Skip to main content
SpringerLink
Log in

Expressing glomerular filtration rate in children

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript

Abstract

We have reviewed the studies that provide the current standards of reference for glomerular filtration rate (GFR) in normal children from 14 days to 12 years of postnatal age. These standards currently are presented as ml/min per 1.73 m2, i.e., adjusted to average adult body surface area. Children from birth to 1 year of age have adjusted values below the adult range, making comparisons of observed to reference values difficult. Currently, there is no accepted way of obtaining reference values that vary smoothly with age. An analysis of the absolute GFR values in normal children taken from published studies led to an equation that estimates average GFR in relation to weight and term-adjusted age from-2 months (7 months gestational age) to 12 years in children at least 14 days post delivery. When these data are transformed to percentage of normal (% nl) for age and weight (i.e., percentage of the estimated average), it is possible to describe approximate apparent lower limits of normal GFR as is now done for adults and older children. For children with loss of renal mass, GFR expressed as % nl for age and weight provides a convenient standardization which has several useful applications. First, results expressed as % nl for children of different ages, particularly under 1 year of age, can be combined with those of older children for summary purposes. Second, the course of GFR measured serially in children is more appropriately described using this method for expressing GFR. Reporting GFR in absolute values is also useful, particularly in patients whose body mass is significantly distorted or whose absolute GFR is low.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Deen WM, Bridges CR, Brenner BM, Myers BD (1985) Heteroporous model of glomerular size selectivity: application to normal and nephrotic humans. Am Physiol 249:F374-F389

    Google Scholar 

  2. Chagnac A, Kiberd BA, Farinas MC, Strober S, Sibley RK, Hoppe R, Myers BD (1989) Outcome of the acute glomerular injury in proliferative lupus nephritis. J Clin Invest 84:922–930

    Google Scholar 

  3. Birmingham Reflux Study Group (1987) Prospective trial of operative versus non-operative treatment of severe vesicoureteric reflux in children: five year's observation. Br Med J 195:237–241

    Google Scholar 

  4. Klahr S (1989) Modification of diet in renal disease study. N Engl J Med 310:864–867

    Google Scholar 

  5. Smith H (1951) The kidney. Oxford University Press, Oxford, pp 542

    Google Scholar 

  6. West JR, Smith HW, Chassis H (1948) Glomerular filtration rate, effective renal blood flow and maximal tubular excretory capacity in infancy. J Pediatr 32:10–18

    Google Scholar 

  7. Heinemann HO, Nash MA, Edelmann CM Jr (1974) Renal function test: man in biology data book, vol III, 2nd edn. Federation of American Societies for Experimenal Biology and Medicine, Bethesda

    Google Scholar 

  8. Goldsmith DI (1978) Clinical and laboratory evaluation of renal function. In: Edelmann CM (ed) Pediatric kidney disease. Little Brown, Boston, pp 217

    Google Scholar 

  9. Chantler C, Barratt TM (1987) In: Holliday MA, Barratt TM, Vernier RL (eds) Pediatric nephrology, 2nd edn. Wilhaus+Wilkins Batterwise, pp 288

    Google Scholar 

  10. Barnett HL, Hare K, McNamara H, Hare R (1948) Measurement of glomerular filtration rate in premature infants. J Clin Invest 32: 591–699

    Google Scholar 

  11. Barnett HL, Hare WK, McNamara H, Hare RS (1948) Infulence of postnatal age on kidney function of premature infants. Proc Soc Exp Biol Med 69:55–57

    Google Scholar 

  12. Rubin MI, Bruck E, Rapoport M (1949) Maturation of renal function in childhood: clearance studies. J Clin Invest 28:1144–1162

    Google Scholar 

  13. Barnett HL, McNamara H, Shultz S, Tompsett R (1949) Renal clearances of sodium penicillen G, procaine penicillen G and inulin in infants and children. Pediatrics 3:418–422

    Google Scholar 

  14. Richmond JB, Kravitz H, Segar W, Waisman HA (1951) Renal clearance of endogenous phosphate in infants and children. Proc Soc Exp Biol Med 77:83–87

    Google Scholar 

  15. Edelmann CM, Barnett HL, Troupkou V (1960) Renal concentrating mechanisms in newborn infants. Effect of dietary protein and water content role of urea and responsiveness to antidiuretic hormone. Clin Invest 39:1061–1069

    Google Scholar 

  16. Guignard JP, Torrado A, DaCunha O, Gautier E (1975) Glomerular filtration rate in the first 3 weeks of life. J Pediatr 87:268–272

    Google Scholar 

  17. Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children and adults. J Pediatr 93:62–66

    Google Scholar 

  18. Box GEP, Cox DR (1964) An analysis of transformations. J R Stat Soc B 26:211–252

    Google Scholar 

  19. Taylor JMG (1986) The retransformed mean after a fitted power transformation. J Am Stat Assoc 81:114–118

    Google Scholar 

  20. Hamill PVV, Drized TA, Johnson CL, Reed RB, Roche AF, Moore WM (1979) Physical growth: National Center for Health Statistics percentiles. Am J Clin Nutr

  21. Lieberman GJ, Miller GRE Jr (1963) Simultaneous tolerance intervals in regression. Biometrika 50:155–168

    Google Scholar 

  22. Miller RG Jr (1981) Simultaneous statistical inference, 2nd edn. Springer, New York Berlin Heidelberg

    Google Scholar 

  23. Guignard JP (1987) Neonatal nephrology. In: Holliday MA, Barratt TM, Vernir RL (eds) Pediatric nephrology, 2nd edn. Williams and Wilkins, Baltimore, pp 928

    Google Scholar 

  24. Coulthard MG, Hey EN (1984) Weight as the best standard for glomerular filtration in the newborn. Arch Dis Child 59:373–375

    Google Scholar 

  25. Holliday MA (1971) Metabolic rate and organ size during growth from infancy to maturity and during late gestation and early infancy. Pediatrics 47:169

    Google Scholar 

  26. Mitch WE, Walser M, Buffington GA, Lemann J Jr (1976) A simple method of estimating progression of chronic renal failure. Lancet II 1326–1328

    Google Scholar 

  27. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259

    Google Scholar 

  28. Davies JG, Taylor CM, White RHR, Marshall T (1982) Clinical limitations of the estimation of glomerular filtration rate from height/plasma creatinine ratio: a comparison with simultaneous51Cr edetic acid slope clearance. Arch Dis Child 57:607–610

    Google Scholar 

  29. Walser M, Drew HH, La France NH (1988) Creatinine measurements often yield false estimates of progression in renal failure. Kidney Int 34:412–418

    Google Scholar 

  30. Shemesh O, Golbetz H, Kriss JP, Myers BD (1985) Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 28:830–838

    Google Scholar 

  31. Ott NT, Wilson DM (1975) A simple technique for estimating glomerular filtration rate with subcutaneous injection of125I iothalamate. Mayo Clin Proc 50:665–668

    Google Scholar 

  32. Cole BR, Giangiacomo J, Ingelfinger JR, Robson AM (1972) Measurement of renal function without urine collection. N Engl J Med 187:1109–1114

    Google Scholar 

  33. Coulthard MG (1983) Comparison of methods of measuring renal function in preterm babies using inulin. J Pediatr 102:923–930

    Google Scholar 

  34. Holliday MA, Conley S, Hogg RJ, Uauy R (1988) Validation of a method for measuring GFR form the clearance of ultrafiltrate (unlabeled) iothalamate (C.Io) using a contant infusion method. Pediatr Res 23:538A

    Google Scholar 

  35. Al-Dahwi A, Kogan B, DuBois J, Holliday MA (1990) Practical measurement of GFR without urine collections using an extended constant subcutaneous infusion of cold iothalmate (Io). Kidney Int 37:270

    Google Scholar 

  36. Tanner JM (1949) Fallacy of per-weight and per-surface area standards and their relation to spurious correlations. J Appl Physiol 93: 62–66

    Google Scholar 

  37. McCance RA, Widdowson EM (1952) The correct physiological basis on which to compare infant and adult renal function. Lancet II: 860–862

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Epidemiology and Biostatistics, University of California, San Francisco, Box 0314, 94143-0704, San Francisco, CA, USA

    David C. Heilbron

  2. Department of Pediatrics, University of California, San Francisco, Box 0314, 94143-0704, San Francisco, CA, USA

    Malcolm A. Holliday & Amira Al-Dahwi

  3. Department of Urology, University of California, San Francisco, Box 0314, 94143-0704, San Francisco, CA, USA

    Barry A. Kogan

Authors
  1. David C. Heilbron
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Malcolm A. Holliday
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amira Al-Dahwi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barry A. Kogan
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Heilbron, D.C., Holliday, M.A., Al-Dahwi, A. et al. Expressing glomerular filtration rate in children. Pediatr Nephrol 5, 5–11 (1991). https://doi.org/10.1007/BF00852829

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00852829

Key words

Search

Navigation