Glomerular Filtration Rate in Children with Chronic Kidney Disease

Abstract

Schwartz et al. (1) have reported a new formula for estimating the glomerular filtration rate (GFR)1 in children with chronic kidney disease (CKD). This is an excellent analysis based on a carefully described, prospectively recruited cohort of children with various types of kidney diseases that have compromised function. The analysis is precise and the results seem to provide a more accurate, noninvasive method of estimating the GFR of children. The obvious first question raised about a study is: Why is it important? In this case, aren’t there existing methods of estimating GFR in these children, and wouldn’t a measured GFR be more accurate and reliable? As indicated in the article, there are 2 important reasons to have an improved method for readily estimating GFR: Knowledge of the GFR would be valuable in adjusting the doses of nephrotoxic medications in children with CKD, and the method is a useful tool in plotting the decline of renal function if it is coupled with intermittent direct measures. As important as these reasons are, they may understate the importance and significance of this work. First, some background. The nephrology community, including the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), professional associations such as the American Society of Nephrology and the American Society of Pediatric Nephrology, and patient advocacy and support organizations such as the National Kidney Foundation, have developed educational programs to alert …