ReviewHow to estimate GFR-serum creatinine, serum cystatin C or equations?
Introduction
Chronic kidney disease (CKD) and end-stage renal disease in particular are major health problems worldwide with dramatically rising incidence and prevalence. The population with end-stage renal disease in the USA increased from approximately 200,000 in 1991 to 380,000 in 2000, and it has recently been predicted to almost double to 710,000 by 2015 [1]. Patients with diabetes and hypertension are particularly affected by this negative development. However, most patients with CKD are only identified or adequately treated with significant delay, which is critical to stop progression of CKD to end-stage renal disease and to lower the enormous cardiovascular co-morbidity associated with CKD. This development has raised great concern and has led to the first global definition and classification of CKD in 2004 by the independent international Kidney Disease Improving Global Outcome organisation (KDIGO) [2]. KDIGO recommended two laboratory tests for an earlier detection of CKD: estimation of glomerular filtration rate, as this is the best estimate of functioning renal mass (eGFR), using the simplified equation derived from the Modification of Diet in Renal Disease Study (MDRD), and determination of proteinuria, preferably microalbuminuria, corrected for urine creatinine. The recommendations have been accepted almost worldwide in the nephrological community. The widespread use of eGFR in particular is an important step forward, but it necessarily represents a simplification. This review will present an overview over the potential and limitations of the most common endogenous GFR markers and estimations of GFR presently used in clinical practice.
Section snippets
Creatinine
An ideal endogenous marker of glomerular filtration rate (GFR) should be produced at a constant rate and be eliminated exclusively by glomerular filtration [3]. Under such conditions, its steady state serum concentration reflects GFR. The urinary clearance of inulin is generally regarded the gold standard to measure GFR [4]. As this method requires continuous intravenous infusion and multiple, timed urine collections, and inulin measurement is expensive and not routinely available, it has
Acknowledgments
Conflict of interest: A.B. received honoraria from Dade Behring, Marburg, Germany, and DAKO, Glostrup, Denmark; S. H. and W. H. received honoraria from Dade Behring, Marburg, Germany.
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