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Assessment of Kidney Function in Children, Adolescents, and Young Adults

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Pediatric Nephrology

Abstract

Kidney function undergoes developmental changes, including postnatal adaptation of nephron recruitment until approximately 18 months of age and glomerular hypertrophy thereafter. Accurate assessment of kidney function across post-conceptual age is important and needs to incorporate factors associated with the person (e.g., body habitus, growth, muscle mass, health status, illnesses, inflammation, and intra-personal variability), measurement technique (e.g., endogenous biomarkers, exogenous techniques, or imaging studies), and interpretation of measurements (e.g., equation used, correction factors, indexing to body surface area, or extracellular volume).

While nephron endowment would be the most important factor for an accurate clearance calculation of more than 60% of drugs processed by the kidney, this cannot be assessed directly. Effective renal plasma flow (ERPF) may be better to assess nephron endowment as it does not undergo autoregulation or hyperfiltration, in contrast to glomerular filtration. However, glomerular filtration rate (GFR) is still the best surrogate tool for kidney function assessment.

The gold standard to measure kidney function is inulin clearance; however, this is impractical. Measurement of GFR using either radiolabeled or cold exogeneous substances such as iohexol, iothalamate, etc. now serve as replacement for more accurate GFR determinations. In the clinical routine, endogenous markers are used, especially serum creatinine and cystatin C. Health care providers need to know when to use which endogenous biomarker(s).

In this chapter we will discuss historical aspects of kidney function measurement, exogenous and endogenous methods, and the technical aspects of assessment or interpretation in health and sickness, from the neonate to the transition-age periods.

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Abbreviations

AYA:

Adolescents and young adults

CAKUT:

Congenital anomalies of the kidneys and urinary tract

CKD:

Chronic kidney disease

CysC:

Cystatin C

DMSA:

Dimercapto succinic acid

DTPA:

Diethylenetriamine penta-acetic acid

EDTA:

Ethylenediamine tetra-acetic acid

eGFR:

Estimated glomerular filtration rate

ERPF:

Effective renal plasma flow

GFR:

Glomerular filtration rate

MAG3:

Mercaptuacetyltriglycine

PAH:

Paraaminohippuric acid

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Acknowledgments

We thank our patients and their parents/caregivers for participating in research projects to help optimize the care of children, adolescents, and young adults with kidney disease. We thank Ms. Ravneet Nagra, BSc, for her thorough review and edits of the final manuscript. We thank our families for the patience that was required to prepare this manuscript.

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Authors and Affiliations

  1. Department of Paediatrics, University of Western Ontario, London, ON, Canada

    Guido Filler

  2. Department of Paediatrics, Children’s Hospital, London Health Sciences Centre, London, ON, Canada

    Guido Filler

  3. University of North Carolina, Chapel Hill, NC, USA

    Maria Ferris

  4. Division of Pediatric Nephrology, UT Southwestern Medical Center, Dallas, TX, USA

    Jyothsna Gattineni

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  1. Guido Filler
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  2. Maria Ferris
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  3. Jyothsna Gattineni
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Corresponding author

Correspondence to Guido Filler .

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Editors and Affiliations

  1. Division of Nephrology, Department of Pediatric Specialties, Bambino Gesù Children’s Hospital – IRCCS, Rome, Italy

    Francesco Emma

  2. Division of Nephrology and Hypertension, The Heart Institute, Cincinnati Children’s Hospital Medical Center, College of Medicine, Cincinnati, OH, USA

    Stuart L. Goldstein

  3. Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Arvind Bagga

  4. Division of Pediatric Nephrology, UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA

    Carlton M. Bates

  5. Department of Paediatric Nephrology, Great Ormond Street Hospital for Children, NHS Foundation Trust and University College London Institute of Child Health, London, UK

    Rukshana Shroff

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Filler, G., Ferris, M., Gattineni, J. (2022). Assessment of Kidney Function in Children, Adolescents, and Young Adults. In: Emma, F., Goldstein, S.L., Bagga, A., Bates, C.M., Shroff, R. (eds) Pediatric Nephrology. Springer, Cham. https://doi.org/10.1007/978-3-030-52719-8_87

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  • DOI: https://doi.org/10.1007/978-3-030-52719-8_87

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  • Print ISBN: 978-3-030-52718-1

  • Online ISBN: 978-3-030-52719-8

  • eBook Packages: MedicineReference Module Medicine

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