{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,11]],"date-time":"2026-07-11T10:06:28Z","timestamp":1783764388863,"version":"3.55.0"},"reference-count":37,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2017,11,1]],"date-time":"2017-11-01T00:00:00Z","timestamp":1509494400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,11,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Impaired renal function may affect the level of diagnostic disease markers. The aim of the study was to investigate the effect of measured glomerular filtration rate (GFR) on 4 diagnostic markers in blood and urine\u2014guanidinoacetate (GAA), creatine (CRE), human epididymis protein 4 (HE4), and neutrophil gelatinase\u2013associated lipocalin (NGAL)\u2014and how this could affect the decision and reference limits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We examined 96 children (median age 9.2 years, range 0.25\u201317.5) with different stages of chronic kidney disease (CKD). GFR [median 65.9 mL \u00b7 min\u22121 \u00b7 (1.73 m2)\u22121, range 6.3\u2013153] was measured by iohexol clearance using 7 venous blood samples after iohexol injection. Fasting serum and urinary GAA, CRE, HE4, NGAL, and creatinine (crn) were analyzed. After appropriate transformation of the markers, a multiple linear regression analysis examined the influence of age, sex, and measured GFR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The level of GFR significantly affected S-GAA (P = 2 \u00d7 10\u22124) and U-GAA\/crn (P = 5 \u00d710\u221211), leading to decreased values in renal impairment. GFR did not correlate significantly with the level of CRE and to a minor degree did the U-CRE\/crn ratio (P = 0.54 and 0.01, respectively). The level of GFR significantly affected S-HE4 (P = 4 \u00d7 10\u221231) and U-HE4\/S-HE4 ratio (P = 2 \u00d7 10\u221221) with increased serum values and decreased U-HE4\/S-HE4 ratio in renal impairment. S-NGAL increased with decreasing kidney function (P = 2 \u00d7 10\u221219).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Diagnostic disease markers may be influenced by the renal function, and this must be taken into account when interpreting test results. Decreased renal function could change the level of the marker above or below decision limits, leading to diagnostic misinterpretation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Clinical Trial Registration<\/jats:title><jats:p>ClinicalTrials.gov, Identifier NCT01092260, https:\/\/clinicaltrials.gov\/ct2\/show\/NCT01092260?term=tondel&amp;rank=2<\/jats:p><\/jats:sec>","DOI":"10.1373\/jalm.2016.022145","type":"journal-article","created":{"date-parts":[[2018,7,23]],"date-time":"2018-07-23T22:26:32Z","timestamp":1532384792000},"page":"297-308","source":"Crossref","is-referenced-by-count":6,"title":["Renal Function Influences Diagnostic Markers in Serum and Urine: A Study of Guanidinoacetate, Creatine, Human Epididymis Protein 4, and Neutrophil Gelatinase\u2013Associated Lipocalin in Children"],"prefix":"10.1093","volume":"2","author":[{"given":"Cathrin L","family":"Salvador","sequence":"first","affiliation":[{"name":"Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway"},{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Camilla","family":"T\u00f8ndel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Haukeland University Hospital, Bergen, Norway"},{"name":"Department of Clinical Medicine, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander D","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bjerre","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Oslo University Hospital, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Atle","family":"Brun","sequence":"additional","affiliation":[{"name":"Laboratory for Clinical Biochemistry, Haukeland University Hospital, Bergen, Norway"},{"name":"Department of Clinical Science, University of Bergen, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Damien","family":"Brackman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Haukeland University Hospital, Bergen, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils","family":"Bolstad","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway"},{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lars","family":"M\u00f8rkrid","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway"},{"name":"Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, 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