By Brian J G Pereira; Mohamed H Sayegh; Peter Gerard Blake
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Extra info for Chronic kidney disease, dialysis, and transplantation : a companion to Brenner and Rector's the kidney
19. Moore AE, Park-Holohan SJ, Blake GM, Fogelman I: Conventional measurements of GFR using 51Cr-EDTA overestimate true renal clearance by 10 percent (See comment). Eur J Nucl Med Mol Imaging 2003; 30(1):4-8. 20. Rehling M, Moller ML, Thamdrup B, et al: Simultaneous measurement of renal clearance and plasma clearance of 99mTc-labelled diethylenetriaminepenta-acetate, 51Cr-labelled ethylenediaminetetra-acetate and inulin in man. Clin Sci (Colch) 1984; 66(5):613-619. 21. Mortensen JB, Rodbro P: Comparison between total and renal plasma clearance of [51Cr] EDTA.
Excretion of more than 30 mg/24 hours (microalbuminuria) is abnormal but may be transient due to such circumstances as exercise, pregnancy, and medications. If persistent, it may reflect the presence of kidney damage. 14 Although albumin excretion rate is currently considered the principal predictor for progression of diabetic nephropathy, this is not applicable to individuals presenting with increased creatinine and normoalbuminuria and may not be applicable even to patients with microalbuminuria in the era of tighter glycemic and blood pressure control and wide spread use of angiotensin converting enzyme inhibition.
Each method has particular strengths, weaknesses, and limitations. Inulin clearance remains the gold standard. For clinical purposes, creatinine and cysC are good markers for measuring GFR. For clinical management, serum creatinine-based estimates of GFR, including the CockcroftGault and MDRD equations, are the preferred methods. For research purposes, inulin and iothalamate clearances are accurate, reliable, and reproducible measures of GFR. Although cysC appears to be a promising new endogenous marker for measuring GFR, further studies are needed.