus in the stage before apparent nephropathy. GFR values were within normal range. Although the reduced RFR and increased filtration fraction indicate the presence of hemodynamic changes, their relevance to the development of hyperfiltration and subsequent diabetic nephropathy remains unknown.

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Section: Discussionsupporting

confidence: 65%

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

et al. 2007

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“…In addition, many mathematical equations and nomograms have been proposed in order to predict [15] creatinine clearance on the basis of readily available patient characteristics such as weight, age, and plasma creatinine level (PCr) [12]. The most used equation in pediatrics for estimating GFR is the Schwartz formula based on the ratio of body length (L) to PCr and a coefficient that differs from one age group to another [12,13,14]. Recently, a model relevant to our discussion has been developed to characterize the maturation and growth of renal function [15].…”

Section: Ontogeny Of Glomerular and Tubular Developmentmentioning

confidence: 99%

Ontogeny of drug elimination by the human kidney

et al. 2005

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Renal clearance is an important route of drug elimination. While during the neonatal period there is minimal glomerular filtration and active tubular secretion of drugs, there is a well-described rapid development in these processes in the post-neonatal period. A less appreciated fact is that during toddlerhood, there is an "overshoot" of the glomerular filtration rate (GFR) well above the levels encountered in older children and adults, and there is an early achievement of adult levels in active drug secretion, which stays at a plateau throughout childhood and adulthood with an "overshoot" in toddlers due to specific transport mechanisms. This phenomenon leads to dose requirements for renally excreted drugs in this age group being, on a per-kilogram basis, much larger than in adults. This review discusses the mechanisms related to renal ontogeny in drug handling.

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“…The early stages of toxic nephropathy and AKI are commonly characterized by very few, nonspecific clinical signs and by nonsignificant variations of conventional serum and urine biomarkers. During toxic nephropathy, the renal functional reserve may mask parenchymal lesions, as estimated by urinalysis, glomerular filtration rate (GFR), blood urea nitrogen (BUN), and serum creatinine (SCr), up to the point where over 75% of the functioning nephrons have been lost [3, 4]. Accordingly, these factors measure incipient kidney failure and in most cases, the finding of normal results does not mean the absence of kidney dysfunction.…”

Section: Introductionmentioning

confidence: 99%

Emerging Biomarkers and Metabolomics for Assessing Toxic Nephropathy and Acute Kidney Injury (AKI) in Neonatology

Mussap

Noto

Fanos

et al. 2014

BioMed Research International

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Identification of novel drug-induced toxic nephropathy and acute kidney injury (AKI) biomarkers has been designated as a top priority by the American Society of Nephrology. Increasing knowledge in the science of biology and medicine is leading to the discovery of still more new biomarkers and of their roles in molecular pathways triggered by physiological and pathological conditions. Concomitantly, the development of the so-called “omics” allows the progressive clinical utilization of a multitude of information, from those related to the human genome (genomics) and proteome (proteomics), including the emerging epigenomics, to those related to metabolites (metabolomics). In preterm newborns, one of the most important factors causing the pathogenesis and the progression of AKI is the interaction between the individual genetic code, the environment, the gestational age, and the disease. By analyzing a small urine sample, metabolomics allows to identify instantly any change in phenotype, including changes due to genetic modifications. The role of liquid chromatography-mass spectrometry (LC-MS), proton nuclear magnetic resonance (1H NMR), and other emerging technologies is strategic, contributing basically to the sudden development of new biochemical and molecular tests. Urine neutrophil gelatinase-associated lipocalin (uNGAL) and kidney injury molecule-1 (KIM-1) are closely correlated with the severity of kidney injury, representing noninvasive sensitive surrogate biomarkers for diagnosing, monitoring, and quantifying kidney damage. To become routine tests, uNGAL and KIM-1 should be carefully tested in multicenter clinical trials and should be measured in biological fluids by robust, standardized analytical methods.

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Measurement of renal functional reserve in children

Cited by 17 publications

References 12 publications

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

Ontogeny of drug elimination by the human kidney

Emerging Biomarkers and Metabolomics for Assessing Toxic Nephropathy and Acute Kidney Injury (AKI) in Neonatology

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