On the relationship between glomerular filtration rate and serum creatinine in children

The Schwartz formula (eGFR=kL/Scr, with k=0.55) to determine the estimated glomerular filtration rate (eGFR) in children with chronic kidney disease (CKD), based on length (L) and serum creatinine (Scr) has recently been updated for enzymatic serum creatinine concentrations, resulting in k=0.413. Based on a meta-analysis, we evaluated the validity of this updated equation and other published equations for healthy children. This is the first time that publicly available data for healthy children of uncorrected and body surface area (BSA)-corrected median GFR have been combined with median serum creatinine values and median lengths and weights from different sources in the literature to evaluate several statistical models to estimate GFR in children. For enzymatic serum creatinine, we show that the simple model for uncorrected GFR (uGFR=k'L-3/Scr, with k'=1.32x10(-5)) and the BSA-corrected GFR (cGFR=kL/Scr, analogous to the Schwartz formula), with an important age-dependent adaptation for k (k - 0.0414 x lndAge + 0.3018), correlate extremely well with chromium-51-ethylenediamine tetra-acetic acid (Cr-51-EDTA) data for children between 1 month and 14 years of age. With this age-dependent modification for k, presented here, the simple bedside calculation tool derived by Schwartz can be used for screening all children for CKD. When height information is not available, the Lund-Malmo equation is an excellent alternative.