Thomas Lothar, Huber Andreas R
Department of Laboratory Medicine, Krankenhaus Nordwest, Frankfurt, Germany.
Clin Chem Lab Med. 2006;44(11):1295-302. doi: 10.1515/CCLM.2006.239.
Assessment and follow-up of renal dysfunction is important in the early detection and management of chronic kidney disease. The glomerular filtration rate (GFR) is the most accurate measurement of kidney disease and is reduced before the onset of clinical symptoms. Drawbacks to the measurement of GFR include the high cost and incompatibility with routine laboratory monitoring. Serum creatinine determination is a mainstay in the routine laboratory profile of renal function. The measurement of serum cystatin C has been proposed as a more sensitive marker for GFR. According to National Kidney Foundation-K/DOQ1 clinical guidelines for chronic kidney disease, serum markers should not be used alone to assess GFR. Based on prediction equations, clinical laboratories should report an estimate of GFR, in addition to reporting the serum value. In this article, information is presented on how best to estimate GFR using prediction equations for adults and for children. Using serum creatinine concentration with the Modification of Diet in Renal Disease (MDRD) study equation offers a suitable estimation of GFR in adults. The cystatin C prediction equation with the use of a prepubertal factor seems superior to creatinine-based prediction equations in children of <14 years.
肾功能障碍的评估和随访对于慢性肾脏病的早期发现和管理至关重要。肾小球滤过率（GFR）是评估肾脏疾病最准确的指标，在临床症状出现之前就会降低。测量GFR的缺点包括成本高以及与常规实验室监测不兼容。血清肌酐测定是肾功能常规实验室检查的主要项目。血清胱抑素C的测定已被提议作为GFR更敏感的标志物。根据美国国家肾脏基金会-K/DOQI慢性肾脏病临床指南，血清标志物不应单独用于评估GFR。基于预测方程，临床实验室除报告血清值外，还应报告GFR的估计值。本文介绍了如何使用成人和儿童的预测方程来最佳估计GFR。使用血清肌酐浓度并结合肾脏病饮食改良（MDRD）研究方程可对成人GFR进行合适的估计。在14岁以下儿童中，使用青春期前因素的胱抑素C预测方程似乎优于基于肌酐的预测方程。
