Measuring renal function in critically ill patients: tools and strategies for assessing glomerular filtration rate.
OBJECTIVE
Alterations in kidney function are common in critically ill patients and are generally assessed by changes in serum creatinine (sCr) or urine output, which are considered surrogates for glomerular filtration rate (GFR) but do not reflect the overall kidney function. There is a great need for more reliable measurements of glomerular filtration in order to guide diagnosis and therapy for acute kidney injury. In this review, we will focus on recent advances to measure GFR that could help to better evaluate kidney function and improve patient care.


RESULTS
Standardized assays for sCr measurements, the use of a more precise scale with more frequent measurements, and the interpretation of the results based on patient's characteristics can increase the clinical value of sCr. New endogenous and exogenous markers will provide a more precise estimation. Imaging techniques are being developed and will probably be available in the near future. New gold standards for glomerular filtration will help in the development and improvement in the use of new biomarkers of kidney injury.
aDivision of Nephrology, University of São Paulo, Avenida Dr Eneas de Carvalho Aguiar, São Paulo, Brazil bDivision of Nephrology, School of Medicine, University of California, San Diego, California, USA.
Etienne
E
Macedo
Ravindra L
RL
Mehta
D058186:Acute Kidney Injury / Q000097:blood / Q000503:physiopathology*; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood*; D003422:Critical Care / Q000379:methods* / Q000639:trends; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007677:Kidney Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D012016:Reference Values; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine