Restrictions on Use of Creatinine Clearance for Measurement of Renal Functional Reserve

Laville, Maurice; Hadj‐Aïssa, Aoumeur; Pozet, N; Jh, Le Bras; Labeeuw, M; Zech, P

doi:10.1159/000185291

Cited by 28 publications

(18 citation statements)

References 8 publications

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“…However, the use of creatinine clearance has many drawbacks in assessing GFR and RFR, specially in renal disease. After a meat meal, plasma creatinine concentration increases significantly as reported by Laville et al [13] and Shomesh et al [14] who showed the inaccuracy of this method for determination of renal reserve after a meat meal and in renal disease. Since DTPA is a glomerular agent excreted solely by the glomerulus and not affected by meat meal, we have …”

Section: Discussionsupporting

confidence: 58%

The role of renal function reserve estimation in children with hydronephrosis

Jindal

Bal

Bhatnagar

2007

J Indian Assoc Pediatr Surg

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Background: Glomerular filtration rate (GFR) is the most widely used indicator of kidney function although it does not invariably reflect the functional status after renal injury. The concept of renal function reserve (RFR) as the ability of the kidney to increase GFR following a protein load was introduced in 1980s. In hydronephrotic children, the acute hemodynamic response to intravenous protein load can cause changes in renal function that are different from changes in normal controls. Materials and Methods: RFR was evaluated in 21 children with hydronephrosis (group I -study group) and in 20 healthy children (group II -control group) by subtracting the baseline GFR from the stimulated GFR following an intravenous protein load. GFR was determined by double compartment-2 plasma sample method using 99m Tc DTPA (diethylenetriamine pentaacetic acid) radioisotope as the filtration agent. Results: The baseline GFR, stimulated GFR and RFR of hydronephrotic children (group I) was found to be significantly lower (P = 0.01, P = 0.001 and P = 0.03 respectively) as compared with healthy normal children (group II). The stimulated GFR shows a strong correlation with the baseline GFR in both the groups, but the RFR shows a high inverse correlation to the baseline GFR in controls and a very low correlation in study group. Conclusion: RFR is preserved in children with hydronephrosis, but it is reduced in comparison to healthy children. However, its clinical utility to unmask the severity of hydronephrosis is limited by the various limiting factors.

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Section: Discussionsupporting

confidence: 58%

The role of renal function reserve estimation in children with hydronephrosis

Jindal

Bal

Bhatnagar

2007

J Indian Assoc Pediatr Surg

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“…However, on the experience made in our laboratory and on the analysis of available information, we would like to elicit a few certainties: (1) an oral protein load in form of a beefsteak prepared without adding sodium, oil or butter, and served without bread/crackers, is asso ciated with a constant reserve; (2) protein and Na intake should be assessed at the time of the evaluation of the reserve; (3) GFR should be measured with inulin since creatinine is inadequate [18,22,27]; (4) hemodynamic response may occur within as early as 30 min in healthy children and within 60 min in renal failure; (5) early GFR response is not dependent on insulin, renin, aldosterone, or on plasma amino acid concentration; (6) during hem odynamic response, the tubulo-glomerular feedback mechanism is normal but the quantity of fluid and so dium delivered from the proximal tubule continuously increases, perhaps due to the changes in plasma insulin; (7) the reserve in early renal disease may be normal but its relationship to protein intake remains undetermined; (8) patients with single kidneys, children with type 1 diabetes mellitus, children with renal failure and high to normal protein intake and children with reduced GFR may all show a reduced renal functional reserve.…”

Section: Discussionmentioning

confidence: 99%

“…Only in 2 of 12 studies (table 3), a renal reserve was present following a protein meal in children with renal disease. However, only 30 of 122 children were studied by inulin and the remaining by creatinine clearance which is not optimal under such experimental conditions [27], Furthermore, only in studies N and P was the protein intake established at the time of the study, whereas all studies lack information on Na intake which is a determi nant of renal reserve [13,28].…”

Section: Renal Reserve In Children With Renal Diseasementioning

confidence: 99%

Renal Functional Reserve in Children with and without Renal Disease

DeSanto¹,

Capasso²,

Anastasio³

et al. 1991

Nephron

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“…Data shown in this study are preliminary and intend to only suggest that RST is a useful, feasible, and cost-effective analysis that should be included in routine clinical practice for living donors kidney transplantation. Second, we used sCr, instead of inulin, as marker solute to quantify the renal clearance and thus the GFR [44,45] . Although potentially overestimated, the GFR obtained with this method is noninvasive, inexpensive, repeatable, and thus clinically applicable in daily routine practice.…”

Section: Discussionmentioning

confidence: 99%

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

Spinelli¹,

Sharma²,

Villa³

et al. 2017

Nephron

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Background: In living kidney transplantation, preoperative donors' renal functional reserve (RFR) may correlate with postoperative residual renal function in both donors and recipients. The aim of this study was to evaluate the donors' RFR before transplantation and to compare basal and stress renal function before and after transplantation in both donors and recipients. Methods: Seven pairs of living kidney donors and recipients were considered for this observational study. RFR was measured with a renal stress test (RST) before and after the kidney transplantation through an oral protein loading test (1 g/kg of body weight). RFR was defined as the difference between the maximum value of creatinine clearance after protein load (stress glomerular filtration rate, sGFR) and baseline creatinine clearance (basal GFR, bGFR). Results: Before transplantation, a significant difference between sGFR and bGFR (p = 0.04) was observed in donors, with an RFR = 30.6 (11.9-41.5) mL/min/1.73 m². After kidney transplantation, sGFR was similar to bGFR for both donors and recipients (p = 0.13), with a limited RFR (7.9 [6.70-19.25] and 14.90 [-6.67 to 25.53] mL/min/1.73 m², respectively). The sum of the donor's and recipient's post-transplant sGFR was similar to the pre-transplant donor's sGFR (p = 0.73). Conclusion: RST is a safe, feasible, easy, and an inexpensive tool that is able to quantify RFR. In living kidney transplantation, it can be used in clinical practice to measure the original global filtration capacity of the donor's kidneys (sGFR) and to quantify the susceptibility of donors and recipients in developing postoperative kidney dysfunction. However, further studies with an adequate sample size and follow-up period are needed to test this hypothesis.

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Restrictions on Use of Creatinine Clearance for Measurement of Renal Functional Reserve

Cited by 28 publications

References 8 publications

The role of renal function reserve estimation in children with hydronephrosis

The role of renal function reserve estimation in children with hydronephrosis

Renal Functional Reserve in Children with and without Renal Disease

Rationale for the Evaluation of Renal Functional Reserve in Living Kidney Donors and Recipients: A Pilot Study

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