Estimation of glomerular filtration rate in liver-transplanted children: comparison of simplified procedures using 51Cr-EDTA and endogenous markers with Sapirstein's method as a reference standard.
This study evaluated simple procedures for GFR determination in 48 liver-transplanted children. After injection of (51)Cr-EDTA, blood samples were obtained up to four h, and activity retention in the body was measured for 60 min with scintillation probes. As a reference, GFR was calculated according to Sapirstein. Simplified calculations were performed according to Brochner-Mortensen, Russel, Devaux and Oberhausen. Additionally, GFR was determined using plasma creatinine and cystatin C according to Schwartz and Filler, respectively. The reference revealed mildly reduced GFR (62 +/- 20 mL/min/1.73 m(2)). Russel's method provided the highest degree of correlation (r(2) = 0.95), the smallest bias in GFR determination (-2%), and only one false exclusion plus one false diagnosis of chronic kidney disease. Oberhausen's method with blood sampling at one h post-injection performed slightly worse (r(2) = 0.67, bias: 3%). All other methods resulted in significantly different GFR estimates compared to the reference. Nevertheless, notably, the second narrowest 95% limits of agreement (-31% to 45%) was observed using cystatin C. In conclusion, this data implies to prefer Russel's method as a simplified procedure, and if patients cannot be available long enough (four h) for measurements, Oberhausen's method instead. If radiotracer methods are not available at all or for screening GFR, cystatin C appears to be the procedure of choice.
Berding
Georg
G
Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany. berding.georg@mh-hannover.de
Geisler
Siegfried
S
Melter
Michael
M
Marquardt
Patricia
P
Lühr
Astrid
A
Scheller
Friedemann
F
Knoop
Bernd O
BO
Pfister
Eva-Doreen
ED
Pape
Lars
L
Bischoff
Lutz
L
Knapp
Wolfram H
WH
Ehrich
Jochen H H
JH
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002860:Chromium Radioisotopes; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood; D004492:Edetic Acid; D005260:Female; D005919:Glomerular Filtration Rate / Q000502:physiology; D006801:Humans; D007223:Infant; D007677:Kidney Function Tests / Q000379:methods; D016031:Liver Transplantation / Q000502:physiology*; D008297:Male; D011183:Postoperative Complications / Q000175:diagnosis; D012015:Reference Standards; D051436:Renal Insufficiency, Chronic / Q000175:diagnosis
D002860:Chromium Radioisotopes; D055316:Cystatin C; D004492:Edetic Acid; D003404:Creatinine