The estimation of glomerular filtration in acute and critical illness: Challenges and opportunities

Reuben Roy, John MacDonald, Paul Dark, Philip Kalra, Darren Green

Research output: Contribution to journalReview articlepeer-review

Abstract

Recent events have made it apparent that the creatinine based estimating equations for glomerular filtration have their flaws. Some flaws have been known for some time; others have prompted radical modification of the equations themselves. These issues persist in part owing to the behaviour of the creatinine molecule itself, particularly in acute and critical illness. There are significant implications for patient treatment decisions, including drug and fluid therapies and choice of imaging modality (contrast vs. non-contrast CT scan for example). An alternative biomarker, Cystatin C, has been used with some success both alone and in combination with creatinine to help improve the accuracy of particular estimating equations. Problems remain in certain circumstances and costs may limit the more widespread use of the alternative assay. This review will explore both the historical and more recent evidence for glomerular filtration estimation, including options to directly measure glomerular filtration (rather than estimate), perhaps the holy grail for both Biochemistry and Nephrology.

Original languageEnglish
Article number110608
JournalClinical biochemistry
Volume118
Early online date20 Jul 2023
DOIs
Publication statusPublished - 1 Aug 2023

Keywords

  • Creatinine
  • Cystatin C
  • eGFR
  • Glomerular filtration

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