SULM – Schweizerische Union für Labormedizin | Union Suisse de Médecine de Laboratoire | Swiss Union of Laboratory Medicine

Summaries Swiss MedLab 2004


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L. Risch1 , A. Huber2

1Department of Internal Medicine, Academic Teaching Hospital, 6800 Feldkirch, Austria , 2Department of Laboratory Medicine, Kantonsspital, 5001 Aarau, Switzerland

Assessment of excretory renal function is of major importance in clinical medicine, as therapeutic regimens (i.e. dose adjustments or avoidance of drugs) and diagnostic procedures (i.e. administration of contrast agents) are altered in patients with impaired or deteriorating renal function. Many accurate methods for determining GFR have been described, including clearances of inulin or I [125I]iothalamate. Unfortunately, these methods are laborious and complicated and are thus not used for routine measurement of GFR. As a surrogate marker, serum creatinine determination is widely used in clinical routine. However, creatinine has significant disadvantages such as an inability to measure renal function impairment of 50% or less and a multitude of analytical interferences in the widely used Jaffé method. Although exhibiting better diagnostic characteristics, estimates of renal function by creatinine based formulas (e.g. Cockroft-Gault or MDRD formula) correct serum creatinine values for age, gender or body weight, but can not fully overcome the drawbacks of creatinine measurement. Determination of creatinine clearance is laborsome for patients and staff, and due to incompliance often poses preanalytical problems. Further, creatinine clearance leads to a significant overestimation of GFR in patients with decreased GFR and allows only a crude estimate of renal function with delayed availability of results. Finally, low molecular weight protein markers like cystatin C, Beta-2-microglobulin, or Beta-trace protein have been proposed as better markers of renal function than serum creatinine. However, these markers were also found to underlie biological interferences (e.g. glucocorticoids, thyroid function). As can be seen, each method has its own properties regarding diagnostic accuracy, costs, availability of results, ease of use for laboratory and patients, and risks for the patient. The use of a particular method results from an optimization process taking into account these properties. This talk discusses drawbacks and advantages of the different methods and emphasizes, which methods are best suited to be used in distinct clinical situations.

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