Uemura Osamu, Nagai Takuhito, Ishikura Kenji, Ito Shuichi, Hataya Hiroshi, Gotoh Yoshimitsu, Fujita Naoya, Akioka Yuko, Kaneko Tetsuji, Honda Masataka
The Japanese Society for Pediatric Nephrology, the Committee of Measures for Pediatric CKD, Tokyo, Japan,
Clin Exp Nephrol. 2014 Oct;18(5):718-25. doi: 10.1007/s10157-013-0910-9. Epub 2013 Nov 20.
Renal inulin clearance is the gold standard for evaluation of kidney function, but is compromised by problems of collecting urine samples in children, especially those <6 years or with a bladder dysfunction. Therefore, we should utilize the serum cystatin C (cysC)-based estimated glomerular filtration rate (eGFR) for measuring serum cysC. The purpose of the present study is to determine the applicability of the new serum cysC-based eGFR in Japanese children and adolescents, including infants with chronic kidney disease (CKD), for evaluation of renal function.
Inulin clearance and standardized serum cysC level determined by the colloidal gold immunoassay were measured in 135 pediatric CKD patients between the ages of 1 month and 18 years with no underlying disease that affects renal function except CKD, to determine serum cysC-based eGFR in Japanese children and adolescents.
We showed the inulin clearance by expression of 1/serum cysC in pediatric CKD patients, which resulted in the equation: inulin GFR (mL/min/1.73 m(2)) = 104.1 × 1/serum cysC (mg/L) - 7.80. We also validated the cysC-based eGFR formula for Japanese adults. eGFR values obtained with the adult formula significantly underestimated GFR by approximately 8 % in children with CKD.
We determined the new cysC-based eGFR formula is useful for clinical screening of renal function in Japanese children and adolescents, including infants.
菊粉清除率是评估肾功能的金标准，但在儿童中，尤其是6岁以下或存在膀胱功能障碍的儿童，收集尿液样本存在问题，这限制了其应用。因此，我们应采用基于血清胱抑素C（cysC）的估算肾小球滤过率（eGFR）来测定血清cysC。本研究的目的是确定新的基于血清cysC的eGFR在日本儿童和青少年（包括患有慢性肾脏病（CKD）的婴儿）中评估肾功能的适用性。
对135例年龄在1个月至18岁之间、除CKD外无其他影响肾功能基础疾病的儿科CKD患者，测量菊粉清除率和通过胶体金免疫测定法测定的标准化血清cysC水平，以确定日本儿童和青少年基于血清cysC的eGFR。
我们通过儿科CKD患者的1/血清cysC表达显示了菊粉清除率，得出方程：菊粉肾小球滤过率（mL/min/1.73 m²）= 104.1 × 1/血清cysC（mg/L） - 7.80。我们还验证了适用于日本成年人的基于cysC的eGFR公式。用成人公式获得的eGFR值在CKD儿童中显著低估了GFR约8%。
我们确定新的基于cysC的eGFR公式可用于日本儿童和青少年（包括婴儿）肾功能的临床筛查。
