Glomerular Filtration Rate

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Andrew S Levey - One of the best experts on this subject based on the ideXlab platform.

Andrew D Rule - One of the best experts on this subject based on the ideXlab platform.

  • single nephron Glomerular Filtration Rate in healthy adults
    The New England Journal of Medicine, 2017
    Co-Authors: Aleksandar Denic, Jerry Mathew, Lilach O Lerman, John C Lieske, Mariam P Alexander, Emilio D Poggio, Joseph J Larson, Richard J Glassock, Andrew D Rule
    Abstract:

    BackgroundThe Glomerular Filtration Rate (GFR) assesses the function of all nephrons, and the single-nephron GFR assesses the function of individual nephrons. How the single-nephron GFR relates to demographic and clinical characteristics and kidney-biopsy findings in humans is unknown. MethodsWe identified 1388 living kidney donors at the Mayo Clinic and the Cleveland Clinic who underwent a computed tomographic (CT) scan of the kidney with the use of contrast material and an iothalamate-based measurement of the GFR during donor evaluation and who underwent a kidney biopsy at donation. The mean single-nephron GFR was calculated as the GFR divided by the number of nephrons (calculated as the cortical volume of both kidneys as assessed on CT times the biopsy-determined Glomerular density). Demographic and clinical characteristics and biopsy findings were correlated with the single-nephron GFR. ResultsA total of 58% of the donors were women, and the mean (±SD) age of the donors was 44±12 years. The mean GFR w...

  • using serum creatinine to estimate Glomerular Filtration Rate accuracy in good health and in chronic kidney disease
    Annals of Internal Medicine, 2004
    Co-Authors: Andrew D Rule, Timothy S Larson, Erik J Bergstralh, Steven J. Jacobsen, Jeff Slezak, Francisco G Cosio
    Abstract:

    The Modification of Diet in Renal Disease equation for Glomerular Filtration Rate (GFR) substantially underestimates GFR in healthy persons. A new equation developed with patients with chronic kidn...

Lesley A Stevens - One of the best experts on this subject based on the ideXlab platform.

Josef Coresh - One of the best experts on this subject based on the ideXlab platform.

  • Measured and estimated Glomerular Filtration Rate: current status and future directions
    Nature Reviews Nephrology, 2020
    Co-Authors: Andrew S Levey, Tom Greene, Hocine Tighiouart, Josef Coresh, Lesley A. Inker
    Abstract:

    Evaluation of Glomerular Filtration Rate (GFR) is central to the assessment of kidney function in medical practice, research and public health. Measured GFR (mGFR) remains the reference standard, but the past 20 years have seen major advances in estimated GFR (eGFR). Both eGFR and mGFR are associated with error compared with true GFR. eGFR is now recommended by clinical practice guidelines, regulatory agencies and public health agencies for the initial evaluation of GFR, with measured GFR (mGFR) typically considered an important confirmatory test, depending on how accuRate the assessment of GFR needs to be for application to the clinical, research or public health setting. Our approach is to use initial and confirmatory tests as needed to develop a final assessment of true GFR. We suggest that GFR evaluation might be improved by more complete implementation of current recommendations and by further research to improve the accuracy of mGFR and eGFR. The authors of this Perspectives article describe the physiological and statistical principles underlying measured Glomerular Filtration Rate (mGFR) and estimated Glomerular Filtration Rate (eGFR). They discuss their limitations, the circumstances under which mGFR and eGFR should be used, and approaches to improve these methodologies.

  • using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating Glomerular Filtration Rate
    Annals of Internal Medicine, 2006
    Co-Authors: Andrew S Levey, Lesley A Stevens, Tom Greene, Josef Coresh, Yaping Zhang, John W. Kusek, Stephen Hendriksen, Frederick Van Lente
    Abstract:

    Using standardized creatinine assays, the authors remeasured serum creatinine levels in 1628 patients whose Glomerular Filtration Rate (GFR) had been measured by urinary clearance of 125I-isothalam...

  • assessing kidney function measured and estimated Glomerular Filtration Rate
    The New England Journal of Medicine, 2006
    Co-Authors: Lesley A Stevens, Tom Greene, Josef Coresh, Andrew S Levey
    Abstract:

    In the coming years, estimates of the Glomerular Filtration Rate (GFR) may replace the measurement of serum creatinine as the primary tool for the assessment of kidney function. Indeed, many clinical laboratories already report estimated GFR values whenever serum creatinine is measured. This review considers current methods of measuring GFR and GFR-estimating equations and their strengths and weaknesses as applied to chronic kidney disease.

  • clinical practice guidelines for chronic kidney disease in adults part ii Glomerular Filtration Rate proteinuria and other markers
    American Family Physician, 2004
    Co-Authors: Cynda Ann Johnson, Josef Coresh, Andrew S Levey, Adeera Levin, Garabed Eknoyan
    Abstract:

    The Kidney Disease Outcome Quality Initiative of the National Kidney Foundation published clinical practice guidelines on chronic kidney disease in February 2002. Of the 15 guidelines, the first six are of greatest relevance to family physicians. Part II of this two-part review covers guidelines 4, 5, and 6. Glomerular Filtration Rate is the best overall indicator of kidney function. It is superior to the serum creatinine level, which varies with age, sex, and race and often does not reflect kidney function accuRately. The Glomerular Filtration Rate can be estimated using prediction equations that take into account the serum creatinine level and some or all of specific variables (age, sex, race, body size). In many patients, estimates of the Glomerular Filtration Rate can replace 24-hour urine collections for creatinine clearance measurements. Urine dipsticks generally are acceptable for detecting proteinuria. To quantify proteinuria, the ratio of protein or albumin to creatinine in an untimed (spot) urine sample is an accuRate alternative to measurement of protein excretion in a 24-hour urine collection. Patients with persistent proteinuria have chronic kidney disease. Other techniques for evaluating patients with chronic kidney disease include examination of urinary sediment, urine dipstick testing for red and white blood cells, and imaging studies of the kidneys (especially ultrasonography). These techniques also can help determine the underlying cause of chronic kidney disease. Family physicians should weigh the value of the National Kidney Foundation guidelines for their clinical practice based on the strength of evidence and perceived cost-effectiveness until additional evidence becomes available on the usefulness of the recommended quality indicators.

  • estimating the prevalence of low Glomerular Filtration Rate requires attention to the creatinine assay calibration
    Journal of The American Society of Nephrology, 2002
    Co-Authors: Josef Coresh, Garabed Eknoyan, Andrew S Levey
    Abstract:

    To the Editor: In the May issue of JASN , Clase et al . ([1][1]) report a much higher estimate of the prevalence of low Glomerular Filtration Rate (GFR) than recently published in the National Kidney Foundation Kidney Disease Outcomes Quality Initiative (K/DOQI) Clinical Practice Guidelines, “

Richard J Glassock - One of the best experts on this subject based on the ideXlab platform.

  • single nephron Glomerular Filtration Rate in healthy adults
    The New England Journal of Medicine, 2017
    Co-Authors: Aleksandar Denic, Jerry Mathew, Lilach O Lerman, John C Lieske, Mariam P Alexander, Emilio D Poggio, Joseph J Larson, Richard J Glassock, Andrew D Rule
    Abstract:

    BackgroundThe Glomerular Filtration Rate (GFR) assesses the function of all nephrons, and the single-nephron GFR assesses the function of individual nephrons. How the single-nephron GFR relates to demographic and clinical characteristics and kidney-biopsy findings in humans is unknown. MethodsWe identified 1388 living kidney donors at the Mayo Clinic and the Cleveland Clinic who underwent a computed tomographic (CT) scan of the kidney with the use of contrast material and an iothalamate-based measurement of the GFR during donor evaluation and who underwent a kidney biopsy at donation. The mean single-nephron GFR was calculated as the GFR divided by the number of nephrons (calculated as the cortical volume of both kidneys as assessed on CT times the biopsy-determined Glomerular density). Demographic and clinical characteristics and biopsy findings were correlated with the single-nephron GFR. ResultsA total of 58% of the donors were women, and the mean (±SD) age of the donors was 44±12 years. The mean GFR w...

  • association between estimated Glomerular Filtration Rate at initiation of dialysis and mortality
    Canadian Medical Association Journal, 2011
    Co-Authors: William F Clark, Yingbo Na, Steven J Rosansky, Jessica M Sontrop, Jennifer J Macnab, Kirby L Jackson, Richard J Glassock, Paul W Eggers, Louise Moist
    Abstract:

    Background Recent studies have reported a trend toward earlier initiation of dialysis (i.e., at higher levels of Glomerular Filtration Rate) and an association between early initiation and increased risk of death. We examined trends in initiation of hemodialysis within Canada and compared the risk of death between patients with early and late initiation of dialysis. Methods The analytic cohort consisted of 25 910 patients at least 18 years of age who initiated hemodialysis, as identified from the Canadian Organ Replacement Register (2001–2007). We defined the initiation of dialysis as early if the estimated Glomerular Filtration Rate was greater than 10.5 mL/min per 1.73 m 2 . We fitted time-dependent proportional-hazards Cox models to compare the risk of death between patients with early and late initiation of dialysis. Results Between 2001 and 2007, mean estimated Glomerular Filtration Rate at initiation of dialysis increased from 9.3 (standard deviation [SD] 5.2) to 10.2 (SD 7.1) ( p 2 among those with early initiation and 7.1 (SD 2.0) mL/min per 1.73 m 2 among those with late initiation. The unadjusted hazard ratio (HR) for mortality with early relative to late initiation was 1.48 (95% CI 1.43–1.54). The HR decreased to 1.18 (95% CI 1.13–1.23) after adjustment for demographic characteristics, serum albumin, primary cause of end-stage renal disease, vascular access type, comorbidities, late referral and transplant status. The mortality differential between early and late initiation per 1000 patient-years narrowed after one year of follow-up, but never crossed and began widening again after 24 months of follow-up. The differences were significant at 6, 12, 30 and 36 months. Interpretation In Canada, dialysis is being initiated at increasingly higher levels of Glomerular Filtration Rate. A higher Glomerular Filtration Rate at initiation of dialysis is associated with an increased risk of death that is not fully explained by differences in baseline characteristics.

  • Routine reporting of estimated Glomerular Filtration Rate: not ready for prime time
    Nature Reviews Nephrology, 2008
    Co-Authors: Richard J Glassock, Christopher G. Winearls
    Abstract:

    According to the Kidney Disease Outcomes Quality Initiative guidelines, estimated Glomerular Filtration Rate can be used to diagnose chronic kidney disease. The authors of this Viewpoint argue, however, that reliance on estimated Glomerular Filtration Rates alone encourages an erroneous disregard of age, gender and other evidence of kidney disease, such as proteinuria. Consequently, mandatory reporting of estimated Glomerular Filtration Rate leads to misdiagnosis of chronic kidney disease and to the unhelpful referral of healthy individuals to nephrologists.

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