title: [Estimation of glomerular filtration rate by inulin clearance: comparison with creatinine clearance].
abstract: Inulin clearance (Cin) is widely believed to be the gold standard of the glomerular filtration rate (GFR). However, in Japan, Cin has not been officially recognized by the Ministry of Health, Labour and Welfare of Japan for clinical use. Creatinine clearance (Ccr) has been used to estimate the renal function of patients, but there have been many studies in which Ccr estimates were GFR falsely high because the metabolism and tubular excretion of creatinine widely varied according to the pathophysiological state of the patient. In the present study, we determined Cin and Ccr simultaneously in 116 adult patients with renal diseases and diabetic mellitus. The clearance study was performed by the modified Wesson's method. The inulin preparation was FFI-1010 (Fuji Yakuhin Co. Ltd.). Inulin in serum and urine was determined by the newly devised enzymatic assay (Toyobo Co. Ltd.), which is specific for inulin. The mean Cin was 35.0 +/- 14.4 ml/min/1.73 m2. The mean Ccr(the enzyme assay) was 63.6 +/- 24.1 ml/min/1.73 m2 and that of the kinetic Jaffe assay was 55.3 +/- 19.3 ml/min/1.73 m2. Mean Ccr/Cin was 1.93 +/- 0.73, 1.69 +/- 0.62, respectively. This ratio was significantly different(p < 0.05) in the degree of reduction of Cin, with values of 2.07 +/- 0.82 (Cin < 40 ml/min/1.73 m2) and 1.64 +/- 0.32(40 < Cin < 80 ml/min/1.73 m2), respectively. Only 8 patients were classified into the same degree of reduced renal function (the Guideline of Japanese Society of Nephrology). The findings of this study suggest that the GFR determined by Ccr could misjudge the renal function of patient and delay the administration of proper treatment of the patient. Introduction of Cin into the clinical field is necessary to avoid this delay.
authors.affiliation: College of Nutrition Koshien University, Hyogo.
authors.forename: Yoshimasa
authors.initials: Y
authors.lastname: Orita
authors.forename: Fumitake
authors.initials: F
authors.lastname: Gejyo
authors.forename: Minoru
authors.initials: M
authors.lastname: Sakatsume
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Shiigai
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Maeda
authors.forename: Enyu
authors.initials: E
authors.lastname: Imai
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujii
authors.forename: Masayuki
authors.initials: M
authors.lastname: Endoh
authors.forename: Kiichiro
authors.initials: K
authors.lastname: Jinde
authors.forename: Masakazu
authors.initials: M
authors.lastname: Haneda
authors.forename: Toshiro
authors.initials: T
authors.lastname: Sugimoto
authors.forename: Akira
authors.initials: A
authors.lastname: Hishida
authors.forename: Satoru
authors.initials: S
authors.lastname: Takahashi
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Hosoya
authors.forename: Hiroyasu
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Hora
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Okada
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Hosaka
authors.forename: Tomomasa
authors.initials: T
authors.lastname: Oguchi
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Kanno
authors.forename: Yasuhide
authors.initials: Y
authors.lastname: Nishio
authors.forename: Shintaro
authors.initials: S
authors.lastname: Yano
authors.forename: Kazuo
authors.initials: K
authors.lastname: Aikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Yasui
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000652:urine; D002908:Chronic Disease; D003404:Creatinine / Q000652:urine; D003920:Diabetes Mellitus / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D005921:Glomerulonephritis / Q000175:diagnosis* / Q000503:physiopathology*; D006801:Humans; D007444:Inulin / Q000652:urine; D008297:Male; D008657:Metabolic Clearance Rate; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000175:diagnosis / Q000503:physiopathology
chemical_list: D015415:Biomarkers; D007444:Inulin; D003404:Creatinine