Estimation of Glomerular Filtration Rate in Preeclamptic Patients

ABSTRACT

Accurate estimation of the glomerular filtration rate (GFR) in patients with preeclampsia is often difficult or impossible to accomplish. In this study, the Cockcroft-Gault (CG), Modification of Diet in Renal Disease (MDRD), and MDRD2 formulas were evaluated for their accuracy in determining GFR in the setting of preeclampsia. The estimated GFR calculated from these formulas was compared with the creatinine clearance values obtained from a 24-hour urine collection in 209 preeclamptic patients recruited from five large hospitals. Additionally, a set of new equations that more accurately estimate GFR in preeclamptic patients based on ethnicity, preeclampsia GFR (PGFR), was created. Both the CG and MDRD formulas were inaccurate in predicting GFR in preeclamptic patients, and both were significantly less accurate than PGFR. In conclusion, current GFR estimation equations based on serum creatinine values in nonpregnant patients are not reliable measures of renal function in patients with preeclampsia. The use of a new (PGFR) formula is recommended.

Preeclampsia - glomerular filtration rate - renal function

REFERENCES

• 1 Rahn K H, Heidenreich S, Bruckner D. How to assess glomerular function and damage in humans.  J Hypertens. 1999;  17 309-317
• 2 Levey A S. Measurement of renal function in chronic renal disease.  Kidney Int. 1990;  38 167-184
• 3 Cockcroft D W, Gault M H. Prediction of creatinine clearance from serum creatinine.  Nephron. 1976;  16 31-41
• 4 Levey A S, Bosch J P, Lewis J B et al.. A more accurate method to estimate glomerular filtration from serum creatinine: a new prediction equation. Modification of diet in Renal Disease Study Group.  Ann Intern Med. 1999;  130 461-470
• 5 Rule A D, Larson T S, Bergstralh E J, Slezak J M, Jacobsen S J, Cosio F G. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease.  Ann Intern Med. 2004;  141 929-937
• 6 Poggio E D, Wang X, Greene T, Van Lente F, Hall P M. Performance of the modification of diet in renal disease and Cockcroft-Gault equations in the estimation of GFR in health and in chronic kidney disease.  J Am Soc Nephrol. 2005;  16 459-466
• 7 Davison J M, Dunlop W. Renal haemodynamics and tubular function in normal human pregnancy.  Kidney Int. 1980;  18 152-161
• 8 Davison J M, Dunlop W, Ezimokhai M. 24-hour creatinine clearance during the third trimester of normal pregnancy.  Br J Obstet Gynaecol. 1980;  87 106-109
• 9 Alper A B, Outland J, Finigan K, Pridjian G, Aina-Mumuney A, Puschett J. Phenotypic characteristics shared by preeclamptic patients and a model of the syndrome: report of a pilot study.  Am J Hypertens. 2006;  19 947-950
• 10 Hypertension in pregnancy. ACOG Tech Bull Jan (no 219) 1996
• 11 Lafayette R A, Druzin M, Sibley R et al.. Nature of glomerular dysfunction in pre-eclampsia.  Kidney Int. 1998;  54 1240-1249
• 12 Lafayette R A. The kidney in preeclampsia.  Kidney Int. 2005;  67 1194-1203
• 13 Karumanchi S A, Maynard S E, Stillman I E, Epstein F H, Sukhatme V P. Preeclampsia: a renal perspective.  Kidney Int. 2005;  67 2101-2113
• 14 Stevens L A, Manzi J, Levey A et al.. Impact of creatinine calibration on performance of GFR estimating equations in a pooled individual patient database.  Am J Kidney Dis. 2007;  50 21-35