Use of any serum creatinine-based estimate requires that kidney function be at a steady state. Kidney Int. See here for more on our approach to addressing race and bias on MDCalc. Enter a numeric height of at least 0.1 centimeters (cm), Estimated Glomerular Filtration Rate Calculators, U.S. Department of Health and Human Services, National Kidney Foundations eGFR calculator, Estimating Time to ESRD in Children with CKD calculator, National Institute of Diabetes and Digestive and Kidney Diseases. Therefore, all laboratories should use an IDMS traceable equation when estimating and reporting GFR. Cookie Preferences. We are upgrading our pediatric eGFR calculator. Serum creatinine values obtained while kidney function is changing will not provide accurate estimates of kidney function. GFR may be best assessed by monitoring trends over time rather than a single point estimate. Estimated glomerular filtration rate (eGFR) calculated using either the MDRD Study equation or the CKD-EPI equation is an estimate of GFR, not the actual GFR. Persistent and increased albuminuria has been shown to be an independent risk factor for CKD progression. Creatinine measurement: state of the art in accuracy and interlaboratory harmonization. Read more about the task force here. The range of scores below 60 may be used to monitor treatment and disease progression. The NIDDKs eGFR calculators rely on creatinine determinations that are isotope dilution mass spectrometry (IDMS) traceable. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases official version of the modified score here. Despite improvements to the MDRD equation, it tends to significantly underestimate measured GFR. Researchers pooled data from multiple studies to develop and validate this new equation. Incase of children it is used the Schwartz formula: When the childs height is expressed in inches, the height should be converted from inches to centimeters: 1 inch = 2.54 cm. For comparison purposes, the results for three prevalent formulas used for estimating GFR are provided. The equation is given in the following table for creatinine in mg/dL (see Appendix for creatinine in mol/L). The results are reported as the number of milligrams (mg) of albumin for every gram (g) of creatinine. It uses just one blood test result for serum creatinine. But even people whove taken excellent care of their health can be at risk for CKD. adjusted for the patient's body surface area) will be calculated (units: mL/min). Standardized creatinine values are traceable to isotope dilution mass spectrometry (IDMS). The National Kidney Foundation recommends using the CKD-EPI Creatinine Equation (2021) to estimate GFR. is 0.7 for females and 0.9 for males, These equations are valid only with standardized creatinine and cystatin methods. The normal range of GFR adjusted for body surface area is 100 to 130 mL/min/1.73m2 in men and 90 to 120mL/min/1.73m2 in women below the age of 40. These equations have traditionally included the person's age, sex . All rights reserved. Creatinine clearance is a measure of how well the kidneys filter creatinine out of the bloodstream for excretion in urine. is -0.329 for females and -0.411 for males, Can be used to estimate kidney function for CKD staging. Creatinine clearance is usually determined from a measurement of creatinine in a 24-hour urine sample and from a serum sample taken during the same time period. Assessment of kidney function through eGFR is essential once albuminuria is discovered. Can be used to adjust or discontinue medications based on kidney function. Incase of adultsthere are few methods to determine GFR as they are presented below: The IDMS-traceable MDRD equation formula: GFR = 175 * (SCr)-1.154* (Age)-0.203* (0.742 only if female) * (1.212 only if black). For patients ages 18 to 25, we recommend using both the pediatric 2021 CKiD U25 calculator and the adult calculator. GFR-estimating equations have poorer agreement with measured GFR for ill hospitalized patients and for people with near normal kidney function than for the patients in the MDRD or CKD-EPI Study. The creatinine- based calculated eGFR has improved the validity of serum creatinine which is considered alone an insensitive index of glomerular function whereby at least approximately 50% of glomerular function has to be lost before creatinine is . Accuracy of the CKD-EPI and MDRD equations to estimate GFR for the validation data set (N=3896). Estimates glomerular filtration rate based on creatinine and patient characteristics. The MDRD equation performs equally to the newer. Laboratories should program their information systems to use an IDMS traceable creatinine-based equation to automatically estimate and report GFR for patients ages 18 and older, when appropriate and feasible. Kidney disease of diabetes. Creatinine is a break down product of the creatinine phosphate from muscles. It is normally removed from your blood by your kidneys, but when kidney function slows down, the creatinine level rises. This may be the case with patients of extreme body size or muscle mass (e.g., bodybuilders; people with obesity; those who are severely malnourished, amputees, or paraplegics; [1] Miller WG, Myers GL, Ashwood ER, et al. The receiver operator curves (ROC) for detecting GFR categories less than 90, 75, 60, 45, 30 and 15 mL/min per 1.73 m2 did not differ between the CKD-EPI and MDRD Study equations.1, 2. All creatinine-based estimates of kidney function are only useful when renal function is stable. Renal Failure Index (RFI) Calculator for Acute Tubular Necrosis, STONE Nephrolithometry For Kidney Stones Calculator. Advertising revenue supports our not-for-profit mission. Call Knowing your eGFR and understanding which stage youre in can help you take steps to preserve kidney function and track any progression. We are upgrading our adult eGFR calculators. Historically, this error was balanced by an error of almost equal magnitude in the measurement of the serum creatinine. Kidneys help clean blood of different waste products and toxins and transport them out of the body through urine. [5] Perrone RD, Madias NE, Levey AS. The normal serum creatinine reference interval does not necessarily reflect a normal GFR for a patient. A GFR score below 60 suggests kidney disease. This includes pregnant women; patients with serious co-morbid conditions; and hospitalized patients, particularly those with acute renal failure. Healthy kidneys filter creatinine out of the blood. doi:10.1053/j.ajkd.2021.08.003, [2] Pierce CB, Muoz A, Ng DK, Warady BA, Furth SL, Schwartz GJ. How is GFR Determined and Interpreted? 1985;28(5):8308. Refer to the table below for population mean estimated GFR for a number of age ranges. Comparing the estimates from both calculators may provide a more informed assessment of kidney function for the patient. Just as your blood pressure and cholesterol levels are important factors in knowing your risk for heart disease, your GFR is important in knowing your risk for CKD. Assessment for CKD staging and CKD progression should generally be assessed using the indexed eGFR value. This value shows how much substance from blood is filtered by the kidneys and contained in urine. Creatinine clearance Choosing "No" will calculate an indexed eGFR value, standardized to a body surface area of 1.73m2 (units: mL/min/1.73m2). This health tool will evaluate and retrieve the overall index of kidney function for adults and children in two separate tabs by taking account of the serum creatinine level, age, sex and race. Below there is a table describing the chronic kidney disease stages: 1) Guyton, Arthur; Hall, John (2006) Chapter 26: Urine Formation by the Kidneys: I. Glomerular Filtration, Renal Blood Flow, and Their Control. Kidney International. Mayo Clinic does not endorse companies or products. As shown in the figure below, the CKD-EPI equation and the MDRD Study equation were equally accurate in a subgroup with estimated GFR (eGFR) less than 60 mL/min/1.73 m2. Your exact GFR cannot be measured directly. 2009;75(10):10718. Why is creatinine used to estimate GFR? eGFR calculators that provide estimates without use of a race coefficient are preferred for adults and children.1 Assessing eGFR trends to observe kidney function change over time, rather than using a single point estimate of eGFR, may provide a more meaningful indicator of prognosis. For a urine test, youll need to provide a single sample in the clinic or collect samples at home over 24 hours and return them to the clinic. Related to the optimal GFR level, the 60mL/min/1.73m2 level is adequate. Albumin is a protein in blood. This includes, but is not limited to, individuals who are amputees, paraplegics, or bodybuilders, or have obesity; patients who have a muscle-wasting disease or a neuromuscular disorder; and those suffering from malnutrition, eating a vegetarian or low-meat diet, or taking creatine dietary supplements. Table 2: CKD EPI Equation for Estimating GFR Expressed for Specified Race, Sex and Serum Creatinine in mol/L (Adapted from Ann Intern Med 2009;150:604-612, used with permission). 2010;25:44957. For comparison purposes, the results for three prevalent formulas used for estimating GFR are provided. Arch Pathol Lab Med. [7] Rule AD, Bailey KR, Schwartz GL, Khosla S, Lieske JC, Melton LJ, 3rd. Call Always seek the advice of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition. A low GFR demonstrates kidney disease.The decline in kidney function can be either acute (sudden, often reversible) or chronic (long-term and permanent). eGFR stands for estimated Glomerular Filtration Rate. People in early stages 1-3 of CKD, for example, may want to focus on lifestyle changes and eating a kidney-friendly diet. To reduce interlaboratory variation in creatinine assay calibration and enable more accurate eGFR results, all major manufacturers have calibrated their serum creatinine measurement procedures to be traceable to IDMS. A creatinine test is a measure of how well your kidneys are performing their job of filtering waste from your blood. Use our GFR calculators to estimate GFR for adults or children. Your doctor should use the results of your serum creatinine test to calculate your GFR. Mayo Clinic College of Medicine and Science, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Graduate Medical Education, Mayo Clinic School of Continuous Professional Development, Mayo Clinic on Incontinence - Mayo Clinic Press, NEW Mayo Clinic on High Blood Pressure - Mayo Clinic Press, Mayo Clinic on Hearing and Balance - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Financial Assistance Documents Minnesota, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition, Monoclonal gammopathy of undetermined significance (MGUS), To make a diagnosis if you have signs or symptoms of kidney disease, To screen for kidney disease if you have diabetes, high blood pressure or other conditions that increase the risk of kidney disease, To monitor kidney disease treatment or progression, To monitor for side effects of drugs that may include kidney damage or altered kidney function, To monitor the function of a transplanted kidney, For adult men, 0.74 to 1.35 mg/dL (65.4 to 119.3 micromoles/L), For adult women, 0.59 to 1.04 mg/dL (52.2 to 91.9 micromoles/L). Estimate Glomerular Filtration Rate (GFR), U.S. Department of Health and Human Services, Making Sense of CKDA Concise Guide for Managing Chronic Kidney Disease in the Primary Care Setting. [4] Shemesh O, Golbetz H, Kriss JP, Myers BD. An estimated GFR (eGFR) calculated from serum creatinine using an isotope dilution mass spectrometry (IDMS) traceable equation is a simple and effective way in which laboratories can help health care providers detect CKD among those with risk factorsdiabetes, hypertension, cardiovascular disease, or family history of kidney disease. Clinical Journal of the American Society of Nephrology 6(8): 1813-14. Because mild and moderate kidney injury is poorly inferred from serum creatinine alone, NIDDK strongly recommends the use of either the MDRD Study or CKD-EPI equation to estimate GFR from serum creatinine in adults. Higher muscle mass increases serum creatinine for any given rate of clearance. Take the next step to early kidney disease detection. Albumin/creatinine ratio describes how much albumin is in a urine sample relative to how much creatinine there is. In some cases, your care team may recommend modifying your daily routine to incorporate an exercise program and a kidney-friendly diet. The cystatin C values are not corrected for IFCC calibration. Note that the sooner that kidney disease is diagnosed and treated, the higher the probability that the need for dialysis can be prevented. Rohren CH (expert opinion). From Ann Intern Med 2009;150:604-612, used with permission. GFR = 141 min (Scr /, 1) max(Scr /, 1)-1.209 0.993Age 1.018 [if female] 1.159 [if black] Creatinine is a chemical compound left over from energy-producing processes in your muscles. Kidney International Supplements 63: S151-4. max indicates the maximum of Scr / or 1. eGFR is more accurate than serum creatinine alone. The original Cockcroft-Gault equation, derived in 1976, relied on non-standardized creatinine measurements. However, the actual GFRs of those individuals will be distributed around that eGFR. PMID 9407445. ; Standardized cystatin C values are traceable to the International Federation of Clinical Chemistry and Laboratory Medicine (IFCC)/Institute for Reference Materials and . 1992;38(10):193353. Creatinine-based estimates of kidney function are only useful when renal function is stable; serum creatinine values obtained while kidney function is changing will not provide accurate estimates of kidney function. You can't find out your GFR on your own because you need specific data from a blood test. All rights reserved. Each stage of kidney disease matches up to an eGFR range, and knowing which stage youre in can help you identify the steps you need to take to stay your healthiest. There are several estimation equations and even online calculators; the American Society of Nephrology and National Kidney Foundation recommends the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation. Estimating GFR begins with a simple serum creatinine blood test. Calculate estimated GFR (eGFR) from serum creatinine levels to assess kidney function. It is only useful in estimating glomerular filtration rate (GFR) in stable chronic kidney disease. GFR = [UCr x V] SCr This formula is called the creatinine clearance and tends to exceed the true GFR by 10 to 20 percent or more depending upon the proportion of urinary creatinine that is derived from tubular secretion [ 4 ]. The GFR in the measurement of volume filtered through the glomerular capillaries and into the Bowman's capsule per unit of time. Textbook of Medical Physiology (Book) (11th ed.) If youre using our GFR calculator, your eGFR is calculated using the results of your blood test, along with your age, ethnicity, and gender. With the use of internationally standardized creatinine measurements, the equation significantly overestimates the GFR (10-40%). This calculator should only be used for children ages 1 to 16. Creatinine-based estimating equations may not be suitable for all populations. As noted above, providers should exercise judgment regarding clinical status when presented with an MDRD Study- or CKD-EPI-derived eGFR for a patient with an unstable creatinine level or other condition for which the equation is not suitable. The most used method in practice involves measuring serum creatinine levels. Assessment of kidney function. In Gruliow, Rebecca. eGFR should be used with caution in acutely ill or hospitalized patients who may exhibit rapidly changing kidney function. Make your tax-deductible gift and be a part of the cutting-edge research and care that's changing medicine. How Do Doctors Compute GFR? The results you receive from this tool are for informational purposes only and should not be the basis of your medical decision making. Copyright 2014 - 2023 The Calculator .CO |All Rights Reserved|Terms and Conditions of Use, Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. It also varies from person to person based on age, gender, muscle mass, and ethnicity. Journal of the American Society of Nephrology. NKF and the American Society of Nephrology have convened a Task Force to focus on the use of race to estimate GFR. Limitations using creatinine as a filtration marker: both the. Related to the optimal GFR level, the 60mL/min/1.73m 2 level is adequate. Regardless of the equation used to calculate estimated glomerular filtration rate (eGFR), the eGFR value is an estimate and is not a precise measure of kidney function. 2021;99(4):948956. All laboratories should be using creatinine methods calibrated to be IDMS traceable. In order to accomplish this task it returns the GFR value based on a few creatinine equations that will be described below. Use the chart below to determine which CKD stage best matches your GFR calculator results and click on the stage to learn about healthy next steps. Serum creatinine is reported as milligrams of creatinine to a deciliter of blood (mg/dL) or micromoles of creatinine to a liter of blood (micromoles/L). Clin Chem. Your doctor may ask you not to eat (fast) overnight before the test. 1-888-373-1470, Need help? For estimating creatinine clearance measuring muscle mass gives better results than those based on demographics. Development and validation of GFR-estimating equations using diabetes, transplant and weight. Please use the NIDDK-funded CKiD U25 eGFR calculator,2 an interactive app developed by the hCode team, to calculate eGFR for children and young adults ages 1 to 25. Estimating gfr begins with a simple serum creatinine blood test. A laboratory that reports eGFR numeric values > 60 mL/min/1.73 m2 should use the CKD-EPI equation, because the CKD-EPI equation is more accurate for values > 60 mL/min/1.73 m2 than is the MDRD Study equation. While you may recognize the GFR as a result that simply comes back on the lab slip, its important to note that this result is based on a calculation that includes serum creatinine, age and gender. Accurate timing and collection of the urine sample is important. Comparing the estimates from both calculators may provide a more informed assessment of kidney function for the patient. Because it includes weight in the equation, the output of the CG equation is in ml/min (compare to MDRD or CKD-EPI, with output units of ml/min/1.73m2). Accessed Dec. 2, 2015. A unifying approach for GFR estimation: recommendations of the NKF-ASN Task Force on reassessing the inclusion of race in diagnosing kidney disease. Glomerular filtration rate describes the rate of flow of filtered fluids through the kidney and is used as a measure of kidney function. By estimating your GFR, along with other blood and urine testssuch as creatinine clearanceyour doctor is able to diagnose kidney disease, determine which stage youre in, and track any progression. A significant decrease in GFR indicates that the kidney is not properly functioning, resulting in lower volumes of fluids being filtered over a given time. GFR is measured in mL/min/1.73m 2. Glomerular filtration rate (GFR) is the best overall index of kidney function. Both equations were derived from large population studies and will generate an estimate of the mean GFR in a population of patients with the same age, gender, race, and serum creatinine. Populations not well represented in the development or validation cohorts: Elderly people and blacks with higher levels of GFR, racial and ethnic minorities other than blacks. Consult your physician to determine the medical implications of any tests you take. The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation was developed in an effort to create a more precise formula to estimate glomerular filtrate rate (GFR) from serum creatinine and other readily available clinical parameters, especially at when actual GFR is >60 mL/min per 1.73m 2.. How do you calculate GFR from height and creatinine? This calculator uses the 4-variable equation from, Noninvasively estimates the measured GFR to determine degree or presence of decreased kidney function. New equations to estimate GFR in children with CKD. The formula for calculating GFR takes into account the serum creatinine count and other factors, such as age and sex. Philadelphia, Pennsylvania: Elsevier Inc. 2) Mathew TH, Johnson DW, Jones GR (2007) Chronic kidney disease and automatic reporting of estimated glomerular filtration rate: revised recommendations. All GFR estimating formulas on this site are designed for use with standardized creatinine and standardized cystatin C values. Because of variability in serum creatinine from one person to another, the GFR may provide a more accurate reading on kidney function. Direct comparison of the MDRD and CKD-EPI equations to other equations such as Cockcroft-Gault2, 3 and to creatinine clearance measured from 24-hour urine collections has demonstrated this superiority.4. GFR Calculator for Adults. For a serum creatinine test, a member of your health care team takes a blood sample by inserting a needle into a vein in your arm. When to Use Pearls/Pitfalls Why Use Sex Female Male Age years Weight lbs Creatinine mg/dL Evidence suggests that eGFR measured by both MDRD and CKD-EPI show better concordance with measured GFR than does the CG equation, and so the use of these equations is appropriate for determining drug dosing. Creatinine Clearance (Cockcroft-Gault Equation) Calculates CrCl according to the Cockcroft-Gault equation. For persons under 18 years of age, use the pediatric GFR calculator. and max indicates the maximum of Scr / or 1. For the purposes of drug dosing or estimating GFR in patients with body size that is very different than average, GFR can be non-normalized using the following equation: 12 B S A = ( H e i g h t I n C m W e i g h t I n K g) 3600 G F R ( m L / m i n) = G F R ( m L / m i n / 1.73 m 2) B S A / 1.73 Adjustment Factors for Female Gender Your doctor or other health care provider may order a creatinine test for the following reasons: A standard blood test is used to measure creatinine levels in your blood (serum creatinine). Below is a table of GFR ranges for the different stages of CKD. "Measurement of glomerular filtration rate." The CKiD "bedside" equation calculator uses serum creatinine and height to estimate GFR in children ages 1 to 16. Scr is serum creatinine in mol/L, The typical range for serum creatinine is: The measure of serum creatinine may also be used to estimate how quickly the kidneys filter blood (glomerular filtration rate). This calculator is for people aged 18 years or older. The glomerular filtration rate (GFR) is a lab value that looks at kidney function. An increased level of creatinine may be a sign of poor kidney function. Calculates CrCl according to the Cockcroft-Gault equation. Kidney Int. American Journal of Kidney Disease. American Association for Clinical Chemistry. Read more about creatinine standardization. Knowing your eGFR is also important to managing your health at every stage of kidney disease. Regardless of the equation used to calculate estimated glomerular filtration rate (eGFR), the eGFR value is an estimate and is not a precise measure of kidney function. Enter your age, serum creatinine, and gender to calculate your GFR. More information regarding this recommendation may be found here. doi:10.1681/ASN.2008030287, [4] Furth SL, Pierce C, Hui WF, et al. This is a product of day-to-day muscle breakdown, and the amount released into the blood varies depending on race, age and body build. Stage 1 CKD also hasan eGFR range of 90 or higher because kidney damage is minimal at this stage. This practice will reduce rounding errors that may contribute to imprecision in the eGFR value. IMPORTANT. The calculator is offered in conventional and SI units . is -0.329 for females and -0.411 for males, [1] Delgado C, Baweja M, Crews DC, et al. eGFR = k x (height in cm) serum Cr k = 0.33 in preemie infants k = 0.45 in term infants to 1 year of age k = 0.55 in children to 13 years of age k = 0.70 in adolescent males (females remain at 0.55 after age 13 years) IDMS-Traceable Schwartz Equation: eGFR = (0.41 x height in cm) serum Cr Counahan-Barratt Equation: Figure 1. After age 40, GFR decreases progressively with age. How to calculate your GFR Estimating GFR begins with a simple serum creatinine blood test. "Measured GFR as 'Gold Standard' All that Glitters Is Not Gold?" Despite its limitations, creatinine clearance still provides an acceptable estimation of GFR due to its ease of measurement when compared to inulin clearance. Note that in any case where SCr< 0.8 mg/dL, the Mayo Quadratic Formula requires to use 0.8 mg/dL for SCr. Your support helps families facing kidney disease at every step of their journey. For persons 18 and older, use the GFR calculator for adults. Caution: It is important to know the method used to measure creatinine in a blood, serum, or plasma sample, as it will affect the formula for estimating GFR in children. In case of children it is used the Schwartz formula: - The GFR = 0.41 * Height (in cm) / S Cr When the child's height is expressed in inches, the height should be converted from inches to centimeters: 1 inch = 2.54 cm. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Healthy kidneys generally don't filter it out of the blood, so there should be little to no albumin found in the urine. Nurse Wellness Is Not Just About Resiliency, Debriefing: It Should Always Be About the Learner, Clinical Judgment: The Doing that Happens after Critical Thinking, Innovation in Nursing Education Practice: A Conversation with Linda Honan, When Nurses Speak, People Listen: An Interview with Pat Patton, An Unforeseen Path from Critical Care Nurse to Editor-in-Chief of American Journal of Nursing, COVID-19 2022 Update: The Nursing Workforce, Lippincott NursingCenters Career Advisor, Lippincott NursingCenters Critical Care Insider, Continuing Education Bundle for Nurse Educators, Lippincott Clinical Conferences On Demand, Alteplase Injection for Acute Ischemic Events, Developing Critical Thinking Skills and Fostering Clinical Judgement, Establishing Yourself as a Professional and Developing Leadership Skills, Facing Ethical Challenges with Strength and Compassion, https://www.uptodate.com/contents/assessment-of-kidney-function, https://www.uptodate.com/contents/definition-and-staging-of-chronic-kidney-disease-in-adults. When SCris expressed in mol/L, the conversion rate that should be used is 88.4 mol/L = 1 mg/dL. 2016-2023 Fresenius Medical Care. This can mean something different for everybody, since your eGFR also depends on your age, gender, muscle mass, ethnicity, and the results of your creatinine serum test. A GFR above 60 mL/min/1.73m2 is usually adequate for most patients and alone is not necessarily indicative of a patient having chronic kidney disease (CKD).1 If, however, there has been a significant decline of GFR since a previous test, this could be an early indicator of kidney disease. Recommended eGFR equations will be changing. Individuals with unstable creatinine concentrations. Discover more on this subject below the form. eGFR Calculator Glomerular filtration rate (GFR) is the best overall index of kidney function. A measurement of creatinine in your blood or urine provides clues to help your doctor determine how well the kidneys are working. Glomerular Filtration Rate. This calculator is for people aged 18 years or older. However, the CKD-EPI equation was more accurate in a subgroup with eGFR between 60 and 120 mL/min/1.73 m2. This method has some limitations though because it is based on a prediction of the 24h creatinine excretion rate, which is itself determined by muscle mass. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. Blog post currently doesn't have any comments. If you take a creatine supplement, you'll likely need to stop use. If your doctor is using eGFR to help diagnose kidney disease or determine your stage, you may also need additional tests to confirm. A GFR score below 60 suggests kidney disease. Hsu, C., Bansal, N. 2011. Learn how to look after your kidney health and thrivein a class that fits your life. https://labtestsonline.org/understanding/analytes/creatinine/tab/glance/.
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