title: 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.
abstract: 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.
authors.affiliation: Department of Nuclear Medicine, Hannover Medical School, Hannover, Germany. berding.georg@mh-hannover.de
authors.forename: Georg
authors.initials: G
authors.lastname: Berding
authors.forename: Siegfried
authors.initials: S
authors.lastname: Geisler
authors.forename: Michael
authors.initials: M
authors.lastname: Melter
authors.forename: Patricia
authors.initials: P
authors.lastname: Marquardt
authors.forename: Astrid
authors.initials: A
authors.lastname: Lühr
authors.forename: Friedemann
authors.initials: F
authors.lastname: Scheller
authors.forename: Bernd O
authors.initials: BO
authors.lastname: Knoop
authors.forename: Eva-Doreen
authors.initials: ED
authors.lastname: Pfister
authors.forename: Lars
authors.initials: L
authors.lastname: Pape
authors.forename: Lutz
authors.initials: L
authors.lastname: Bischoff
authors.forename: Wolfram H
authors.initials: WH
authors.lastname: Knapp
authors.forename: Jochen H H
authors.initials: JH
authors.lastname: Ehrich
mesh_terms: 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
chemical_list: D002860:Chromium Radioisotopes; D055316:Cystatin C; D004492:Edetic Acid; D003404:Creatinine