Skip to main content

Measuring Kidney Function

Quantifying Glomerular Filtration from Laboratory Tests

  • Chapter
  • First Online:
Understanding Kidney Diseases

Abstract

In this chapter we explain:

  • How serum creatinine is related to glomerular filtration rate (GFR)

  • The limitations of creatinine as a measure of GFR

  • How GFR is estimated from serum creatinine and cystatin C

  • Common errors made when using eGFR

  • How to interpret urea and creatinine together

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28(5):830–8. http://www.nature.com/ki/journal/v28/n5/pdf/ki1985205a.pdf.

    Article  CAS  PubMed  Google Scholar 

  2. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70. PubMed: 10075613. http://annals.org/article.aspx?articleid=712617.

    Article  CAS  PubMed  Google Scholar 

  3. Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009;4(11):1832–43. doi:10.2215/CJN.01640309. Published ahead of print October 9, 2009. http://cjasn.asnjournals.org/content/4/11/1832.full.

    Article  PubMed  Google Scholar 

  4. Schwartz GJ, Muñoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL. New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 2009;20:629–37. doi:10.1681/ASN.2008030287. http://jasn.asnjournals.org/content/20/3/629.full.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Smith M, Moran P, Ward M, Davison J. Assessment of glomerular filtration rate during pregnancy using the MDRD formula. BJOG. 2008;115:109–12. http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01529.x/full.

    Article  CAS  PubMed  Google Scholar 

  6. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. www.kdigo.org/clinical_practice_guidelines/pdf/CKD/KDIGO_2012_CKD_GL.pdf; www.nice.org.uk/guidance/CG182/chapter/introduction.

  7. Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro 3rd AF, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration). A new equation to estimate glomerular filtration rate. Ann Intern Med. 2009;150(9):604–12. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2763564/.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kilbride HS, Stevens PE, Eaglestone G, Knight S, Carter JL, Delaney MP, Farmer CK, Irving J, O’Riordan SE, Dalton RN, Lamb EJ. Accuracy of the MDRD (Modification of Diet in Renal Disease) study and CKD-EPI (CKD Epidemiology Collaboration) equations for estimation of GFR in the elderly. Am J Kidney Dis. 2013;61(1):57–66. doi:10.1053/j.ajkd.2012.06.016. Epub 2012 Aug 11. http://www.ajkd.org/article/S0272-6386(12)00941-9/abstract.

    Article  PubMed  Google Scholar 

  9. Xie D, Joffe MM, Brunelli SM, Beck G, Chertow GM, Fink JC, Greene T, Hsu C-Y, Kusek JW, Landis R, Lash J, Levey AS, O’Conner A, Ojo A, Rahman M, Townsend RR, Wang H, Feldman HI. A comparison of change in measured and estimated glomerular filtration rate in patients with nondiabetic kidney disease. Clin J Am Soc Nephrol. 2008;3(5):1332–8. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2518808/.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Padala S, Tighiouart H, Inker LA, Contreras G, Beck GJ, Lewis J, Steffes M, Rodby RA, Schmid CH, Levey AS. Accuracy of a GFR estimating equation over time in people with a wide range of kidney function. Am J Kidney Dis. 2012;60(2):217–24. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3399947/.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Franz KA, Reubl FC. Rate of functional deterioration in polycystic kidney disease. Kidney Int. 1983;23:526–9. http://www.nature.com/ki/journal/v23/n3/pdf/ki198351a.pdf.

    Article  CAS  PubMed  Google Scholar 

  12. Ama PF, Simoneau JA, Boulay MR, Serresse O, Thériault G, Bouchard C. Skeletal muscle characteristics in sedentary black and Caucasian males. J Appl Physiol (1985). 1986;61(5):1758–61. http://jap.physiology.org/content/61/5/1758.

    CAS  Google Scholar 

  13. Lugaresi R, Leme M, de Salles Painelli V, Murai IH, Roschel H, Sapienza MT, Herbert Lancha AH, Gualano B. Does long-term creatine supplementation impair kidney function in resistance-trained individuals consuming a high-protein diet? J Int Soc Sports Nutr. 2013;10:26. doi:10.1186/1550-2783-10-26. http://www.jissn.com/content/10/1/26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, Rossert J, Van Lente F, Bruce RD, Zhang YL, Greene T, Levey AS. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3418 individuals with CKD. Am J Kidney Dis. 2008;51(3):395–406. doi:10.1053/j.ajkd.2007.11.018. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2390827/.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Prowle JR, Kolic I, Purdell-Lewis J, Taylor R, Pearse RM, Kirwan CJ. Serum creatinine changes associated with critical illness and detection of persistent renal dysfunction after AKI. Clin J Am Soc Nephrol. 2014;9(6):1015–23. doi:10.2215/CJN.11141113. published ahead of print April 17, 2014, http://cjasn.asnjournals.org/content/9/6/1015.abstract.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Berg KJ, Gjellestad A, Nordby G, Rootwelt K, Djøseland O, Fauchald P, Mehl A, Narverud J, Talseth T. Renal effects of trimethoprim in ciclosporin- and azathioprine-treated kidney-allografted patients. Nephron. 1989;53(3):218–22. http://www.karger.com/Article/Abstract/185747.

    Article  CAS  PubMed  Google Scholar 

  17. Duncker D, Oswald H, Gardiwal A, Lüsebrink U, König T, Schreyer H, Klein G. Stable cystatin C serum levels confirm normal renal function in patients with dronedarone-associated increase in serum creatinine. J Cardiovasc Pharmacol Ther. 2013;18(2):109. http://cpt.sagepub.com/content/18/2/109.abstract.

    Article  CAS  PubMed  Google Scholar 

  18. Van Slyke DD. The effect of urine volume on urea excretion. J Clin Invest. 1947;26:1159–67. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC439461/pdf/jcinvest00386-0111.pdf.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Austin JH, Stillman E, Van Slyke DD. Factors governing the excretion rate of urea. J Biol Chem. 1921;46:91–112. http://www.jbc.org/content/46/1/91.full.pdf.

    CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Rayner, H., Thomas, M., Milford, D. (2016). Measuring Kidney Function. In: Understanding Kidney Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-23458-8_2

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-23458-8_2

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-23457-1

  • Online ISBN: 978-3-319-23458-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics