Measuring vs estimating glomerular filtration rate in kidney transplantation

Evaluation of kidney function is crucial in the care of kidney transplant recipients and in the design and interpretation of clinical trials in transplantation. Kidney function is most commonly assessed in both instances using serum creatinine concentration or an estimate of glomerular filtration rate (GFR) based on serum creatinine. These are inexpensive, widely available, and easily administered. Both have significant drawbacks, notably with respect to their inability to accurately identify changes in GFR. Novel markers of GFR such as cystatin C and β-trace protein show promise as accurate and sensitive markers of GFR but have not yet been adequately evaluated in kidney transplantation. In addition, they are relatively expensive compared to creatinine and their assays are not available in most clinical laboratories. Glomerular filtration rate measurement using a variety of different available tracers and techniques is infrequently used in either clinical care or research protocols because of its cost and cumbersomeness. This review will discuss the merits and pitfalls of the various tools available to evaluate GFR in kidney transplantation.