Chapter

The assessment of kidney function

Eric P. Cohen and Jean-Marie Krzesinski

in Cancer and the Kidney

Second edition

Published on behalf of Oxford University Press

Published in print November 2010 | ISBN: 9780199580194
Published online November 2012 | e-ISBN: 9780191753404 | DOI: http://dx.doi.org/10.1093/med/9780199580194.003.0001

Series: Oxford Clinical Nephrology Series

The assessment of kidney function

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This case illustrates the use of the serum creatinine and the equations dependent on its value to estimate the glomerular filtration rate (GFR). It shows clearly the difficulty in the assessment and management of reduced kidney function in subjects with cancer. In them, as in this patient, a low body and muscle mass will reduce the creatinine production, and what appears to be a normal serum creatinine will instead indicate a reduced GFR. The formula-based estimates of GFR appear in this case to have been overestimates, whereas the 24-hour urine studies indicated a GFR of about 25 mL/min. That latter value is consistent with her adverse response to the intravenous acyclovir.

The level, or amount, of kidney function is often conflated with the GFR, or even more commonly, with the level of the serum creatinine. While this approximation is useful for day-to-day management, it has some inaccuracies and it ignores some of the other aspects of kidney function, including proteinuria and the differentiation of tubular from glomerular injury. This chapter will discuss the assessment of kidney function by history and physical exam, urinalysis, testing the GFR, assessment of proteinuria and testing the renal tubular function.

Chapter.  6705 words.  Illustrated.

Subjects: Nephrology

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