TY - JOUR
T1 - The estimation of glomerular filtration in acute and critical illness
T2 - Challenges and opportunities
AU - Roy, Reuben
AU - MacDonald, John
AU - Dark, Paul
AU - Kalra, Philip
AU - Green, Darren
N1 - Publisher Copyright:
© 2023 The Author(s)
PY - 2023/8/1
Y1 - 2023/8/1
N2 - 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.
AB - 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.
KW - Creatinine
KW - Cystatin C
KW - eGFR
KW - Glomerular filtration
UR - http://www.scopus.com/inward/record.url?scp=85165475433&partnerID=8YFLogxK
UR - https://www.mendeley.com/catalogue/61ba9cd5-5759-3d7c-acfe-9fed6dbfdc56/
U2 - 10.1016/j.clinbiochem.2023.110608
DO - 10.1016/j.clinbiochem.2023.110608
M3 - Review article
C2 - 37479107
AN - SCOPUS:85165475433
SN - 0009-9120
VL - 118
JO - Clinical biochemistry
JF - Clinical biochemistry
M1 - 110608
ER -