Revised Schwartz Equation for Glomerular Filtration Rate (GFR) (2009)

Nephrotoxic medications may require renal dosing. Different dose adjustments may be required based upon the degree of renal functional impairment.

• Urine output is an important consideration in interpreting estimates of GFR. Anuric patients are more immediately concerning and may require renal replacement therapy (RRT) to avoid severe electrolyte disturbances, arrhythmias, and seizures.
• Consider renal ultrasound in children with newly-diagnosed CKD to evaluate for congenital renal malformation or other genetic issues such as polycystic kidney disease.
• GFR <15 indicates end-stage renal disease and will likely require RRT.

Remember that serum creatinine levels may be elevated initially after birth as neonates’ kidneys work to clear out maternal creatinine. Infants’ and children’s creatinine levels are much lower than those in adults. A creatinine value of 1.0 mg/dL, considered normal in an adult male, may indicate renal impairment in a male child.