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Why Is the GFR So High?

Implications for the Treatment of Kidney Failure

Timothy W. Meyer and Thomas H. Hostetter
CJASN December 2020, CJN.14300920; DOI: https://doi.org/10.2215/CJN.14300920
Timothy W. Meyer
1Departments of Medicine, Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, California
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Thomas H. Hostetter
2Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
3University of North Carolina Kidney Center, University of North Carolina, Chapel Hill, North Carolina
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Abstract

The high GFR in vertebrates obligates large energy expenditure. Homer Smith’s teleologic argument that this high GFR was needed to excrete water as vertebrates evolved in dilute seas is outdated. The GFR is proportional to the metabolic rate among vertebrate species and higher in warm-blooded mammals and birds than in cold-blooded fish, amphibians, and reptiles. The kidney clearance of some solutes is raised above the GFR by tubular secretion, and we presume secretion evolved to eliminate particularly toxic compounds. In this regard, high GFRs may provide a fluid stream into which toxic solutes can be readily secreted. Alternatively, the high GFR may be required to clear solutes that are too large or too varied to be secreted, especially bioactive small proteins and peptides. These considerations have potentially important implications for the understanding and treatment of kidney failure.

  • glomerular filtration rate
  • hemodialysis
  • uremia
  • Copyright © 2021 by the American Society of Nephrology
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Clinical Journal of the American Society of Nephrology: 16 (1)
Clinical Journal of the American Society of Nephrology
Vol. 16, Issue 1
January 07, 2021
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Why Is the GFR So High?
Timothy W. Meyer, Thomas H. Hostetter
CJASN Dec 2020, CJN.14300920; DOI: 10.2215/CJN.14300920

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Why Is the GFR So High?
Timothy W. Meyer, Thomas H. Hostetter
CJASN Dec 2020, CJN.14300920; DOI: 10.2215/CJN.14300920
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  • Article
    • Abstract
    • The Relation of Glomerular Filtration Rate to Metabolic Rate
    • Solutes Cleared by Secretion
    • Solutes Cleared by Filtration
    • Clues to the Nature of Solutes that Require a High Glomerular Filtration Rate for Their Removal
    • Kidney Size and Glomerular Filtration Rate
    • Why Is Glomerular Filtration on All the Time?
    • Medical Considerations
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More in this TOC Section

  • Mass Disasters and Burnout in Nephrology Personnel
  • Metabolic Alkalosis
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