Abstract
The reference method to determine the glomerular filtration rate (GFR) in children is the urinary clearance of inulin during a continuous intravenous infusion. Alternatively, the plasma clearance of inulin can be determined, which does not require urine collection. This study compared the determination of the inulin plasma clearance in 24 pediatric patients by two methods: the single injection and the continuous infusion method. In the single injection method 5000 mg/m2 inulin was administered as bolus injection, and blood samples were drawn 10, 30, 90, and 240 min after administration. For the continuous infusion method inulin was started overnight and blood samples were collected the next day. The inulin plasma clearance determined by the single injection method was on average 9.7 ml min−1 1.73 m−2 higher than the clearance determined with the continuous infusion method (95% CI: 5.3–14.2). The difference between the two methods was smaller at lower GFRs. The difference in results generated by the two methods in children is small and is considered acceptable in clinical practice. For practical reasons, the single injection method with minimum sampling is preferred.
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References
Barratt TM, Avner ED, Harmon WE (1999) Pediatric nephrology, 4th edn. Lippincott Williams & Wilkins, Baltimore, pp 351–352
Earle DP, Berliner RW (1946) A simplified clinical procedure for measurement of glomerular filtration rate and renal plasma flow. Proc Soc Exp Biol Med 62:262–264
Hellerstein S, Berenbom M, Alon U, Warady BA (1993) The urinary clearance and infusion clearance of inulin are similar, but not identical. Kidney Int 44:1058–1061
Coulthard MG (1983) Comparison of methods of measuring renal function in preterm babies using inulin. J Pediatr 102:923–930
Van der Heijden AJ, Grose WF, Ambagtsheer JJ, Provoost AP, Wolff ED, Sauer PJ (1988) Glomerular filtration rate in the preterm infant: the relation to gestational and postnatal age. Eur J Pediatr 148:24–28
Rowland M, Tozer T (1994) Clinical pharmacokinetics, concepts and application, 3rd edn. Williams & Wilkins, USA, pp 70–71
Swinkels DW, Hendriks JCM, Nauta J, de Jong MCJW (2000) GFR by single-injection inulin clearance: definition of a workable protocol for children. Ann Clin Biochem 37:60–66
Van Rossum LK, Mathot RAA, Cransberg K, Vulto AG (2003) Optimal sampling strategies to assess inulin clearance in children by the inulin single injection method. Clin Chem 49:1170–1179
Florijn KW, Barendregt JNM, Lentjes EGWM, van Dam W, Prodjosudjadi W, van Saase JLCM et al (1994) Glomerular filtration rate measurement by single-shot injection of inulin. Kidney Int 46:252–259
Orlando R, Floreani M, Padrini R, Palatini P (1998) Determination of inulin clearance by bolus intravenous injection in healthy subjects and ascitic patients: equivalence of systemic and renal clearances as glomerular filtration markers. Br J Clin Pharmacol 46:605–609
Summerfield AL, Hortin GL, Smith CH, Wilhite TR, Landt M (1993) Automated enzymatic analysis of inulin. Clin Chem 39:2333–2337
Wong EC, Wilhite TR, Miller R, Smith CH, Landt M (1994) Less expensive enzymatic analysis for inulin with a kinetic assay. Clin Chem 40:1788–1789
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I 307–310
Muller-Suur R, Goransson M, Olsen L, Backlund G, Backlund L (1983) Inulin single injection clearance. Microsample technique useful in children for determination of glomerular filtration rate. Clin Physiol 3:19–27
Backlund L, Goransson M, Muller-Suur R, Olsen L (1983) Evaluation of glomerular filtration rate in infants. Acta Paediatr Scand Suppl 305:77–78
Koopman MG, Koomen GC, Krediet RT, de Moor EA, Hoek FJ, Arisz L (1989) Circadian rhythm of glomerular filtration rate in normal individuals. Clin Sci (Colch) 77:105–111
Acknowledgements
We thank the research nurses of the Department of Pediatric Nephrology, Erasmus MC-Sophia, for performing the inulin clearances. We also thank G.P. Koelewijn and S.M.A. Smit, laboratory technicians of the Department of Clinical Chemistry, Erasmus MC, for measuring the inulin concentrations. We are grateful to Dr. F. Derkx and Dr. R.A.A. Mathot, Department of Hospital Pharmacy, Erasmus MC, for their scientific support and helpful discussions. This project was made possible by a grant from College voor Zorgverzekeringen in the context of VAZ-doelmatigheidsonderzoek (project no. 00114).
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van Rossum, L.K., Cransberg, K., de Rijke, Y.B. et al. Determination of inulin clearance by single injection or infusion in children. Pediatr Nephrol 20, 777–781 (2005). https://doi.org/10.1007/s00467-004-1782-8
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DOI: https://doi.org/10.1007/s00467-004-1782-8