How is renal function assessed in patients with azotemia?

Updated: Sep 19, 2018
  • Author: Moro O Salifu, MD, MPH, FACP; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Radionuclide assessment of the GFR is the best available test for measuring kidney function. However, this test is expensive and not widely available, and as a result, serum creatinine concentration and creatinine clearance (CrCl) more commonly are used to estimate GFR.

An inverse relation between serum creatinine and the GFR exists; however, serum creatinine and CrCl are not sensitive measures of kidney damage, for 2 reasons. First, substantial renal damage can take place before any decrease in the GFR occurs. Second, a substantial decline in the GFR may lead to only a slight elevation in serum creatinine (see the image below). Because of compensatory hypertrophy and hyperfiltration of the remaining healthy nephrons, an elevation in serum creatinine is apparent only when the GFR falls to about 60-70 mL/min.

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