Using the bedside Schwartz equation, what is the estimated glomerular filtration rate (eGFR) for a 4‑year‑old child who is 106 cm tall with a serum creatinine of 0.72 mg/dL (enzymatic assay)?

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Bedside Schwartz Formula Calculation

For this 4-year-old child (106 cm tall, serum creatinine 0.72 mg/dL measured by enzymatic assay), the estimated GFR using the Bedside Schwartz equation is approximately 61 mL/min/1.73 m².

Formula Application

Use the revised Bedside Schwartz equation with the 0.413 constant because an enzymatic creatinine assay was used: 1, 2

  • GFR = 0.413 × [height (cm) / serum creatinine (mg/dL)] 1, 2
  • GFR = 0.413 × (106 / 0.72) = 0.413 × 147.2 = 60.8 mL/min/1.73 m² 1

Why This Formula and Constant

  • The 0.413 constant is specifically calibrated for enzymatic creatinine assays, which are the preferred method in pediatric populations because they avoid interference from non-creatinine chromogens that disproportionately affect the low creatinine values typical in children 1, 2

  • Never use the older 0.55 constant (designed for Jaffe assays) with enzymatic creatinine measurements—doing so will substantially overestimate GFR 2

  • This equation is validated for children aged 1-16 years and has been confirmed in both chronic kidney disease and non-CKD populations 1, 3

Clinical Interpretation

  • Normal GFR for children over 2 years of age is approximately 100-120 mL/min/1.73 m² 4

  • This child's estimated GFR of ~61 mL/min/1.73 m² falls below 90 mL/min/1.73 m², which warrants repeat measurement and consideration of cystatin C-based confirmation 4

  • Because the estimated GFR is below 60 mL/min/1.73 m², initiate evaluation for chronic kidney disease and investigate underlying etiologies 4

Critical Caveats

  • The Bedside Schwartz equation overestimates GFR, particularly at lower GFR levels, so this estimate may be higher than the true measured GFR 5, 6

  • The equation becomes unreliable when the height-to-creatinine ratio exceeds 251 cm/(mg/dL), corresponding to GFR >103 mL/min/1.73 m² 6

  • Accurate height measurement is essential—the equation is height-dependent and errors in measurement will propagate through the calculation 2, 5

  • Serum creatinine alone should never be used to assess renal function in children because it is affected by muscle mass, age, gender, and tubular function 5, 4

  • In children with low muscle mass, creatinine-based equations may overestimate kidney function; cystatin C-based measurements are preferred in this population 5

References

1
Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

2
Guideline

Revised Bedside Schwartz Equation for Estimating Pediatric GFR

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

4
Guideline

Estimating Glomerular Filtration Rate in Children Using the Revised Bedside Schwartz Equation

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

5
Guideline

Estimating GFR in Children

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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