Baas Marije C, Bouman Catherine S C, Hoek Frans J, Krediet Raymond T, Schultz Marcus J
Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Hemodial Int. 2006 Oct;10 Suppl 2:S33-7. doi: 10.1111/j.1542-4758.2006.00115.x.
Assessment of residual renal function in critically ill patients with acute renal failure (ARF) treated with continuous venovenous hemofiltration (CVVH) is difficult. Cystatin C (CysC) is a low-molecular-weight protein (13.3 kDa) removed from the body by glomerular filtration. Its serum concentration has been advocated for assessment of renal function in patients with kidney disease. To investigate whether the removal of CysC by CVVH is likely to influence its serum concentration, concentrations of CysC were measured in 3 consecutive samples in 18 patients with oliguric ARF treated with CVVH (2 L/hr). Samples were taken from the afferent and efferent blood lines and from the ultrafiltrate line. Concentrations of CysC did not change during the time interval studied. The mean serum concentrations of CysC were 2.25+/-0.45 mg/L in the afferent and 2.19+/-0.56 mg/L in the efferent samples (NS); ultrafiltrate concentrations of CysC were 1.01+/-0.45 mg/L. The sieving coefficient of CysC was 0.52+/-0.20; the clearance of CysC was 17.3+/-6.6 mL/min; and the quantity of CysC removed averaged 2.13 mg/hr. During CVVH (2 L/hr), the quantity of CysC removed is less than 30% of its production and no rapid changes in its serum concentration are observed. Therefore, CVVH (2 L/hr) is unlikely to influence serum concentrations of CysC significantly, which suggests that it can be used to monitor residual renal function during CVVH.
评估接受连续性静脉-静脉血液滤过（CVVH）治疗的急性肾衰竭（ARF）危重症患者的残余肾功能很困难。胱抑素C（CysC）是一种低分子量蛋白质（13.3 kDa），通过肾小球滤过从体内清除。其血清浓度已被推荐用于评估肾病患者的肾功能。为了研究CVVH对CysC的清除是否可能影响其血清浓度，对18例接受CVVH（2 L/小时）治疗的少尿型ARF患者的3个连续样本进行了CysC浓度测定。样本取自输入和输出血路以及超滤液管路。在研究的时间间隔内，CysC浓度没有变化。输入样本中CysC的平均血清浓度为2.25±0.45 mg/L，输出样本中为2.19±0.56 mg/L（无显著性差异）；CysC的超滤液浓度为1.01±0.45 mg/L。CysC的筛滤系数为0.52±0.20；CysC的清除率为17.3±6.6 mL/分钟；CysC的平均清除量为2.13 mg/小时。在CVVH（2 L/小时）期间，CysC的清除量小于其生成量的30%，且未观察到其血清浓度有快速变化。因此，CVVH（2 L/小时）不太可能显著影响CysC的血清浓度，这表明它可用于监测CVVH期间的残余肾功能。
