Which glomerular filtration rate estimation formula should be used for nephrological evaluation in patients with common variable immune deficiency?
Abstract
Background: Common variable immunodeficiency (CVID) is the most common primary immunodeficiency in adults. In addition to renal complications of the disease, there may be an increased likelihood of renal dysfunction due to sucrose in immunoglobulin replacement therapies or other drugs used in treatment. In CVID patients, it is important to monitor patients for renal complications at routine intervals. We compared creatinine-based calculation methods for estimated glomerular filtration rate (eGFR) such as Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault (CG), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) with 24-hour urine creatinine clearance measurement. We aimed to investigate which calculation method was more reliable and consistent in this patient population.
Methods: The records of 14 patients who had clinical follow-up at our hospital were retrospectively reviewed. Patients’ eGFR values were measured by three different methods (CKD-EPI, MDRD , and CG formulas). The 24-hour urinary creatinine clearance of all patients and e-GFR calculated by the formula were compared.
Results: The eGFR calculated using the MDRD formula was 122.99±41.22 mL/min/1.73 m2, whereas the eGFR measured using the 24-hour urinary creatinine clearance was 99.64(83.35-156.58) mL/min/1.73 m2. Moreover, eGFR calculated by CKD-EPI formula was 113.83±26.46 mL/min/1.73 m2, while eGFR calculated by CG formula was 133.52±45.35 mL/min/1.73 m2. 24-hour urinary creatinine clearance was positively correlated with MDRD, CKD-EPI and CG formulas (r=0.726, p=0.003, r=0.634, p=0.015, r=0.806, p=0.001, respectively).
Conclusions: We found that all creatinine-based formulas used in clinical practice for eGFR measurement correlate with 24-hour urine creatinine clearance in patients with CVID. In addition, we have shown that eGFR calculated with the formula CKD-EPI is more closely related to 24-hour urinary creatinine clearance. Therefore, we believe that the eGFR measurement calculated with CKD-EPI is more useful for nephrological follow-up of patients with CVID. It should be noted that our study has some limitations due to the
small number of patients.
Keywords
Common Variable Immune Deficiency , Cockcroft-Gault , Common Variable Immune Deficiency , Chronic Kidney Disease Epidemiology Collaboration , Cockcroft-Gault , Glomerular Filtration Rate , Modification of Diet in Renal Disease.
References
- 1. Bonilla FA, Barlan I, Chapel H, Costa-Carvalho BT, Cunningham- Rundles C, de la Morena MT, et al. International Consensus Document (ICON): Common Variable Immunodeficiency Disorders. J Allergy Clin Immunol Pract. 2016;4(1):38-59.
- 2. Picard C, Bobby Gaspar H, Al-Herz W, Bousfiha A, Casanova JL, Chatila T, et al. International Union of Immunological Societies: 2017 Primary Immunodeficiency Diseases Committee Report on Inborn Errors of Immunity. J Clin Immunol. 2018;38(1):96-128.
- 3. Endo LM, Giannobile JV, Dobbs AK, Foote JB, Szymanska E, Warnock DG, et al. Membranous glomerulopathy in an adult patient with X-linked agammaglobulinemia receiving intravenous gammaglobulin. J Investig Allergol Clin Immunol. 2011;21(5):405-9.
- 4. Fakhouri F, Robino C, Lemaire M, Droz D, Noel LH, Knebelmann B, et al. Granulomatous renal disease in a patient with common variable immunodeficiency. Am J Kidney Dis. 2001;38(2):E7.
- 5. Meyer A, Lachmann HJ, Webster AD, Burns A, Thway K. Hypercalcemia in a patient with common variable immunodeficiency and renal granulomas. Am J Kidney Dis. 2005;45(5):e903.
- 6. Tsuji K, Uchida HA, Ono T, Inoue T, Shinagawa K, Kitamura S, et al. A case of focal segmental glomerulosclerosis in an adult patient with hypogammaglobulinemia superimposed on membranoproliferative glomerulonephritis in childhood. BMC Nephrol. 2012;13:46.
- 7. Aydin Z, Gursu M, Ozturk S, Kilicaslan I, Kazancioglu R. A case of primary immune deficiency presenting with nephrotic syndrome. NDT Plus. 2010;3(5):456-8.
- 8. Capistrano GG, Meneses GC, de Oliveira Neves FM, de Almeida Leitao R, Martins AMC, Liborio AB. Renal Evaluation in Common Variable Immunodeficiency. J Immunol Res. 2018;2018:5841031.
- 9. Toto RD. Conventional measurement of renal function utilizing serum creatinine, creatinine clearance, inulin and para-aminohippuric acid clearance. Curr Opin Nephrol Hypertens. 1995;4(6):505-9; discussion 3-4.
- 10. Conley ME, Notarangelo LD, Etzioni A. Diagnostic criteria for primary immunodeficiencies. Representing PAGID (Pan-American Group for Immunodeficiency) and ESID (European Society for Immunodeficiencies). Clin Immunol. 1999;93(3):190-7.