Serum Creatinine and other Measures of GFR in Diabetes

  • Peter Rossing


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 [1]. 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.


Serum Creatinine Glomerular Filtration Rate Diabetic Nephropathy Renal Clearance Plasma Clearance 
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  1. 1.
    Modification of Diet in Renal Disease Study group., Levey AS, Gassman J, Hall PM, Walker WG: Assessing the progression of renal disease in clinical studies: effects of duration of follow-up and regression to the mean. J Am Soc Nephrol 1991;1:1087–1094.PubMedGoogle Scholar
  2. 2.
    Mitch WE, Walser M, Buffington GA, Lemann J: A simple method of estimating progression of chronic renal failure. Lancet 1976;ii: 1326–1328.CrossRefGoogle Scholar
  3. 3.
    Levey AS, Perrone RD, Madias NE: Serum creatinine and renal function. Ann Rev Med 1988;39:465–490.PubMedCrossRefGoogle Scholar
  4. 4.
    Shemesh O, Golbetz HV, Kriss JP, Myers BD: Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985;28:830–838.PubMedCrossRefGoogle Scholar
  5. 5.
    Jacobsen FK, Christensen CK, Mogensen CE, Andreasen F, Hejlskov NSC: Pronounced increase in serum creatinine concentration after eating cooked meat Br Med J 1979;1:1049–1050.PubMedCrossRefGoogle Scholar
  6. 6.
    van Acker BAC, Koome GCM, Koopman MG, de Waart DR, Arisz L: Creatinine clearance during Cimetidine administration for measurement of glomerular filtration rate. Lancet 1992;340:1326–1329.PubMedCrossRefGoogle Scholar
  7. 7.
    Cockcroft DW, Gault MH: Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31–41.PubMedCrossRefGoogle Scholar
  8. 8.
    Sampson MJ, Drury PL: Accurate estimation of glomerular filtration rate in diabetic nephropathy from age, body weight, and serum creatinine. Diabetes Care 1992;15:609–612.PubMedCrossRefGoogle Scholar
  9. 9.
    Waz WR, Qattrin T, Feld LG: Serum creatinine, height, and weight do not predict glomerular filtration rate in children with IDDM. Diabetes Care 1993;16:1067–1070.PubMedCrossRefGoogle Scholar
  10. 10.
    Rossing P, Astrup A-S, Smidt UM, Parving H-H: Monitoring kidney function in diabetic nephropathy. Diabetologia 1994;37:708–712.PubMedCrossRefGoogle Scholar
  11. 11.
    Lewis E, Hunsicker L, Bain R, Rhode R: The effect of angiotensin-converting-enzyme inhibition on diabetic nephropathy. N Engl J Med 1993,329:1456–1462.PubMedCrossRefGoogle Scholar
  12. 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. 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
  14. 14.
    Parving H-H, Andersen AR, Smidt UM: Monitoring progression of diabetic nephropathy. Upsala J Med Sci 1985;90:15–23.PubMedCrossRefGoogle Scholar
  15. 15.
    Viberti GC, Bilous RW, Mackintosh D, Keen H: Monitoring glomerular function in diabetic nephropathy. Am J Med 1983;74:256–264.PubMedCrossRefGoogle Scholar
  16. 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
  17. 17.
    Levey AS: Assessing the effectiveness of therapy to prevent the progression of renal disease. Am J Kidney Dis 1993;22:207–214.PubMedGoogle Scholar
  18. 18.
    Frimondt-Møller C: Diabetic cystopathy. Dan Med Bull 1978;25:49–60.Google Scholar
  19. 19.
    Bröchner-Mortensen J: Current status on assessment and measurement of glomerular filtration rate. Clin Physiol 1985;5:1–17.PubMedCrossRefGoogle Scholar
  20. 20.
    Bröchner-Mortensen J: Routine methods and their reliability for assessment of glomerular filtration rate in adults with special reference to total [51Cr]EDTA plasma clearance. Dan Med Bull 1978;25:181–202.PubMedGoogle Scholar
  21. 21.
    Bröchner-Mortensen J, Rödbro P: Selection of routine method for determination of glomerular filtration rate in adult patients. Scand J Clin Lab Invest 1976;36:35–45.PubMedCrossRefGoogle Scholar
  22. 22.
    Bröchner-Mortensen J: A simple method for the determination of glomerular filtration rate. Scand J Clin Lab Invest 1972;30:271–274.PubMedCrossRefGoogle Scholar
  23. 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
  24. 24.
    Parving H-H, Smidt UM, Hommel E, Mathiesen ER, Rossing P, Nielsen FS, Gall M-A: Effective Antihypertensive Treatment Postpones Renal Insufficiency in Diabetic Nephropathy. Am J Kidney Dis 1993;22:188–195.PubMedGoogle Scholar
  25. 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. 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
  27. 27.
    Rodby RA, Ali A, Rohde RD, Lewis E: Renal scanning 99mTc diethylene-triamine pentaacetic acid glomerular filtration rate (GFR) determination compared with iothalamate clearance GFR in diabetics. Am J Kidney Dis 1992;20:569–573.PubMedGoogle Scholar
  28. 28.
    Stake G, Monn E, Rootwell IT, Monclair T: The clearance of iohexol as a measure of glomerular filtration rate in children with chronic renal failure. Scand J Clin Lab Invest 1991;51:729–734.PubMedCrossRefGoogle Scholar
  29. 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

Copyright information

© Springer Science+Business Media Dordrecht 1998

Authors and Affiliations

  • Peter Rossing
    • 1
  1. 1.Steno Diabetes CenterGentofteDenmark

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