By Brian J G Pereira; Mohamed H Sayegh; Peter Gerard Blake

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Extra info for Chronic kidney disease, dialysis, and transplantation : a companion to Brenner and Rector's the kidney

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In the African-American Study of Kidney Disease and Hypertension (AASK) study ad hoc analysis, overall estimated GFR (MDRD equation) and measured GFR (iothalamate clearance) provided similar results in terms of the outcome of rate of decline in GFR. However, there were subtle differences in some of the other GFR based outcomes. 63 At this time, the MDRD equation is widely used to estimate glomerular filtration rate and to stage chronic kidney disease. In the future, better estimation equations using serum creatinine and other factors known to influence kidney function should be developed.

Knight EL, Verhave JC, Spiegelman D, et al: Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 2004; 65:1416-1421. Woitas RP, Stoffel-Wagner B, Flommersfeld S, et al: Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis. Clin Chem 2000; 46(5):712-715. Stabuc B, Vrhovec L, Stabuc-Silih M, Cizej TE: Improved prediction of decreased creatinine clearance by serum cystatin C: Use in cancer patients before and during chemotherapy.

The protocol is similar to that used for renal clearance of inulin or iothalamate, except that endogenous creatinine in blood and urine is the marker for estimating GFR. This method is inexpensive because the creatinine assay is widely available, reproducible, and not costly. However, like other renal clearance techniques, it is time-consuming. 0. 45 Even though it is a safe marker, factors limiting its current use include reduced access and higher cost of laboratory methods for measuring cysC as compared to SCr, which may make it a less attractive alternative for clinical use.

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