Renal functional reserve
Serum creatinine and glomerular filtration rate (GFR) are the current standard tests to
measure kidney function. The baseline GFR does not reflect full function of the kidney since
human kidneys do not always work at full capacity. Similarly, serum creatinine is not a sensitive
measure for kidney function or injury. In healthy individuals the GFR physiologically increases
in response to certain stresses or stimuli, such as protein loading.
Renal functional reserve (RFR) is defined as the difference between the maximal
glomerular filtration rate (generally determined after oral or intravenous protein loading) and the
baseline glomerular filtration rate. The absence of a normal RFR can help identify patients who
are more susceptible to kidney injury. The RFR is also important in patients who develop acute
kidney injury and chronic kidney disease. Even though the GFR might return to a baseline
level, there may be some loss of RFR which can make the patient more susceptible to another
episode of kidney injury.
Acute kidney injury and chronic kidney disease are considered interconnected syndromes;
each is a risk factor for the other. There are no current recommendations regarding the
performance of routine determinations of RFR. Physicians should focus on clinical history and
physical examination in patients with a history of prior episodes of acute kidney injury, monitor
renal function, and avoid nephrotoxic insults.
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