Document Detail

Understanding estimated glomerular filtration rate: implications for identifying chronic kidney disease.
MedLine Citation:
PMID:  17420668     Owner:  NLM     Status:  MEDLINE    
PURPOSE OF REVIEW: Glomerular filtration rate (GFR) can be estimated using serum markers such as serum creatinine (SCr) or cystatin C. This review presents new insights into estimated GFR based on theory, validation studies, SCr assay standardization, cystatin C, and longitudinal comparison with measured GFR. RECENT FINDINGS: The estimation of GFR by SCr differs in health and in chronic kidney disease (CKD) due to differences in GFR range and in creatinine production between these two populations. Among populations with normal baseline GFR, there is a more rapid decline in measured GFR than in SCr-based estimated GFR. While elevated SCr is specific for CKD, other disease processes may lead to elevated cystatin C. Validation is improved by refitting equation coefficients to compare populations, recognizing the asymmetry between estimated GFR and measured GFR, and using residual plots instead of Bland-Altman plots to assess bias. SUMMARY: As a screening test, SCr should be interpreted as a marker of CKD probability in the context of the patient's clinical presentation. Measured GFR or creatinine clearance may be helpful in high-risk patients with normal SCr levels. GFR estimating equations should be reserved for patients with identified CKD. Standardized SCr and cystatin C assays are needed.
Andrew D Rule
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Current opinion in nephrology and hypertension     Volume:  16     ISSN:  1062-4821     ISO Abbreviation:  Curr. Opin. Nephrol. Hypertens.     Publication Date:  2007 May 
Date Detail:
Created Date:  2007-04-10     Completed Date:  2007-06-07     Revised Date:  2008-11-21    
Medline Journal Info:
Nlm Unique ID:  9303753     Medline TA:  Curr Opin Nephrol Hypertens     Country:  England    
Other Details:
Languages:  eng     Pagination:  242-9     Citation Subset:  IM    
Division of Nephrology, Mayo Clinic, Rochester, Minnesota, USA.
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MeSH Terms
Biological Markers / blood*
Cardiovascular Diseases / blood,  diagnosis
Chronic Disease
Creatinine / blood
Cystatin C
Cystatins / blood
Glomerular Filtration Rate*
Kidney Diseases / blood,  diagnosis*,  physiopathology
Kidney Function Tests / methods
Mass Screening / methods*,  standards
Models, Biological
Predictive Value of Tests
Reproducibility of Results
Sensitivity and Specificity
Reg. No./Substance:
0/Biological Markers; 0/CST3 protein, human; 0/Cystatin C; 0/Cystatins; 60-27-5/Creatinine

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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