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Rheumatology 2001; 40: 324-328
© 2001 British Society for Rheumatology

Chromium-51 ethylenediamine tetraacetic acid glomerular filtration rate: a better predictor than glomerular filtration rate calculated by the Cockcroft–Gault formula for renal involvement in systemic lupus erythematosus patients

T. Godfrey, M. J. Cuadrado, C. Fofi, I. Abbs1, M. A. Khamashta, T. Nunan2 and G. R. V. Hughes

Lupus Research Unit, The Rayne Institute,
1 Nephrology and
2 Nuclear Medicine Department, St Thomas' Hospital, London SE1 7EH, UK

Objective. To investigate whether the ethylenediamine tetraacetic acid (EDTA) glomerular filtration rate (GFR) is a better indicator of the degree of renal involvement than serum creatinine concentration or creatinine clearance calculated by the Cockroft–Gault formula.

Methods. We studied prospectively all systemic lupus erythematosus (SLE) patients with normal or borderline serum creatinine concentration (<110 µmol/l) and urinary sediment abnormalities and/or proteinuria in the last 2 yr. EDTA-GFR, serum creatinine concentration, calculated creatinine clearance (Cockroft–Gault formula) and 24-h urine protein were determined at the same time. Renal biopsies were performed in patients with low values of EDTA-GFR or significant proteinuria.

Results. Twenty-three patients were identified, of whom 22 were females. The average age of the patients was 31.6±8.2 yr. Biopsies were assigned to WHO classes as follows: class II, 1 patient; class III, 6 patients; class IV, 10 patients; class V, 6 patients. The average serum creatinine concentration, EDTA-GFR and calculated creatinine clearance were 79.8±mol/l, 74.5 ml/min and 97 ml/min respectively. EDTA-GFR showed abnormal values (<80 ml/min) in 15 of the 23 patients (65.2%) while calculated creatinine clearance was abnormal (<80 ml/min) in three of the 23 patients (13%) (P<0.001). Using the Pearson correlation test, we did not find any correlation between EDTA-GFR or creatinine clearance values and the sum of activity and chronicity indices.

Conclusion. GFR performed by EDTA-GFR correctly predicted renal involvement in SLE patients, whereas GFR calculated by the Cockcroft–Gault formula may have underestimated renal function. Significant numbers of patients with WHO class III, IV or V lupus nephritis may be missed if biochemical creatinine clearance or serum creatinine concentration alone is used to assess renal disease.

KEY WORDS: Creatinine clearance, Predictive value, Diagnosis, Lupus nephritis.

Correspondence to: M. A. Khamashta.


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