Limitations of Creatinine as a Filtration Marker in Glomerulopathic Patients
| Autor: | Bryan D. Myers, Ovadia Shemesh, Helen V. Golbetz, Joseph P. Kriss |
|---|---|
| Rok vydání: | 1986 |
| Předmět: |
medicine.medical_specialty
Metabolic Clearance Rate Urology Kidney Glomerulus Inulin Renal function Iothalamate Clearance Fractional clearance law.invention chemistry.chemical_compound law Internal medicine medicine Humans Longitudinal Studies Glomerular disease Particle Size Cimetidine Filtration Creatinine Inulin Clearance urogenital system business.industry Pentetic acid Technetium Dextrans Pentetic Acid Cross-Sectional Studies Endocrinology chemistry Nephrology Technetium Tc 99m Pentetate Kidney Diseases business Glomerular Filtration Rate medicine.drug |
| Zdroj: | Journal of Urology. 135:1111-1111 |
| ISSN: | 1527-3792 0022-5347 |
| DOI: | 10.1016/s0022-5347(17)46009-5 |
| Popis: | Limitations of creatinine as a filtration marker in glomerulopathic patients. To determine the reliability of creatinine as a measure of the glomerular filtration rate (GFR), we compared the simultaneous clearance of creatinine to that of three true filtration markers of graded size in 171 patients with various glomerular diseases. Using inulin (radius [rs] = 15 Å) as a reference marker, we found that the fractional clearance of 99mTc-DTPA (rs = 4 Å) was 1.02 ± 0.14, while that of a 19 Års dextran was 0.98 ± 0.13, with neither value differing from unity. In contrast, the fractional clearance (relative to inulin) of creatinine (rs = 3 Å) exceeded unity, averaging 1.64 ± 0.05 (P < 0.001), but could be lowered towards unity by acute blockade of tubular creatinine secretion by IV cimetidineCross-sectional analysis of all 171 patients revealed fractional creatinine secretion to vary inversely with GFR. This inverse relationship was confirmed also among individual patients with either deteriorating (N = 28) or remitting (N = 26) glomerular disease, who were studied longitudinally. As a result, changes in creatinine relative to inulin clearance were blunted considerably or even imperceptible. We conclude that true filtration markers with rs < 20 Å, including inulin, are unrestricted in glomerular disease, and that creatinine is hypersecreted progressively by remnant renal tubules as the disease worsens. Accordingly, attempts to use creatinine as a marker with which to evaluate or monitor glomerulopathic patients will result in gross and unpredictable overestimates of the GFR. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
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