Department of Rheumatology and Rehabilitation, Faculty of medicine, Cairo University, Cairo, Egypt.
Clin Rheumatol. 2010 Jul;29(7):729-37. doi: 10.1007/s10067-010-1389-3. Epub 2010 Feb 23.
Prognosis of systemic sclerosis largely depends on involvement of internal organs. The aim was to evaluate renal impairment in patients with systemic sclerosis by measuring the Glomerular filteration rate (GFR) and then calculating the GFR using the Cockgroft and Gault formula and the Modification of Diet in Renal Disease Equation (MDRD) formula. Thirty one scleroderma patients were recruited from the Rheumatology and Rehabilitation Department, Cairo University Hospitals, mean age 43.25 +/- 11.28 years, 31 healthy controls were included. Disease severity was done using Medsger score. GFR was measured using classical Gates method TC99mDTPA. The modified Cockcroft and Gault formula and equation 7 from the MDRD were used for calculation of GFR. All patients had within normal serum creatinine levels. A normal GFR (>89ml/min) was found in 45.1%. Gates method showed reduced GFR was reported in 54.9%. Stage II chronic kidney disease (60-89 ml/min) found 32.3%, and stage III (30-59 ml/min) in 22.6%. The formulae used showed reduction of GFR in 35.29% of those affected by the Cockcroft-Gault and in 41.17% of those affected using the MDRD. No correlation to patients' age, disease duration, or severity. A positive correlation was also reported between the presence of renal involvement and pulmonary vascular involvement p = 0.04. Gates method showed reduction of the GFR in 54.9% of the systemic sclerosis patients. The formulae used were not as precise as the measured GFR in diagnosing all cases with subclinical renal involvement. Patients with systemic sclerosis should be screened for renal involvement irrespective of disease severity or duration.
系统性硬化症的预后在很大程度上取决于内脏器官的受累情况。本研究旨在通过测量肾小球滤过率（GFR），然后使用 Cockcroft 和 Gault 公式以及改良肾脏病饮食方程（MDRD）公式计算 GFR，来评估系统性硬化症患者的肾功能损害。从开罗大学医院风湿病和康复科招募了 31 名硬皮病患者，平均年龄为 43.25±11.28 岁，纳入 31 名健康对照者。使用 Medsger 评分评估疾病严重程度。使用经典的 TC99mDTPA Gates 方法测量 GFR。使用改良的 Cockcroft 和 Gault 公式和 MDRD 方程 7 计算 GFR。所有患者的血清肌酐水平均在正常范围内。45.1%的患者发现正常 GFR（>89ml/min）。Gates 方法显示 54.9%的患者 GFR 降低。发现 32.3%的患者患有慢性肾脏病 2 期（60-89ml/min），22.6%的患者患有慢性肾脏病 3 期（30-59ml/min）。受 Cockcroft-Gault 影响的患者中有 35.29%，受 MDRD 影响的患者中有 41.17%的患者的公式显示 GFR 降低。与患者年龄、疾病持续时间或严重程度无相关性。还报告了肾功能损害与肺血管受累之间存在正相关，p=0.04。Gates 方法显示 54.9%的系统性硬化症患者 GFR 降低。在诊断所有亚临床肾受累病例时，使用的公式不如测量的 GFR 精确。无论疾病严重程度或持续时间如何，系统性硬化症患者均应进行肾受累筛查。
