Serum Creatinine and other Measures of GFR in Diabetes
The measurement of renal function or the glomerular filtration rate (GFR) in diabetes can be used 1) to estimate the renal clearance of drugs to guide dosing or to identify patients at increased risk for radiocontrast-induced acute renal failure, 2) for confirming the need for treatment of end stage renal disease, or 3) to measure progression of chronic renal disease i.e. diabetic nephropathy. The evaluation of progression in renal disease is important in the clinical setting for the monitoring of development of renal insufficiency and evaluation of the effectiveness of treatment in the individual, as well as in research to evaluate the importance of putative progression promoters in observational studies or to assess and compare the rate of progression in experimental groups in clinical trials. In order to obtain a valid assessment of the rate of decline in GFR it is necessary with regular measurements of GFR over a period of at least (2)-3 years applying a method with high precision and accuracy . This is due to the usually rather slow rate of decline in GFR in diabetic nephropathy. The ideal method for assessing GFR does not exist and the available methods differ regarding precision and accuracy, cost, inconvenience and safety. In general the more precise methods are being more expensive and inconvenient. Thus one has to select a method according to the clinical situation.
KeywordsSerum Creatinine Glomerular Filtration Rate Diabetic Nephropathy Renal Clearance Plasma Clearance
Unable to display preview. Download preview PDF.
- 12.Klahr S, Levey AS, Beck GJ, Caggiula AW, Hunsicker L, Kusek JW, Striker G, For The Modification Of Diet In Renal Disease Study Group: The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal disease. N Engl J Med 1994;330:877–884.PubMedCrossRefGoogle Scholar
- 13.Levey AS, Bosch JP, Coggins CH, Greene T, Mitch WE, Schluchter MD, Schwab SJ, The Modification of Diet in Renal Disease Study: Effects of diet and blood pressure on creatinine clearance (Co) and serum creatinine (Pcr) in the MDRD study. J Am Soc Nephrol 1993;4:253(Abstract)Google Scholar
- 16.Kasiske BL, Keane WF: Laboratory assessment of renal disease: clearance, urinalysis, and renal biopsy; in Brenner BM (ed): The kidney. Philadelphia, Saunders, 1997, pp 1137–1174.Google Scholar
- 18.Frimondt-Møller C: Diabetic cystopathy. Dan Med Bull 1978;25:49–60.Google Scholar
- 23.Sambataro M, Thomaseth K, Pacini G, Robaudo C, Carraro A, Bruseghin M, Brocco E, Abaterusso C, DeFerrari G, Fioretto P, Maioli M, Tonolo G, Crepaldi G, Nosadini R: Plasma clearance rate of 51Cr-EDTA provides a precise and convenient technique for measurement of glomerular filtration rate in diabetic humans. J Am Soc Nephrol 1996;7:118–127.PubMedGoogle Scholar
- 25.Chantier C, Garnett ES, Parsons V, Veall N: Glomerular filtration rate measurement in man by the single injection method using 51Cr-EDTA Clin Sci 1969;37:169–180.Google Scholar
- 26.Carlsen, J.E., Lehd Moller M, Lund JO, Trap-Jensen J: Comparison of four commercial Tc-99 (sn) DTPA preparations used for the measurement of glomerular filtration rate: concise communication. JNucl Med 1980;126–129.Google Scholar
- 29.Mantini G, Datton RN, Tomlinson PA The estimation of glomerular filtration rate from single injection plasma inulin measurements using numerical analysis. Abst Paeditr 1989;cl28 (Abstract).Google Scholar