Dear Dr. Aryati,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

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[AA was supported by Universitas Airlangga, Surabaya, East Java, Indonesia, grant number 345/UN3.LPPM/PT.01.03/2024 under Penelitian Unggulan Airlangga (PUA) 2024 initiative and FRM received support by Soetomo Hospital, Surabaya, East Java, Indonesia, with grant number 100.3.3/25.1/102.6/2024 by Penelitian Unggulan Hospital Scheme.].

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: I Don't Know

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: In this study by Marpaung et al, two different eGFR calculators, the bedside Schwartz and EKFC are compared to measured GFR using 99mTc DTPA in a cohort of children with CAKUT from their institution. They find that both eGFR equations correlated with mGFR but that the bedside Schwartz tended to overestimate GFR while the EKFC underestimated GFR. This could provide helpful information for clinicians in guiding interpretation of creatinine-based eGFR equations for children with CAKUT. However, there are some major concerns that should be addressed, including whether serum creatinine was measured at the same time as the 99mTc DTPA study.

Major Concerns:

1. I am curious why the authors chose the bedside Schwartz and EKFC equations as there are many other calculating equations that have been developed. In fact, many pediatric nephrologists have shifted to using the recently developed CKiD U25 creatinine and cystatin C based eGFR formulas (Pierce Kidney Int 99:948, 2021). It would be informative to compare the CKiD U25 creatinine based equation with the bedside Schwartz and EKFC equation. If the authors have cystatin C data, addition of a combined creatinine-cystatin C based calculation would also be informative.

2. Given that this is a retrospective study, I am wondering if it is routine for all children with CAKUT to undergo mGFR measurements? Could there be selection bias in favor of discordant mGFR vs. eGFR in your cohort due to the inclusion of only patients who underwent 99mTc DTPA?

3. Was the serum creatinine used to calculate the bedside Schwartz and EKFC eGFR taken at the same time that the 99mTc DTPA was done?

4. While some discrepancy in eGFR calculators is expected, it is surprising to me the number of very discordant cases (Table 3). If I am understanding the table correctly, it appears that there are two individuals with a G1 mGFR and G4 or G5 EKFC. Similarly there are a few individuals with G1 or G2 EKFC and G4 or G5 mGFR. There are also a few individuals with a G1 bedside Schwartz and G4 and G5 mGFR. Can you please comment on these discrepancies as this is very surprising. Were these individuals with complex medical conditions and very low muscle mass, for example, and, if so, should they be excluded in your analysis?

5. CAKUT is a very heterogeneous group of disorders. It would be useful to provide some baseline demographic information regarding the type of CAKUT (even if just broken into things like solitary kidney, dysplasia/hypodysplasia, VUR, PUV, etc)

6. The figure legends are difficult to read. Please load higher quality figures.

Minor Concerns:

1. Methods, page 6 and Conclusion, page 9: In general, the accepted definition of CKD is either the presence of “kidney damage for > 3 months as defined by structural or functional abnormalities with or without decreased GFR” or “GFR < 60 mL/min/1.73m2 for > 3 months, with or without kidney damage). Thus by definition, children with CAKUT have chronic kidney disease; those with eGFR > 90 will have CKD 1. Thus in paragraph 3 on page 9, in the sentence “The prevalence of CKD in this CAKUT cohort was CKD 8.7%,” should specify which stage of CKD you mean.

2. Results, page 7, first full paragraph: Do you mean Table 3 instead of Table 2?

3. Can you explain the meaning of “P30” in the body of the document.

4. Conclusion, page 9: I don’t think this study was necessarily designed to study the incidence or age of onset of CAKUT in your population, especially given that 19% of patients with CAKUT were excluded due to incomplete data. Also, I am surprised that the age of onset was 7 years but perhaps this is due to lower prevalence or quality of prenatal imaging studies in Indonesia?

5. While the majority of the manuscript is well-written, there are certain sentences that should be reviewed and edited (e.g. Results, page 6, paragraph 3; Discussion, page 7, paragraph 1 – suggest changing “early diagnosis of kidney disorders” to “early and accurate diagnosis of impaired GFR”, also “Scwartz” is spelled incorrectly here and “recently equation” does not make grammatical sense; Conclusion, page 9, paragraph 2, “may affected to this varied result”). Also in the title, suggest “Performance of Glomerular Filtration Rate Equations Using Serum Creatinine in Children with Congenital Anomalies of the Kidney and Urinary Tract.”

Reviewer #2: This study composed of 276 children with CAKUT compared the bedside Schwartz and EKFC creatinine-based equations against measured GFR using technetium-99m diethylenetriaminepentaacetic acid (Tc-99mDTPA) clearance. The results showed that in children over 2 years old, EKFC demonstrated more accuracy compared to the bedside Schwartz. Below is my suggestions that may improve the quality of this study:

1. The proportion of patient with mGFR Tc-99mDTPA ≥ 60 ml/mnt/1.73 is 91.3%. Could the authors further classified these patients such as ≥ 90 ml/mnt/1.73, 60~89 ml/mnt/1.73?

2. The layout of Table 2 and Table 3 needs to be improved.

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Reviewer #1: No

Reviewer #2: No

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Dear Dr. Aryati,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised by Reviewer 1 regarding the methods section, especially the inclusion and exclusion criteria.

Please submit your revised manuscript by Feb 05 2026 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols .

We look forward to receiving your revised manuscript.

Kind regards,

Weining Lu, MD

Academic Editor

PLOS One

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2. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

Reviewer #1: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions??>

Reviewer #1: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously? -->?>

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available??>

The PLOS Data policy

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English??>

Reviewer #1: Yes

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Reviewer #1: This is a nice revision and the authors addressed my concerns. My only suggestion is to be more clear in the methods section regarding the inclusion criteria. I appreciate the additional demographic information in Table 1, but it would still be helpful if the authors could more explicitly spell out their inclusion criteria for this study, including how they defined “CAKUT”, what age ranges they considered for inclusion, and the exact time range that was considered. In addition, the authors say that 65 (19%) were excluded due to incomplete data – were these the 19% that did not undergo 99mTc DTPA? If so, I think it would be helpful to mention this in the methods section in addition to the nice commentary in the discussion.

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Reviewer #1: No

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Performance of Glomerular Filtration Rate Equations Using Serum Creatinine in Children with Congenital Anomalies of the Kidney and Urinary Tract

PONE-D-25-32018R2

Dear Dr. Aryati,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements, including correction of any typos in your manuscript as described in the comment section below.

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Kind regards,

Weining Lu, MD

Academic Editor

PLOS One

Additional Editor Comments:

Please review your final manuscript carefully and correct any typo (e.g., typo "CAUT" should be corrected as "CAKUT" on page 3, in the Material and Methods Population Study section).

Reviewers' comments: