Simultaneous measurement of glomerular filtration rate and renal plasma flow using plasma disappearance curves

Silkalns, G.I.; Jeck, D.; Earon, J; Edelman, C.M.; Chervu, L. Rao; Blaufox, M. Donald; Spitzer, Adrian

doi:10.1016/s0022-3476(73)80365-8

Cited by 44 publications

(12 citation statements)

References 23 publications

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“…125 Iothalamate has been used extensively to measure GFR in children (43)(44)(45), both by standard renal clearance and by constant infusion and plasma disappearance; however, there are problems with this agent. The use of renal iothalamate clearances with the collection of urine result in major inaccuracies, especially in children, because of the inability to assure quantitative emptying of the bladder (43,46,47). Indeed, urine collection adds to the uncertainty of measuring GFR in children and adults (16,48 -51).…”

Section: Use Of Radioisotopesmentioning

confidence: 99%

Measurement and Estimation of GFR in Children and Adolescents

Schwartz

Work

2009

Clinical Journal of the American Society of Nephrology

822

604

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GFR is the best indicator of renal function in children and adolescents and is critical for diagnosing acute and chronic kidney impairment, intervening early to prevent end-stage renal failure, prescribing nephrotoxic drugs and drugs cleared by a failing kidney, and monitoring for side effects of medications. Renal inulin clearance was the gold standard for GFR but is compromised by lack of availability, difficult assays, and problems of collecting timed urine samples, especially in children with vesicoureteral reflux or bladder dysfunction. Creatinine clearance-based estimates of GFR are often used in pediatrics. The addition of cimetidine to eliminate creatinine secretion permits accurate measurement of GFR in those who can completely empty their bladders to provide timed urine collections. Radioisotopes are used in plasma disappearance GFR determinations; however, these are not ideal for use in children, especially for repeated studies. The plasma disappearance of iohexol serves as a promising alternative GFR marker, because it is safe and not radioactive, easily measured, not metabolized or transported by the kidney, and excreted primarily by glomerular filtration. GFR estimating equations, based on serum concentrations of creatinine or cystatin C, are popular clinically and in research studies. Efforts are ongoing to improve these estimating equations for children and make the results readily available to clinicians obtaining standard chemistry profiles, as is being done for adults. However, at this time, there is no dependable substitute for an accurately determined GFR, and iohexol plasma disappearance offers the best combination of safety, accuracy, and reproducible precision.

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Section: Use Of Radioisotopesmentioning

confidence: 99%

Measurement and Estimation of GFR in Children and Adolescents

Schwartz

Work

2009

Clinical Journal of the American Society of Nephrology

822

604

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“…By application of the twocompartment model, renal plasma flow was calculated from the disappearance curve of '"I-PAH. 18 - 19 Arterial blood samples were immediately centrifuged to avoid contamination of the plasma with PAH that originated from red blood cells. In normotensive subjects, the PAH extraction is approximately 90% and is not substantially reduced until renal plasma flow is less than 300 mL/min.…”

Section: Hemodynamic Assessmentmentioning

confidence: 99%

Accelerated decline in renal perfusion with aging in essential hypertension.

1994

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The present cross-sectional study was designed to assess the effect of the severity of hypertensive cardiovascular disease and age on renal hemodynamics. In a homogeneous population of 157 white men (aged 15 to 87 years), we assessed renal and systemic hemodynamics by measuring mean arterial pressure invasively, renal blood flow by 131 Ipara-aminohippuric acid clearance, and cardiac output by the indocyanine dye dilution technique. Stepwise multiple regression analysis revealed the following independent determinants of renal blood flow: age (/3=-.42, P<.001), height O = + .14, P<.03), mean arterial pressure (/3= -.15, P<.02), and cardiac output (/3=+.19, P<.008). Renal blood flow corrected for height correlated inversely with age in all three groups. However, the renal fraction of cardiac output S tructural changes in the vascular bed of the kidneys caused by arterial hypertension, termed arteriolar nephrosclerosis, have been found to correlate with similar changes in the retina, pancreas, and salivary glands but nevertheless do occur more frequently and extensively in the kidneys than in any other organ.1 Studies of end-stage renal disease showed that hypertension accounted for 15% to 20% of all cases of renal failure in the United States, a percentage that increased to 30% of cases of renal failure in minority populations. 24 In a previous report on the natural history of essential hypertension (at a time when high blood pressure frequently remained untreated), 18% of 350 patients had evidence of impaired renal function that led to end-stage renal disease in 12%. 5At necropsy, 68% to 97% of patients with well-established hypertension had histologicalry proven renal arteriosclerosis.6 -7 The severity of arteriolar renal involvement appeared to be determined by the severity of hypertensive disease. 6 The degree of the renal vascular involvement, either structural or functional, was closely correlated with the reduction in renal blood flow. 8 ' 9 A subsequent study using selective renal arteriography confirmed a good corReceived July 14, 1993; accepted in revised form December 3, 1993.From the Department of Medicine IV, University of ErlangenNurnberg (Germany) (R.E.S.); the Department of Medicine, University of Bonn, Bonn-Venusberg, Germany (H.S.); and the Department of Internal Medicine, Section on Hypertensive Diseases, Ochsner Clinic and Alton Ochsner Medical Foundation, New Orleans, La (F.H.M.).This manuscript, in which one of the authors (F.H.M.) is from the Alton Ochsner Medical Foundation, was sent to the previous Hypertension editorial office at the University of Iowa for review by expert referees, for editorial decision, and for final disposition.Reprint requests to Dr Roland E. Schmieder, 4. Medizinische Klinik/Nephrologie, University of Erlangen-Nurnberg, Kontumazgarten 14-18, D-8500 Nurnberg 80, FRG.did not correlate with age in borderline hypertension (r=.17, P=NS) and in normotension (r=.12, P=NS), suggesting a parallel decline in renal blood flow and cardiac output with aging. In contrast,...

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“…The single injection tech nique allows one to avoid these drawbacks. It has been shown to give a reliable estimation of GFR in adults and children (12,13,16), and its usefulness in pediatric practice has been re viewed recently (2). The method has also been applied to neonates, but its validity during the very first days of life remains questionable.…”

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confidence: 99%

Single Injection Clearance in the Neonate

Fawer

Torrado

Jp³

1979

Neonatology

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The single injection clearance of inulin was compared to the standard clearance in neonates aged 1–20 days. In the first 3 days of life, the single injection method overestimated glomerular filtration rate by approximately 30%. From the 2nd week of life, values obtained by the two techniques were not significantly different. We conclude that caution should be paid when interpreting results obtained by the single injection technique during the very first days of life.

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Simultaneous measurement of glomerular filtration rate and renal plasma flow using plasma disappearance curves

Cited by 44 publications

References 23 publications

Measurement and Estimation of GFR in Children and Adolescents

Measurement and Estimation of GFR in Children and Adolescents

Accelerated decline in renal perfusion with aging in essential hypertension.

Single Injection Clearance in the Neonate

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