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General Pediatric Renal Replacement Options

Kidney Function Assessment

The glomerular filtration rate (GFR) is equal to the sum of the filtration rates in all of the functioning nephrons; therefore, estimating the GFR gives a rough measure of the number of functioning nephrons.

Initial calculations utilized to estimate GFR in children relied heavily upon serum creatinine concentration.
 Given the well-recognized influences on creatinine (ie, muscle mass) and the introduction of cystatin C as a reliable marker of renal function, a newer equation has since emerged. The “CKiD under 25” (also known as “U25”) is the most recently validated GFR estimating equation, which utilizes both age- and sex-specific constants “K” and incorporates creatinine as well as cystatin C.

The global nonprofit foundation Kidney Disease: Improving Global Outcomes (KDIGO) has stratified renal function in chronic kidney disease (CKD) based on the GFR.
 See Table 1 below.

Table 1. CKD Stage (Open Table in a new window)

CKD Stage* GFR (mL/min/1.73 m2)
1 ≥90
2 60-89
3a 45-59
3b 30-44
4 15-29
5 < 15

*The classification in Table 1 applies to children aged 2 years or older, because the GFR only becomes equivalent to that of adults between 1 and 2 years of age.

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