肾病综合征中的估计肾小球滤过率。

Estimated glomerular filtration rate in the nephrotic syndrome.

机构信息

Department of Nephrology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.

出版信息

Nephrol Dial Transplant. 2011 Feb;26(2):550-6. doi: 10.1093/ndt/gfq443. Epub 2010 Jul 25.

DOI:10.1093/ndt/gfq443

PMID:20660475

Abstract

BACKGROUND

Plasma creatinine concentration and creatinine-based equations are most commonly used as markers of glomerular filtration rate (GFR). The abbreviated MDRD formula is considered the best available formula. Altered renal handling of creatinine, which may occur in the nephrotic syndrome, will invalidate creatinine-based formulas. We have evaluated the abbreviated MDRD formula in a large cohort of patients with proteinuria.

METHODS

Data on a cohort of patients with glomerular diseases were available from a large database. We have studied the relationship between estimated GFR (MDRD formula), and plasma cystatin C (CysC) and plasma beta-2-microglobulin (β2m) as markers of GFR.

RESULTS

The final analysis included 142 patients (93 M/49 F), median age 48 years (±15), plasma creatinine 101 μmol/L (42-368), plasma albumin 28.0 g/L (10.0-47.0), proteinuria 6.4 g/day (0.03-37.9), eGFR-MDRD4 64 mL/min/1.73 m2 (15-165), β2m 3.43 mg/L (0.7-13.8) and CysC 1.14 mg/mL (0.56-4.00). As expected, we observed a hyperbolic relationship between eGFR and both β2m and CysC. In multivariable analysis, plasma albumin concentration proved to be the most important predictor of the relationship between eGFR and both CysC and β2m. In the presence of hypoalbuminaemia, eGFR was ~ 30-40% higher at equal levels of plasma CysC or β2m. Conclusions were similar when using the recently developed CKD-EPI formula. Plasma albumin concentration did not effect the relationship between eGFR estimated by the six-variable original MDRD formula and β2m.

CONCLUSIONS

Our data point to discrepancies between eGFR using the six-variable MDRD formula and eGFR using the abbreviated MDRD formula as well as the CKD-EPI formula in patients with hypoalbuminaemia. One should be aware of possible limitations of creatinine-based eGFR formulas in patients with a nephrotic syndrome.

摘要

背景

血肌酐浓度和基于肌酐的方程通常被用作肾小球滤过率（GFR）的标志物。简化的 MDRD 公式被认为是最佳的可用公式。在肾病综合征中，可能会出现肌酐的肾脏处理改变，这将使基于肌酐的公式无效。我们已经在大量蛋白尿患者中评估了简化的 MDRD 公式。

方法

来自一个大型数据库的肾小球疾病患者的数据可用。我们研究了估计的肾小球滤过率（MDRD 公式）与血浆胱抑素 C（CysC）和血浆β-2-微球蛋白（β2m）之间的关系，作为 GFR 的标志物。

结果

最终分析包括 142 名患者（93 名男性/49 名女性），中位年龄 48 岁（±15），血肌酐 101 μmol/L（42-368），血浆白蛋白 28.0 g/L（10.0-47.0），蛋白尿 6.4 g/天（0.03-37.9），eGFR-MDRD4 64 mL/min/1.73 m2（15-165），β2m 3.43 mg/L（0.7-13.8）和 CysC 1.14 mg/mL（0.56-4.00）。正如预期的那样，我们观察到 eGFR 与β2m 和 CysC 之间呈双曲线关系。在多变量分析中，血浆白蛋白浓度被证明是 eGFR 与 CysC 和β2m 之间关系的最重要预测因素。在低白蛋白血症的情况下，在相等的 CysC 或β2m 水平下，eGFR 升高约 30-40%。当使用最近开发的 CKD-EPI 公式时，得出的结论是相似的。血浆白蛋白浓度不影响使用简化 MDRD 公式（包括原始 MDRD 公式的六个变量）和 CKD-EPI 公式估计的 eGFR 之间的关系。在低白蛋白血症患者中，应该意识到基于肌酐的 eGFR 公式可能存在局限性。