Stevens Lesley A, Levey Andrew S
Tufts Medical Center, Boston, Massachusetts, USA.
J Am Soc Nephrol. 2009 Nov;20(11):2305-13. doi: 10.1681/ASN.2009020171. Epub 2009 Oct 15.
Clinical assessment of kidney function is central to the practice of medicine. GFR is widely accepted as the best index of kidney function in health and disease, and accurate values are required for optimal decision making. Estimated GFR based on serum creatinine is now widely reported by clinical laboratories, and in most circumstances, estimated GFR is sufficient for clinical decision making. GFR estimates may be inaccurate in the non-steady state and in people in whom non-GFR determinants differ greatly from those in whom the estimating equation was developed. If GFR estimates are likely inaccurate or if decisions based on inaccurate estimates may have adverse consequences, a measured GFR is an important confirmatory test. Endogenous creatinine clearance is the most common method used to measure GFR in clinical practice but may be difficult to obtain or fraught with error. We review methods for GFR measurement using urinary and plasma clearance of exogenous filtration markers and focus on urinary clearance of iothalamate and plasma clearance of iohexol compared with inulin clearance. We suggest plasma clearance of nonradioactive markers be more widely implemented in clinical settings. Further research is necessary on the impact of the use of measured GFR as a confirmatory test.
肾功能的临床评估是医学实践的核心。肾小球滤过率（GFR）被广泛认为是健康和疾病状态下肾功能的最佳指标，做出最佳决策需要准确的GFR值。目前临床实验室广泛报告基于血清肌酐的估算GFR，在大多数情况下，估算GFR足以用于临床决策。在非稳态以及非GFR决定因素与开发估算方程时所依据的人群差异很大的人群中，GFR估算值可能不准确。如果GFR估算值可能不准确，或者基于不准确估算值做出的决策可能产生不良后果，那么测量GFR就是一项重要的验证性检查。内生肌酐清除率是临床实践中用于测量GFR的最常用方法，但可能难以获得或充满误差。我们综述了使用外源性滤过标记物的尿清除率和血浆清除率来测量GFR的方法，并重点比较了碘他拉酸的尿清除率和碘海醇的血浆清除率与菊粉清除率。我们建议在临床环境中更广泛地应用非放射性标记物的血浆清除率。关于将测量GFR用作验证性检查的影响，还需要进一步研究。
