Research Article| Volume 13, ISSUE 1, P33-52, March 1993

Assessment of Renal Function—Glomerular and Tubular

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      The tests most commonly used to estimate the status of renal function via alterations in glomerular filtration rate (GFR) are plasma creatinine concentration (PCr), blood, urea, nitrogen (BUN), and creatinine clearance (CCr). Unfortunately, these tests have some drawbacks. Nevertheless, they are quite useful to clinicians aware of their limitations, especially in many instances when it may be unnecessary or impractical to have precise measurements. Accordingly, serial measurements of PCr, especially when related to simultaneous BUN determinations, or CCr, may suffice. However, the functional status of the kidneys often needs to be corroborated by more precise methods when subtle changes in renal function are detected or when clinically indicated.
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        • Anderson C.F.
        • Jaecks D.M.
        • Ballows H.S.
        • et al.
        Renal handling of creatinine in nephrotic and non-nephrotic patients.
        Clin Sei. 1979; 38: 555
        • Baldwin D.W.
        • Sirota J.H.
        • Villarreal H.
        Diurnal variations of renal function in congestive heart failure.
        Proc Soc Exp Biol Med. 1950; 74: 758
        • Becker J.A.
        Evaluation of renal function.
        Radiology. 1991; 179: 337
        • Becker J.A.
        • Carvlin M.
        • Choyke P.L.
        • et al.
        Imagining of renal failure.
        in: Pollack H. Clinical Urography, vol 3. WB Saunders, Philadelphia1990: 2595
        • Berglund F.
        • Killander J.
        • Pompeius R.
        Effects of trimethoprim-sulfamethoxazole on the renal excretion of creatinine in man.
        J Urol. 1975; 114: 802
        • Blaufox M.D.
        Procedures of choice in renal nuclear medicine.
        J Nucl Med. 1991; 32: 1301
        • Bleiler R.E.
        • Schedl H.P.
        Creatinine excretion: Variability and relationship to diet and body size.
        J Lab Clin Med. 1962; 59: 945
        • Bloch K.
        • Schonheimer R.
        The biological precursors of creatinine.
        J Biol Chem. 1941; 138: 167
        • Bonsness R.W.
        • Taussky H.H.
        On the colorimetric determination of creatinine by the Jaffe reaction.
        J Biol Chem. 1945; 158: 581
        • Boorsook H.
        • Dubnoff J.W.
        The hydrolysis of phosphocreatine and the origin of urinary creatine.
        J Biol Chem. 1947; 163: 493
        • Bosch J.P.
        • Lauer A.
        • Glabman S.
        Short-term protein loading in assessment of patients with renal disease.
        Am J Med. 1984; 77: 873
        • Bosch J.P.
        • Saccaggi A.
        • Lauer A.
        • et al.
        Renal function reserve in humans. Effect of protein intake on glomerular filtration rate.
        Am J Med. 1983; 75: 943
        • Brod J.
        • Fend V.
        Diurnal variations of systemic and renal hemodynamics in normal subjects and in hypertensive disease.
        Cardiologia (Basel). 1957; 31: 494
        • Burbank J.K.
        • Tauxe W.M.
        • Maher F.T.
        • et al.
        Evaluation of radio-iodinated hippuran for estimation of renal plasma flow.
        Proc Staff Mayo Clin. 1961; 36: 372
        • Burgess E.
        • Blair A.
        • Krichman K.
        • et al.
        Inhibition of renal creatinine secretion by cimetidine in humans.
        Renal Physiol. 1982; 5: 27
        • Burry H.C.
        • Dieppe P.A.
        Apparent reduction of endogenous creatinine clearance by salicylate treatment.
        Br Med J. 1976; 2: 16
        • Camara A.A.
        • Arn K.D.
        • Reimer A.
        • et al.
        The 24-hour hourly endogenous creatinine clearance as a critical measure of functional state of the kidneys.
        J Lab Clin Med. 1951; 37: 743
        • Chan A.Y.M.
        • Cheng M.-L.I.
        • Keil L.C.
        • et al.
        Functional response of healthy and disease glomeruli to a large protein-rich meal.
        J Clin Invest. 1988; 81: 245
        • Chasson A.L.
        • Grady H.J.
        • Stamey M.A.
        Determination of creatinine clearance by means of automatic chemical analysis.
        Am J Clin Pathol. 1961; 35: 83
        • Christiansen J.S.
        • Gammelgaard J.
        • Frandsen M.
        • et al.
        Increased kidney size, glomerular filtration rate and renal plasma flow in short-term insulin dependent diabetes.
        Diabetologia. 1981; 20: 451
        • Clinicopathological Conference
        Nephrotic syndrome in a 76-year-old man.
        Am J Med. 1991; 91: 80
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31
        • Crim M.C.
        • Calloway D.H.
        • Margen S.
        Creatinine metabolism in man: Urinary creatine and creatinine excretion with creatine feeding.
        J Nutr. 1975; 105: 428
        • Dalton R.N.
        • Wiseman M.J.
        • Turnet C.
        • et al.
        Measurement of urinary para-aminohippuric acid in glycosuric patients.
        Kidney Int. 1988; 34: 117
        • Davies D.F.
        • Shock N.W.
        Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males.
        J Clin Invest. 1950; 29: 496
        • Doolan P.D.
        • Alpen E.L.
        • Theil G.
        A clinical appraisal of the plasma concentration and endogenous clearance of creatinine.
        Am J Med. 1962; 32: 65
        • Dossetor J.B.
        Creatininemia versus uremia: The relative significance of blood urea nitrogen and serum creatinine concentrations in azotemia.
        Ann Intern Med. 1966; 65: 1287
        • Dousa T.P.
        General principles of tubular function.
        in: Knox F.G. Textbook of Renal Pathophysiology. Harper & Row, Flagerstown MD1978: 54
        • Duarte C.G.
        • Elveback L.R.
        • Liedtke R.R.
        in: Duarte C.G. Renal Function Tests: Clinical Laboratory Procedures and Diagnosis. Little, Brown and Co, Boston1980: 1
        • Duarte C.G.
        • Elveback L.R.
        • Liedtke R.R.
        Glomerular filtration rate and renal plasma flow.
        in: Duarte C.G. Renal Function Tests: Clinical Laboratory Procedures and Diagnosis. Little, Brown and Co, Boston1980: 29
        • Du Bois E.F.
        • Du Bois D.
        Formula to estimate the approximate surface area if height and weight be known.
        Arch Intern Med. 1916; 17: 863
        • Elwood C.M.
        • Sigman E.M.
        • Treger C.
        The measurement of glomerular filtration rate with 125I-sodium iothalamate (Conray).
        Br J Radiol. 1967; 40: 581
        • Epstein F.H.
        • Goodyear A.N.
        • Lawrason F.D.
        • et al.
        Studies of the antidiuresis of quiet standing: the importance of changes in plasma volume and glomerular filtration rate.
        J Clin Invest. 1951; 30: 63
        • Espinel C.H.
        The FENA test. Use in the differential diagnosis of acute renal failure.
        JAMA. 1976; 236: 579
        • Fabiny D.L.
        • Ertingshausen G.
        Automated reaction-rate method for determination of serum creatinine with Centrichen.
        Clin Chem. 1971; 24: 1196
        • Fjeldbo W.
        • Stamey T.A.
        Adapted method for determination of inulin in serum and urine with AutoAnalyzer.
        J Lab Clin Med. 1968; 107: 353
        • Friedman E.A.
        Diabetic nephropathy: Strategies in prevention and management.
        Kidney Int. 1982; 21: 780
        • Friedman S.A.
        • Raiszner A.E.
        • Rosen H.
        • et al.
        Functional defects in the aging kidney.
        Ann Intern Med. 1972; 76: 41
        • Ganong W.F.
        Renal function and micturition.
        in: Review of Medical Physiology. ed 15. Appleton & Lange, Norwalk, CT1991: 649
        • Gershberg H.
        • Heinemann H.O.
        • Stumpf H.H.
        Renal function studies and autopsy report in patients with gigantism and acromegaly.
        J Clin Endocrinol Metab. 1957; 17: 337
        • Guignard J.-P.
        Renal function in the newborn infant.
        Med Clin North Am. 1982; 29: 777
        • Hakim R.M.
        • Goldszer R.C.
        • Brenner B.M.
        Hypertension and proteinuria: Long-term sequelae of uninephrectomy in humans.
        Kidney Int. 1984; 25: 930
        • Hankins D.A.
        • Babb A.L.
        • Uvelli D.A.
        • et al.
        Creatinine degradation. 1. The kinetics of creatinine removal in patients with chronic renal disease.
        Int J Artif Organs. 1981; 4: 35
        • Hansen A.P.
        Serum growth hormone patterns in juvenile diabetes.
        Dan Med Bull. 1972; 19: 3
        • Harvey R.B.
        • Brothers A.J.
        Renal extraction of p-aminohippurate and creatinine measured by continuous in vivo sampling of arterial and renal vein blood.
        NY Acad Sei. 1962; 102: 46
        • Healy J.K.
        Clinical assessment of glomerular filtration rate by different forms of creatinine clearance and a modified urinary phenolsulphonphtalein excretion test.
        Am J Med. 1968; 44: 348
        • Heinemann H.O.
        Creatinine clearance.
        in: Netter F.N. Kidney, Ureters and Urinary Bladder (The Ciba Collection of Medical Illustrations, vol 6). NJ, Summitt1973: 45
        • Hoberman H.D.
        • Sims E.A.H.
        • Peters J.H.
        Creatine and creatinine metabolism in the normal adult studied with the aid of isotope nitrogen.
        J Biol Chem. 1948; 172: 45
        • Husdan H.
        • Rappaport A.
        Estimation of creatinine by the Jaffe reaction: A comparison of three methods.
        Clin Chem. 1968; 14: 222
        • Ikkos D.
        • Ljungren H.
        • Luft R.
        Glomerular filtration rate and renal plasma flow in acromegaly.
        Acta Endocrinol. 1958; 21: 226
        • Israelit A.N.
        • Long D.L.
        • White M.G.
        • et al.
        Measurement of glomerular filtration rate utilizing a single subcutaneous injection of 125I-iothalamate.
        Kidney Int. 1973; 4: 346
        • Jackson S.
        Creatinine in urine as an index of urinary excretion rate.
        Health Phys. 1966; 12: 843
        • Jacobsen F.K.
        • Christensen C.K.
        • Mogensen C.E.
        Pronounced increase in serum creatinine concentration after eating cooked meat.
        Br Med J. 1979; 1: 1049
        • Jones J.D.
        • Burnett P.C.
        Implication of creatinine and gut flora in the uremic syndrome: Induction of “creatininase” in colonic contents of the rat by dietary creatinine.
        Clin Chem. 1972; 18: 280
        • Jones J.D.
        • Burnett P.C.
        Creatinine metabolism in humans with decreased renal function: creatinine deficit.
        Clin Chem. 1974; 20: 204
        • Jones J.D.
        • Burnett P.C.
        Creatinine metabolism and toxicity.
        Kidney Int. 1975; 7: S-294
        • Jones R.A.
        • McDonald G.O.
        • Last J.H.
        Reversal of diurnal variation in renal function in cases of cirrhosis and ascites.
        J Clin Invest. 1952; 31: 326
        • Kampmann J.P.
        • Hanson J.M.
        Glomerular filtration rate and creatinine clearance.
        Br J Clin Pharmacol. 1981; 12: 7
        • Kassirer J.
        • Harrington J.T.
        Laboratory evaluation of renal function.
        in: Schrier R.W. Gottschalk C.W. Diseases of the Kidney. ed 4. Little, Brown & Co, Boston1988: 333
        • Kim K.E.
        • Onesti G.
        • Ramirez O.
        • et al.
        Creatinine clearance in renal disease: A reappraisal.
        Br Med J. 1969; 4: 11
        • Lerner A.
        • DeLosAngeles A.
        • Goldstein S.
        • et al.
        Correlation of predicted glomerular filtration rate (PGFR) with measured creatinine and inulin clearance (abstract).
        Kidney Int. 1985; 27: 145
        • Levey A.S.
        Measurement of renal function in chronic renal disease. Nephrology Forum.
        Kidney Int. 1990; 38: 167
        • Levey A.S.
        • Madaio M.P.
        • Perrone R.D.
        Laboratory assessment of renal disease: Clearance, urinalysis and renal biopsy.
        in: Brenner B.M. Rector Jr, F.C. The Kidney. ed 4. WB Saunders, Philadelphia1991: 919
        • Levey A.S.
        • Perrone R.D.
        • Madaias N.E.
        Serum creatinine and renal function.
        Ann Rev Med. 1988; 39: 465
        • Liedtke R.R.
        • Duarte C.G.
        Laboratory protocols and methods for the measurement of glomerular filtration rate and renal plasma flow.
        in: Duarte C.G. Renal Function Tests: Clinical Laboratory Procedures and Diagnosis. Little, Brown & Co, Boston1980: 49
        • Ljungman S.
        • Grunerus G.
        The evaluation of kidney function in hypertensive patients.
        in: Laragh J.H. Brenner B.M. Hypertension: Pathophysiology, Diagnosis and Management. Raven Press, New York1990: 1493
        • Lubowitz H.
        • Slatopolski E.
        • Shankel S.
        • et al.
        Glomerular filtration rate determinations in patients with chronic renal disease.
        J Am Med Assoc. 1967; 199: 252
        • Luft F.
        • Fineberg N.S.
        • Miller J.
        • et al.
        The effects of age, race, and heredity on glomerular filtration rate following volume expansion and contraction in normal man.
        Am J Med Sei. 1980; 279: 15
        • Maddox D.A.
        • Brenner B.M.
        Glomerular ultrafiltration.
        in: Brenner B.M. Rector F.C. The Kidney. ed 4. WB Saunders, Philadelphia1991: 205
        • Mandeli E.E.
        • Jones F.L.
        Studies in nonprotein nitrogen. 111. Evaluation of methods measuring creatinine.
        J Lab Clin Med. 1953; 41: 423
        • Mayersohn M.
        • Conrad K.A.
        • Achari R.
        The influence of cooked meat meal on creatinine plasma concentration and creatinine clearance.
        Br J Clin Pharmacol. 1983; 15: 227
        • Memoli B.
        • Liberia C.
        • Sabbatini M.
        • et al.
        Renal reserve: Its significance in normal and salt depletion conditions.
        Kidney Int. 1991; 40: 1134
        • Mitch W.E.
        • Buffington J.
        • Lemann J.
        • et al.
        A simple method of estimating progression of chronic renal failure.
        Lancet. 1976; 2: 326
        • Mitch W.E.
        • Collier V.W.
        • Walser M.
        Creatinine metabolism in chronic renal failure.
        Clin Sei. 1980; 58: 327
        • Mogensen C.E.
        Renal function changes in diabetes.
        Diabetes. 1976; 25: 872
        • Mogensen C.E.
        • Andersen M.J.F.
        Increased renal size and glomerular filtration rate in early juvenile diabetes.
        Diabetes. 1973; 22: 706
        • Möller E.
        • McIntyre J.F.
        • Van Slyke D.D.
        Studies of urea excretion. 11. Relationship between urine volume and rate of urea excretion by normal adults.
        J Clin Invest. 1929; 6: 427
        • Osberg I.M.
        • Hammond K.B.
        A solution to the problem of bilirubin interference with the kinetic Jaffe method for serum creatinine.
        Clin Chem. 1978; 24: 1196
        • Ott N.T.
        • Wilson D.M.
        A simple technique for estimating glomerular filtration rate with subcutaneous injection of 125I-iothalamate.
        Mayo Clin Proc. 1975; 50: 664
        • Paaby P.
        • Brochner-Mortensen J.
        • Fjelborg P.
        • et al.
        Endogenous overnight creatinine clearance compared with 51Cr-EDTA clearance during the menstrual cycle.
        Acta Med Scand. 1987; 222: 281
        • Pasternack A.
        • Kuhlback B.
        Diurnal variation of serum and urine creatine and creatinine.
        Scand J Clin Lab Invest. 1971; 27: 1
        • Perrone R.D.
        • Steiman T.I.
        • Beck G.J.
        • et al.
        Utility of radioisotope filtration markers in chronic renal insufficiency: Simultaneous comparison of 125I-Iothalamate, 169Yb-DTPA, 99mTc-DTPA and inulin.
        Am J Kidney Dis. 1990; 16: 224
        • Pitts R.F.
        Tubular reabsorption.
        in: Physiology of the Kidney and Body Fluids: An Introductory Text. ed 3. Year Book Medical Publishers, Chicago1974: 71
        • Premen A.J.
        • Hall J.E.
        • Smith Jr, M.F.
        Postprandial regulation of renal hemodynamics: Role of pancreatic glucagon.
        Am J Physiol. 1987; 248: F656
        • Preuss H.G.
        Laboratory evaluation of renal patients.
        in: Preuss H.G. The Clinical Practice of Nephrology. Field & Wood Medical Publishers, New York1989: 1
        • Refsum N.E.
        • Stromme S.B.
        Relationship between urine flow, glomerular filtration, and urine solute concentration during prolonged heavy exercise.
        Scand J Clin Lab Invest. 1975; 35: 775
        • Richardson J.A.
        • Philbin P.E.
        The 1-hour creatinine clearance in healthy man.
        JAMA. 1971; 216: 987
        • Rolin H.
        • Hall P.M.
        Evaluation of glomerular filtration rate and renal plasma flow.
        in: Jacobson H.D. Striker G.E. Klahr S. The Principles and Practice of Nephrology. BC Decker, Philadelphia1991: 158
        • Rowe J.W.
        • Andres R.
        • Tobin J.D.
        • et al.
        Age-adjusted standards for creatinine clearance.
        Ann Intern Med. 1976; 84: 567
        • Rowe J.W.
        • Andres R.
        • Tobin J.D.
        • et al.
        The effect of age on creatinine clearance in man: A cross-sectional and longitudinal study.
        J Gerontol. 1976; 31: 155
        • Saah A.J.
        • Koch T.R.
        • Drusano G.L.
        Cefoxitin falsely elevates creatinine levels.
        JAMA. 1982; 247: 205
        • Shannon F.
        The renal excretion of creatinine in man.
        J Clin Invest. 1935; 14: 403
        • Shemesh O.
        • Golbetz H.
        • Kriss J.S.
        • et al.
        Limitations of creatinine as filtration marker in glomerulopathic patients.
        Kidney Int. 1985; 28: 830
        • Sherman R.A.
        Creatinine in the crock pot (letter).
        Arch Intern Med. 1981; 141: 543
        • Sirota J.H.
        • Baldwin D.S.
        • Villarreall H.
        Diurnal variations of renal function in man.
        J Clin Invest. 1950; 29: 187
        • Smith H.W.
        The reliability of inulin as a measure of glomerular filtration.
        in: The Kidney: Structure and Function in Health and Disease. Oxford University Press, New York1955: 231
        • Smith H.W.
        Measurements of the rate of glomerular filtration.
        in: Principles of Renal Physiology. Oxford University Press, New York1956: 25
        • Spriggs El
        On the excretion of creatinine and uric acid in some diseases involving the muscles.
        Q J Med. 1907; 41: 63
        • Tapson J.S.
        Prognosis after donor nephrectomy: An update.
        Int J Artif Organs. 1987; 10: 341
        • Vagnucci A.I.
        • Wesson Jr, L.G.
        Diurnal cycles of renal hemodynamics and excretion of chloride and potassium in hypertensive subjects.
        J Clin Invest. 1964; 43: 522
        • Walser M.
        • Drew H.H.
        • La France N.D.
        Reciprocal creatinine slopes often give erroneous estimates of progression of chronic renal failure.
        Kidney Int. 1989; 36: S-81
        • Werko L.
        • Bucht H.
        • Josephson B.
        The renal extraction of para-amino hippuric acid and oxygen in man during postural changes of the circulation.
        Scand J Clin Lab Invest. 1949; 1: 321
        • Wesson L.G.
        Glomerular filtration.
        in: Wesson L.G. Physiology of the Human Kidney. Grune & Stratton, New York1969: 82
        • Wesson L.G.
        Renal hemodynamics in pathological states.
        in: Wesson L.G. Physiology of the Human Kidney. Grune & Stratton, New York1969: 109
        • Wesson L.G.
        Renal hemodynamics in physiological states.
        in: Wesson L.G. Physiology of the Human Kidney. Grune & Stratton, New York1969: 96
        • West J.R.
        • Smith H.W.
        • Chasis H.
        Glomerular filtration rate, renal plasma flow, and maximal tubular excretory capacity in infants.
        J Pediatr. 1948; 32: 10
        • Young D.S.
        • Pestamer L.
        • Gibberman V.
        Effects of drugs on clinical laboratory tests.
        Clin Chem. 1975; 21: 1D