Departamento de Ciências Farmacêuticas, Universidade de Brasília, DF, Brasil.
Braz J Med Biol Res. 2010 Jun;43(6):528-36. doi: 10.1590/s0100-879x2010007500040. Epub 2010 May 14.
Chronic kidney disease (CKD) is a world-wide public health problem, with adverse outcomes of kidney failure, cardiovascular disease, and premature death. This finding has led to the hypothesis that earlier recognition of kidney disease and successful intervention may improve outcome. The National Kidney Foundation, through its Kidney Disease Outcomes Quality Initiative (K/DOQI), and other National institutions recommend glomerular filtration rate (GFR) for the definition, classification, screening, and monitoring of CKD. Blood creatinine clearance, the most widely used clinical marker of kidney function, is now recognized as an unreliable measure of GFR because serum creatinine is affected by age, weight, muscle mass, race, various medications, and extra-glomerular elimination. Cystatin C concentration is a new and promising marker for kidney dysfunction in both native and transplanted kidneys. Because of its low molecular weight, cystatin C is freely filtered at the glomerulus and is almost completely reabsorbed and catabolized, but not secreted, by tubular cells. Given these characteristics, cystatin C concentration may be superior to creatinine concentration in detecting chronic kidney disease. This review aims to evaluate from recent literature the clinical efficiency and relevance of these GFR markers in terms of screening CKD.
慢性肾脏病（CKD）是一个全球性的公共卫生问题，其不良后果包括肾衰竭、心血管疾病和过早死亡。这一发现促使人们提出假设，即更早地发现肾脏疾病并进行成功干预可能会改善预后。美国国家肾脏基金会通过其肾脏病预后质量倡议（K/DOQI）和其他国家机构，推荐肾小球滤过率（GFR）用于 CKD 的定义、分类、筛查和监测。血肌酐清除率是目前最广泛用于评估肾功能的临床标志物，但它被认为是 GFR 的不可靠测量指标，因为血清肌酐受年龄、体重、肌肉量、种族、各种药物和肾小球外滤过的影响。胱抑素 C 浓度是一种新的、有前途的用于评估原发性和移植肾肾功能障碍的标志物。由于其分子量小，胱抑素 C 可自由地在肾小球滤过，几乎完全被肾小管细胞重吸收和分解代谢，但不分泌。鉴于这些特性，胱抑素 C 浓度在检测慢性肾脏病方面可能优于肌酐浓度。本综述旨在从近期文献中评估这些 GFR 标志物在筛查 CKD 方面的临床效率和相关性。
