Laboratoriumsmedizin, Krankenhaus Nordwest, Frankfurt am Main.
Dtsch Arztebl Int. 2009 Dec;106(51-52):849-54. doi: 10.3238/arztebl.2009.0849. Epub 2009 Dec 18.
Chronic renal disease is common, and its prevalence is rising. Its main causes are hypertension and diabetes mellitus. An abnormally low glomerular filtration rate (GFR) often escapes medical notice in the earliest, most treatable stage, so that an increasing number of patients progress to end-stage renal failure. Early recognition of low GFR would thus be an important clinical advance.
The authors selectively review the literature retrieved by a PubMed search on the topic and also present their own clinical and laboratory data.
Chronic renal failure can be detected early by direct measurement of the GFR with the aid of an exogenous filtration marker. Such techniques are costly and time-consuming and are therefore indicated only for patients at special risk. Chronic renal disease can also be diagnosed early with the aid of the endogenous filtration markers creatinine and cystatin C, which serve as indicators of a low GFR. The serum levels of these two substances are not taken as measures of GFR in themselves, but are rather entered into predictive equations for the estimation of GFR. Cystatin C-based equations seem to be more sensitive indicators of low GFR than creatinine-based equations.
Creatinine- and cystatin C-based equations for the estimation of GFR are valuable tools for the early diagnosis of chronic renal disease and for disease staging according to the US National Kidney Foundation criteria.
慢性肾病较为常见，且其发病率正在上升。其主要病因是高血压和糖尿病。肾小球滤过率（GFR）异常降低往往在最早、最具治疗性的阶段未被医学所察觉，导致越来越多的患者进展为终末期肾衰竭。因此，早期识别 GFR 降低将是一个重要的临床进展。
作者选择性地回顾了在这一主题上通过 PubMed 检索获得的文献，并展示了他们自己的临床和实验室数据。
借助外源性滤过标志物直接测量 GFR 可以早期检测慢性肾衰竭。这些技术既昂贵又耗时，因此仅适用于特殊风险患者。借助内源性滤过标志物肌酐和胱抑素 C 也可以早期诊断慢性肾病，这些标志物是 GFR 降低的指标。这两种物质的血清水平本身不作为 GFR 的测量指标，而是被纳入预测方程以估算 GFR。基于胱抑素 C 的方程似乎比基于肌酐的方程更能敏感地反映 GFR 降低。
基于肌酐和胱抑素 C 的 GFR 估算方程是早期诊断慢性肾病和根据美国国家肾脏基金会标准进行疾病分期的有用工具。
