Flynn F V
Department of Chemical Pathology, University College Hospital, London, England.
Clin Biochem. 1990 Feb;23(1):49-54. doi: 10.1016/0009-9120(90)90435-w.
Tests commonly used to assess the glomerular filtration rate (GFR) and to detect renal tubular damage are critically reviewed. Creatinine clearance which is frequently used for assessment of the GFR is prone to several errors. The plasma creatinine can be used to provide a rough guide but for reliable measurement of the GFR, 51Cr-EDTA clearance is recommended. Measurements of the urinary excretion of low molecular weight proteins, enzymes and kidney tissue proteins have been used to detect tubular damage. Of the low molecular weight proteins excreted, beta-2-microglobulin is unstable and measurement of retinol-binding protein or alpha-1-microglobulin is recommended for the detection of chronic renal tubular malfunction. Of the many enzymes that have been studied, urinary N-acetyl-beta-D-glucosaminidase or alanine aminopeptidase are recommended as being the most useful for the early detection of acute renal tubular damage. Among renal tissue proteins that have been measured in urine adenosine-deaminase-binding protein, a tubular brush border antigen appears to have considerable potential for providing early warning of renal allograft rejection.
对常用于评估肾小球滤过率（GFR）和检测肾小管损伤的测试进行了批判性综述。常用于评估GFR的肌酐清除率容易出现多种误差。血浆肌酐可用于提供大致指导，但为了可靠测量GFR，建议采用51Cr-EDTA清除率。测量低分子量蛋白质、酶和肾组织蛋白的尿排泄量已用于检测肾小管损伤。在排泄的低分子量蛋白质中，β2-微球蛋白不稳定，建议测量视黄醇结合蛋白或α1-微球蛋白以检测慢性肾小管功能障碍。在已研究的众多酶中，尿N-乙酰-β-D-氨基葡萄糖苷酶或丙氨酸氨基肽酶被认为对早期检测急性肾小管损伤最有用。在尿液中测量的肾组织蛋白中，腺苷脱氨酶结合蛋白（一种肾小管刷状缘抗原）似乎在提供肾移植排斥早期预警方面具有相当大的潜力。
