PMID: 18209420Jan 23, 2008Paper

Assessment of renal functional reserve by dynamic renal function testing

Saudi Journal of Kidney Diseases and Transplantation : an Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Sabine ZittaWillibald Estelberger

Abstract

Renal clearances of suitable clearance markers such as inulin and p-aminohippurate, determined before and after protein load, have been used for a long time to determine glomerular filtration rate (GFR), renal blood-flow, renal functional reserve as well as renal vascular resistance. Despite this long history, inconsistent results were achieved in determining renal functional reserve after protein ingestion or aminoacids infusion. Most authors found acute 'blunted increases' in GFR after dietary stresses, whereas others found acute decreases. In hypertensive patients showing hyperfiltration, a contradictory situation was observed; the traditionally observed 'blunted increase' in GFR and increase in the intraglomerular pressure were neither accompanied by a change in albumin excretion nor by an expected dynamic GFR response after administration of angiotensin converting enzyme (ACE)-inhibitors. We are of the opinion that the traditional clinical methods for assessing acutely provoked changes in renal function have been inappropriate and that an approach based on the two-compartment model of pharmacokinetics is more adequate for studying dynamic clearance changes within clinically feasible time horizons. Such test evaluations per...Continue Reading

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