Maftei Irinel-Doina, Cepoi V, Covic A
Departamentul Nefrologie, Spitalul Clinic Universitar "Dr. C. I. Parhon", Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2007 Jan-Mar;111(1):27-38.
Accurate renal function measurement is important for identification of chronic renal disease which may allow early implementation of renoprotective therapy and proper medication dosing among elderly individuals. This paper proposed to review available data about the strengths and weaknesses of current methods of measuring and estimating of renal function and to appoint which of them is the best in older people. Serum creatinine and creatinine clearance are inaccurate screening tests for renal failure in elderly subjects leading to under-recognition and/or underestimation of the degree of renal failure due to the reduced muscle mass and the inappropriate collection of a timed urine sample (urinary incontinence, cognitive impairment). For all their limitations, formulaic estimates of glomerular filtration rate can provide better information in this population. Further researches must be focused on development of a more precise estimation equation and on implementation in clinical practice of a novel marker of renal function, serum cystatin C, claimed to be superior to plasma creatinine in the elderly individuals.
准确测量肾功能对于识别慢性肾病很重要,这可能有助于在老年人中尽早实施肾脏保护治疗并合理用药。本文旨在回顾现有关于当前测量和评估肾功能方法优缺点的数据,并确定其中哪种方法对老年人最为适用。血清肌酐和肌酐清除率作为老年受试者肾衰竭的筛查试验并不准确,由于肌肉量减少以及定时尿样采集不当(尿失禁、认知障碍),会导致对肾衰竭程度的认识不足和/或低估。尽管存在局限性,但肾小球滤过率的公式估算在这一人群中能提供更好的信息。进一步的研究必须集中在开发更精确的估算方程以及将新型肾功能标志物血清胱抑素C应用于临床实践,据称血清胱抑素C在老年人中优于血浆肌酐。