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Journal ArticleDOI

Measurement of renal function in chronic renal disease

01 Jul 1990-Kidney International (Kidney Int)-Vol. 38, Iss: 1, pp 167-184
TL;DR: A 42-year-old woman with a mild sensorineural hearing loss bilaterally, and a family history of renal disease, a diagnosis of hereditary nephritis was made and she entered the feasibility phase of the Modification of Diet in Renal Disease (MDRD) Study.
About: This article is published in Kidney International.The article was published on 1990-07-01 and is currently open access. It has received 561 citations till now. The article focuses on the topics: Renal function.
Citations
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Journal ArticleDOI
TL;DR: The purpose of this study was to develop an equation from MDRD Study data that could improve the prediction of GFR from serum creatinine concentration, and major clinical decisions in general medicine, geriatrics, and oncology are made by using the Cockcroft-Gault formula and other formulas to predict the level of renal function.
Abstract: The serum creatinine concentration is widely used as an index of renal function, but this measure is affected by factors other than the glomerular filtration rate (GFR). This study examined an equa...

14,711 citations

Journal ArticleDOI
TL;DR: Current methods of measuring GFR and GFR-estimating equations and their strengths and weaknesses as applied to chronic kidney disease are considered.
Abstract: In the coming years, estimates of the glomerular filtration rate (GFR) may replace the measurement of serum creatinine as the primary tool for the assessment of kidney function. Indeed, many clinical laboratories already report estimated GFR values whenever serum creatinine is measured. This review considers current methods of measuring GFR and GFR-estimating equations and their strengths and weaknesses as applied to chronic kidney disease.

2,685 citations

Journal ArticleDOI
TL;DR: The fundamental principles of physiology, metabolism, and analytical chemistry that are necessary to correctly interpret the serum creatinine concentration are reviewed and applied to important clinical circumstances, including aging, pregnancy, diabetes mellitus, drug administration, and acute and chronic renal failure.
Abstract: The serum creatinine concentration is widely interpreted as a measure of the glomerular filtration rate (GFR) and is used as an index of renal function in clinical practice. Glomerular filtration of creatinine, however, is only one of the variables that determines its concentration in serum. Alterations in renal handling and metabolism of creatinine and methodological interferences in its measurement may have a profound impact on the serum concentration of creatinine. We review the fundamental principles of physiology, metabolism, and analytical chemistry that are necessary to correctly interpret the serum creatinine concentration. These principles are then applied to important clinical circumstances, including aging, pregnancy, diabetes mellitus, drug administration, and acute and chronic renal failure. Despite numerous limitations, serum creatinine remains a useful clinical tool, but more accurate measures of renal function are frequently necessary.

1,550 citations

Journal ArticleDOI
TL;DR: The NKDEP Laboratory Working Group has developed a plan that enables standardization and improved accuracy (trueness) of serum creatinine measurements in clinical laboratories worldwide that includes the use of the estimating equation for GFR based on serum Creatinine concentration that was developed from the Modification of Diet in Renal Disease (MDRD) study.
Abstract: Background: Reliable serum creatinine measurements in glomerular filtration rate (GFR) estimation are critical to ongoing global public health efforts to increase the diagnosis and treatment of chronic kidney disease (CKD). We present an overview of the commonly used methods for the determination of serum creatinine, method limitations, and method performance in conjunction with the development of analytical performance criteria. Available resources for standardization of serum creatinine measurement are discussed, and recommendations for measurement improvement are given. Methods: The National Kidney Disease Education Program (NKDEP) Laboratory Working Group reviewed problems related to serum creatinine measurement for estimating GFR and prepared recommendations to standardize and improve creatinine measurement. Results: The NKDEP Laboratory Working Group, in collaboration with international professional organizations, has developed a plan that enables standardization and improved accuracy (trueness) of serum creatinine measurements in clinical laboratories worldwide that includes the use of the estimating equation for GFR based on serum creatinine concentration that was developed from the Modification of Diet in Renal Disease (MDRD) study. Conclusions: The current variability in serum creatinine measurements renders all estimating equations for GFR, including the MDRD Study equation, less accurate in the normal and slightly increased range of serum creatinine concentrations [<133 μmol/L (1.5 mg/dL)], which is the relevant range for detecting CKD [<60 mL · min−1 · (1.73 m2)−1]. Many automated routine methods for serum creatinine measurement meet or exceed the required precision; therefore, reduction of analytical bias in creatinine assays is needed. Standardization of calibration does not correct for analytical interferences (nonspecificity bias). The bias and nonspecificity problems associated with some of the routine methods must be addressed.

1,140 citations

Journal ArticleDOI
TL;DR: Lower GFR and hematocrit were associated with a higher prevalence of traditional cardiovascular risk factors and decreased kidney function and anemia are risk factors for all-cause mortality in patients with LV dysfunction.

713 citations


Cites background from "Measurement of renal function in ch..."

  • ...Serum creatinine is determined by a number of factors, other than GFR, such as gender, age, muscle mass and ethnicity and, therefore, provides only a rough estimate of level of kidney function (21)....

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References
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Journal ArticleDOI
01 Jan 1976-Nephron
TL;DR: A formula has been developed to predict Creatinine clearance from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr (mg/100ml) (15% less i).
Abstract: A formula has been developed to predict creatinine clearance (Ccr) from serum creatinine (Scr) in adult males: Ccr = (140 – age) (wt kg)/72 × Scr(mg/100ml) (15% less i

14,211 citations

Journal ArticleDOI
TL;DR: It is concluded that true filtration markers with rs less than 20 A, including inulin, are unrestricted in glomerular disease, and that creatinine is hypersecreted progressively by remnant renal tubules as the disease worsens.

1,182 citations

Journal ArticleDOI
TL;DR: While creatinine excretion may serve as a useful approximation of muscle mass in carefully selected subjects, there remains a need for accurate and practical indices of Muscle mass for use in the individuals in whom the method cannot be reliably applied.

812 citations


"Measurement of renal function in ch..." refers background in this paper

  • ...Generation of creatinine from creatine depends on the size of the creatine pool and its rate of turnover to creatinine [55]....

    [...]

Journal ArticleDOI
TL;DR: It is anticipated that different diseases associated with glomerular sclerosis will be found to depend to varying extents on these two potential mechanisms of sclerosis: the capacity of both intrinsic cells and infiltrating cells to alter the microenvironment of the glomerulus so that sclerosis progresses inexorably long after the disappearance of the initiating insult.
Abstract: The diversity of its causes, the unpredictability of its clinical course, and our expanding knowledge of the conditions that may exacerbate or retard its progression suggest that glomerular sclerosis cannot be attributed to a single aberration in glomerular physiology. Nonetheless, the welter of clinical and experimental observations is beginning to yield a pattern. Agents or conditions injurious to glomerular epithelium tend to cause glomerular sclerosis. Agents or conditions that induce short-term or long-term activation of mesangial cells may lead to glomerular sclerosis. Indeed, one contribution of the healthy epithelium may be to serve as a tonic inhibitor of the intraglomerular processes arising from mesangial-cell activation. Long-term activation of the mesangium is associated with the proliferation and infiltration of cells and with the expansion of the mesangial matrix--the antecedents of sclerosis. We anticipate that different diseases associated with glomerular sclerosis will be found to depend to varying extents on these two potential mechanisms of sclerosis. Beyond a certain threshold of glomerular injury, glomerular diseases share an additional factor: the capacity of both intrinsic cells and infiltrating cells to alter the microenvironment of the glomerulus so that sclerosis progresses inexorably long after the disappearance of the initiating insult. Several potential risk factors may contribute to the progression of chronic renal disease. These factors include systemic hypertension, proteinuria, hyperlipidemia, high protein intake, and probably conditions that lead to glomerular hypertrophy. Interventions designed to minimize the potential contribution of these factors to the progression of renal insufficiency may halt or slow the loss of function of the kidney. Clinical trials designed to examine the effects of these factors on the progressive course of renal insufficiency will help to establish their role and relative importance in humans.

782 citations

Journal ArticleDOI
TL;DR: It is concluded that in persistent glomerular nephritis the glomersular filtration-rate is more affected by changes in the tubules than by changesinine clearance, and that in some patients with extensiveglomerular changes but little or no tubular damage, the creatinine clearances were normal.

640 citations

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