Abstract
Renal functional reserve (RFR) is the capacity of the kidney to increase its glomerular filtration rate (GFR) in response to physiological or pathological stimuli. The most commonly used stimuli to assess this reserve are an oral load of proteins of animal origin, amino acid infusions, dopamine, glucagon or combinations of them. RFR is calculated as the difference between stimulated and baseline GFR. Vegetarians have lower baseline GFR than the general population and an increased RFR. Subjects with only one kidney and those suffering from chronic nephropathies usually have a reduced or absent RFR despite having normal basal GFR. Quantification of RFR may be useful to detect subclinical renal damage, physiological conditions that reduce baseline GFR, evaluation of potential donors for kidney transplantation, suspected hyperfiltration, detection of renal lability against acute injuries or pregnancy and the evaluation after an acute renal injury when renal function seems to be recovered and residual subclinical damage is suspected.
Highlights
(Rev Med Chile 2019; 147: 1323-1328) Key words: Acute Kidney Injury; Exercise Test; Glomerular Filtration Rate; Kidney Failure, Chronic
En 1993 Fliser y col. compararon la velocidad de filtración glomerular (VFG) basal y estimulada en sujetos sanos, jóvenes y añosos, encontrando que la Renal functional reserve (RFR) era significativamente menor en los segundos, aunque los valores basales en los pacientes añosos eran normales[11]
Renal functional reserve: time to find a new bottle for the old wine? Clin Exp Nephrol 2018; 22: 4867
Summary
Renal functional reserve (RFR) is the capacity of the kidney to increase its glomerular filtration rate (GFR) in response to physiological or pathological stimuli. Quantification of RFR may be useful to detect subclinical renal damage, physiological conditions that reduce baseline GFR, evaluation of potential donors for kidney transplantation, suspected hyperfiltration, detection of renal lability against acute injuries or pregnancy and the evaluation after an acute renal injury when renal function seems to be recovered and residual subclinical damage is suspected. Se ha privilegiado a la velocidad de filtración glomerular (VFG) para cuantificar su función en forma global. La VFG a menudo es considerada como una función fija por los médicos no nefrólogos[5]. En sujetos sanos los riñones funcionan normalmente en aproximadamente 75% de su capacidad máxima (filtración glomerular basal), pudiendo adaptar su funcionamiento a demandas metabólicas y hemo-. Es la función cardiaca en reposo, en que el gasto es de alrededor de 5 L/min pudiendo aumentar hasta en 3 veces durante el ejercicio[3,9]
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