The use of transcutaneous gfr monitors in mice was first reported by schreiber and colleagues in 2012 and was validated by comparing gfr measurements obtained using this technique, with results obtained by direct measurement of fitcsinistrin bolus clearance from serial blood samples1. Median intratest coefficient of variation cv for the igfr was 9. Measurement of renal function in chronic renal disease. Direct measurement of glomerular filtration rate date written. Measurement of singlekidney glomerular filtration rate. Serum creatinine measurements were done in the cric central laboratory at the university of pennsylvania on the hitachi vitros 950 and calibrated to the idmstraceable standardized creatinine. Renal clearance of a substance quantifies the effectiveness of kidneys in excreting substances. Measurement of glomerular function during cisplatin therapy d. Levey new england medical center, and tufts university school of medicine, boston, massachusetts patient 1. Stage 1 kidney damage with normal or elevated gfr 90 mlmin1. Single injection plasma clearance method without urine collection article pdf available in journal of nuclear medicine 2611. Determining the glomerular filtration ratean overview. Measurement of glomerular function during cisplatin therapy.
The same plasma samples can be used for measurement of glomerular filtration rate. Before moving to clinical trials, we have to recall the physiological characteristics of an ideal gfr marker. Measurement and estimation of glomerular filtration rate. Pdf transdermal measurement of glomerular filtration. Contractor information contractor name contract typecontract number jurisdictionstates noridian healthcare solutions, llc a and b mac 01111 mac a j e california entire state noridian healthcare. Transdermal measurement of glomerular filtration rate in. Perhaps we need to move to a more regular measurement of gfr in a variety of different clinical circumstances. Molitoris 2,3 1nephrology division, department of medicine, university of alabama at birmingham, birmingham, alabama. Measurement error as alternative explanation for the. In the present study, plasma clearance of iopromide ultravist 300, schering ag, berlin, germany was measured as the reference value for gfr. For direct measurement of gfr, isotope tests are most commonly used. The increasing pace with which novel estimation formulae, current and newer biomarkers, assay standard ization procedures as well as invasive measurement methods of gfr were published, has been overwhelming for many clinicians.
Another study showed that among patients with preserved gfr, iothalamatemeasured gfr was approximately 20 mlmin per 1. A plot of the peak height in arbitrary units on hplc versus the concentration of hypaque meglumine. Transdermal measurement of glomerular filtration rate in mice. Most studies on obesity surgery have measured renal function using the estimated gfr. Gfr measurement without infusion or isotopes 0 50 100 150 200 250 300 350 400 hypaque meglumine, jigmi fig. Measurement of glomerular filtration rate in patients. The measurement system consists of a miniaturized fluorescence detector. Examples of clinically complex situations for which mgfr is more helpful than egfr include patients who exhibit discrepant results between a creatininebased and a cystatin cbased gfr. The rationale is that gfr is a property of the kidney, has a large range, and is affected by physiologic, pharmacologic, and pathologic. In contrast, research studies have often used multipleperiod measures to reduce the impact of errors in timing of blood and urine sampling. To compare the performance of a new gfr measurement compared to inulin, we need to know the bias mean difference between the two results and the precision standard deviation sd.
If repetition of the investigation is desired, it should take place with the. Clinical guideline for the measurement of glomerular. A 42yearold woman first was evaluated at the new england medical center after an episode of dysuria that resolved following treatment with an antibiotic. The level of gfr is used in patients with chronic kidney disease ckd to classify them into ckd stages. In the literature, any direct measure of gfr is typically taken to be the gold standard, without much attention paid to the details of the methodology. While plasma and urinary clearances provide the greatest accuracy for assessing glomerular filtration rate gfr, these are often impractical particularly for the care of children. Measurement of renal function in chronic renal disease principal discussant. Preservation of gfr, even at its very low level, is of great importance in both dialysis and non. Direct measurement of glomerular filtration rate gfr avoids the limitations of serum creatinine overestimating gfr in mice with mild ckd 19. Fda grants breakthrough device status for medibeacons.
Gfr reference determination nonionic xray contrast media such as iohexol and iopromide are accurate test substances for measuring gfr 1012. Measured gfr as gold standardall that glitters is not. Glomerular filtration rate gfr the rate at which plasma is filtered by the kidney glomeruli. Guidelines for the measurement of glomerular filtration. An important measurement in the evaluation of kidney function gfr 125 ml plasmamin or, 180 lday plasma volume 70kg young adult man. Gfr was measured directly by urinary clearance of 125 iiothalamate igfr 24,25. Using the complete plasma clearance curve as a reference eight samples at 10 to 240 min, the. Note the excellent correlation in the range of concentrations encountered in urine. Stage 5 ckd encompasses patients with a gfr below 15 mlminute1. Twentythree patients received an injection of 12 ml. The definition of clearance is the volume typically of plasma cleared of a drug per unit time. Assessment of glomerular filtration rate measurement with. Measurement of gfr with nonradioisotopic radio contrast. A novel method for rapid bedside measurement of gfr.
Transdermal analysis of glomerular filtration rate gfr is an established technique that is used to assess renal function in mouse and rat models of acute kidney injury and chronic kidney disease. Gfr is the most useful measurement of kidney function. Clearance concept and ideal marker for glomerular filtration rate the history of the renal physiology is deeply influenced by the book published by homer. Cystatin c measurement l37616 links in pdf documents are not guaranteed to work. Serum creatinine, the most commonly used endogenous marker, is simple, convenient, and practical but less. For more information, see chart on the bottom of page 2. The urinary or plasma clearance of an ideal filtration marker, such as inulin, iothalamate or iohexol, is the gold standard for the measurement of gfr.
A novel method for rapid bedside measurement of gfr dana v. Urinary inulin clearance, the classic method for measuring gfr described by smith,x5measurement of the filtration rate. If other methods are used then the systematic differences relative to this standard should be noted. Edta is the most widely used radiopharmaceutical for gfr measurement in the uk and venous plasma sampling is a precise and convenient technique. The ability to measure gfr is of high clinical interest especially in patients with or at risk of kidney disease. Clinicalpharmacology group and 2department of nuclear medicine, southampton general hospital, southampton s094xy 1 creatininebased methods for.
Like inulin, or the radiographic contrast agent iohexol, these markers eg 51credta, 99tcdtpa are cleared almost entirely by glomerular filtration, and measures of their disappearance rate from the circulation, or appearance in the urine, can be used to estimate gfr. The normal gfr is 120 mlmin, the erpf 600 ml min and the ff 0,20. The accuracy of the gfr value has been shown to be deficient. Describe the principles of measurement of glomerular filtration rate and renal blood flow. Measurement of glomerular filtration rate in patients undergoing obesity surgery ling l. Gfr represents the volume of plasma ultrafiltrate presented to. Kidney disease is a hidden epidemic, affecting more than 850 million people worldwide. The use of transcutaneous gfr monitors in mice was first reported by schreiber and colleagues in 2012 and was validated by comparing gfr measurements obtained using this technique, with results obtained by direct measurement of fitcsinistrin bolus clearance from serial blood samples 1.
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