The GFR of a 26-year-old man with glomerulonephritis decreases by 50% and remains at that level. For which substance would you expect to find the greatest increase in plasma concentration?
## **Core Concept**
The Glomerular Filtration Rate (GFR) is a critical indicator of kidney function, reflecting the rate at which the kidneys filter the blood to remove wastes. A 50% decrease in GFR indicates significant impairment of kidney function. Substances that are primarily excreted through glomerular filtration will accumulate in the blood when GFR decreases.
## **Why the Correct Answer is Right**
The correct answer, **C. Creatinine**, is a substance for which plasma concentration is directly influenced by the GFR. Creatinine is a product of muscle metabolism that is freely filtered by the glomeruli and not significantly reabsorbed or secreted by the renal tubules. As a result, serum creatinine levels are a practical indicator of kidney function. A 50% decrease in GFR would lead to a significant increase in plasma creatinine concentration because less creatinine is being filtered out of the blood.
## **Why Each Wrong Option is Incorrect**
- **Option A:** Urea. While urea levels do increase with decreased GFR, urea is also influenced by factors other than GFR, such as hydration status, dietary protein intake, and liver function. Urea reabsorption in the tubules can also vary, making it a less reliable marker for GFR compared to creatinine.
- **Option B:** Glucose. Glucose levels are primarily regulated by insulin and glucagon and are not directly affected by GFR until very high levels of glucose are reached, at which point the renal threshold for glucose is exceeded, and glucose appears in the urine. However, plasma glucose concentration is not directly used as a marker for GFR.
- **Option D:** Bilirubin. Bilirubin is a product of heme catabolism primarily metabolized by the liver and excreted into the bile. Its plasma concentration is not directly related to GFR but rather to liver function and hemolysis.
## **Clinical Pearl / High-Yield Fact**
A key point to remember is that serum **creatinine** is a critical marker for assessing kidney function, and its levels are directly correlated with GFR. For a given decrease in GFR, the plasma concentration of creatinine will increase more predictably than that of urea because creatinine is less affected by extrarenal factors.
## **Correct Answer:** . Creatinine