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• • • • • • • Glomerular Filtration Rate (GFR) affects many people worldwide, and a great number of people will have milder degrees of damage. This can go undetected and untreated for many years.
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An acute or chronic problem of the kidneys can be discovered when an abnormal result is detected on routine or tests. If any abnormalities are detected, it is important that the kidneys are further investigated to rule out any reversible causes and to reveal the likely cause of your kidney deterioration. Once this has been determined, the doctor can initiate management and optimise treatment for your kidney condition. You may have heard of the – a value that is becoming increasingly useful to help measure your level of kidney function. The GFR can give the doctor an indication of how much damage has been done to the kidneys and determine your stage of kidney disease.
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By monitoring the trends and changes in the GFR over a period of time, the course of your disease can be observed. The earlier kidney disease is detected, the better the chances of slowing progression of disease and restoring function of the kidneys. Multiple studies have been performed in patients with kidney disease and the diagnosis and further investigation of kidney disease has been guided by results of these studies. For example, the Kidney Disease Outcomes Quality Initiative (K/DOQI) released a comprehensive set of guidelines, which support the use of the GFR in helping diagnose kidney impairment. A reduction in the GFR has been shown to correlate with the amount of kidney damage present.
The blood creatinine level is one of the most commonly used measures in assessing the overall kidney function. Is a waste product in your blood that is produced after muscle activity. It is normally removed by the kidneys, but when the kidney fails to function to it’s normal capacity, the creatinine level rises. However, creatinine is affected by many factors and varies between patients due to differences in age, sex and muscle mass.
Compared to blood creatinine levels, the GFR provides a much more accurate picture of kidney function, taking into consideration these factors of patient age, gender and lean weight. What is the GFR and how do we calculate it?
Your GFR tells you how much kidney function you have. It is defined as the sum of the filtration rates of all your functioning (filtering units making up the kidneys). An estimate of the normal value for your GFR can be obtained by using the equation: GFR = 140 – [your age]. For example, if you are a fit, healthy 30 yr old, your GFR should be approximately 110mls/min.
• It is also important to remember that your GFR is affected by other factors such as gender, age and your body size. There is considerable variation even amongst people in the population who have similar characteristics. There are many formulae that can be used to calculate the GFR, but you will hear of commonly used formulas such as the Cockcroft & Gault and the MDRD formulas.The Cockcroft-Gault equation, accounts for age, sex and muscle mass (this value is multiplied by 1.23 for men, to account for a greater fraction of the body weight being composed of muscle): Creatinine clearance = [140 – age (years)] x LBW (kg) x 1.23 (if male) (mls/min) Serum creatinine (umol/L) Automatic calculators are now available that can directly calculate the GFR. To gain an idea of your GFR, you should input your age, Lean Body Weight (LBW) and you also need creatinine levels from your blood tests. Your lean body weight is approximately: Height (cm) – 100, and also equal to the expected serum creatinine if you are female and have normal kidney function. If your actual weight is less than the values calculated for the lean body weight, you should use this weight. • MDRD (modification of diet in renal disease).