A generic method for analysis of plasma concentrations

Clin Nephrol. 2020 Jul;94(1):43-49. doi: 10.5414/CN110056.

Abstract

The purpose of this NephEd contribution is to introduce a generic method for analyzing plasma concentrations ([x]p). The method is applicable to substances that are filtered by glomeruli, reabsorbed or secreted by tubules, and excreted in urine. The equality from which the method follows states that the filtration rate of substance x is the sum of excretion and net reabsorption rates of x (Fx = Ex + TRx). If x is completely ultrafilterable, Fx = GFR[x]p, and [x]p = Ex/GFR + TRx/GFR. If creatinine clearance (Ccr) is substituted for GFR, Ex/Ccr simplifies to [x]u[cr]p/[cr]u, which can be calculated from measurements in simultaneous aliquots of serum and urine. TRx/Ccr is then deduced as [x]p - Ex/Ccr. The ratios Ex/Ccr and TRx/Ccr - the determinants of [x]p - quantify the amounts of x excreted and reabsorbed per volume of filtrate. If [x]p is abnormal, the generic method identifies which of the determinants is creating the abnormality. If [x]p is normal despite disruptive circumstances, e.g., a reduced GFR, the method elucidates the preservation of normalcy. Herein, we develop these concepts and illustrate their practical utility.

MeSH terms

  • Biomarkers / blood*
  • Biomarkers / metabolism
  • Biomarkers / urine
  • Creatinine / blood
  • Creatinine / metabolism
  • Creatinine / urine
  • Glomerular Filtration Rate / physiology*
  • Humans
  • Kidney Function Tests / methods*
  • Kidney Glomerulus / physiology*
  • Metabolic Clearance Rate / physiology

Substances

  • Biomarkers
  • Creatinine