Journal
CURRENT OPINION IN NEPHROLOGY AND HYPERTENSION
Volume 32, Issue 1, Pages 58-66Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MNH.0000000000000847
Keywords
intraglomerular pressure; renal hyperfiltration; SGLT2; single nephron glomerular filtration rate
Categories
Ask authors/readers for more resources
Assessing and estimating glomerular filtration rate (GFR) has been a long-standing challenge in medicine and public health. Current estimation formulas do not account for variations in body surface area (BSA) or metabolic rate compared to nephron number, and fail to define renal hyperfiltration accurately.
Purpose of reviewGlomerular filtration rate (GFR) assessment and its estimation (eGFR) is a long-lasting challenge in medicine and public health. Current eGFR formulae are indexed for standardized body surface area (BSA) of 1.73 m(2), ignoring persons and populations wherein the ratio of BSA or metabolic rate to nephron number might be different, due to increased BSA, increased metabolic rate or reduced nephron number. These equations are based on creatinine, cystatin C or a combination of the two, which adds another confounder to eGFR assessment. Unusually high GFR values, also known as renal hyperfiltration, have not been well defined under these equations.Recent findingsSpecial conditions such as solitary kidney in kidney donors, high dietary protein intake, obesity and diabetes are often associated with renal hyperfiltration and amenable to errors in GFR estimation. In all hyperfiltration types, there is an increased intraglomerular pressure that can be physiologic, but its persistence over time is detrimental to glomerulus leading to progressive glomerular damage and renal fibrosis. Hyperfiltration might be underdiagnosed due to BSA standardization embedded in the formula. Hence, timely intervention is delayed. Reducing intraglomerular pressure in diabetes can be achieved by SGLT2 inhibitors or low protein diet to reverse the glomerulopathy process.Accurate identification of glomerular hyperfiltration as a pre-CKD condition needs accurate estimation of GFR in the above normal range should establish a threshold for timely intervention.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available