蛋白尿、（99m）锝-二乙三胺五乙酸肾动态显像、基于肌酐、胱抑素及联合指标的方程在慢性肾脏病评估中的应用

Proteinuria, (99m) Tc-DTPA Scintigraphy, Creatinine-, Cystatin- and Combined-Based Equations in the Assessment of Chronic Kidney Disease.

作者信息

Trimarchi Hernán, Muryan Alexis, Toscano Agostina, Martino Diana, Forrester Mariano, Pomeranz Vanesa, Lombi Fernando, Young Pablo, Raña María Soledad, Karl Alejandra, Alonso M, Dicugno Mariana, Fitzsimons Clara

机构信息

Servicios de Nefrología, Hospital Británico de Buenos Aires, Perdriel 74, 1280 Buenos Aires, Argentina.

Laboratorio Central, Hospital Británico de Buenos Aires, Perdriel 74, 1280 Buenos Aires, Argentina.

出版信息

ISRN Nephrol. 2014 Feb 11;2014:430247. doi: 10.1155/2014/430247. eCollection 2014.

Background. Precise estimation of the glomerular filtration rate (GFR) and the identification of markers of progression are important. We compared creatinine, cystatin, and combined CKD-EPI equations with (99m)Tc-DTPA scintigraphy to measure GFR and proteinuria as markers of progression. Methods. Cross-sectional, observational study including 300 subjects. CKD was classified by (99m)Tc-DTPA scintigraphy. Determinations. Creatinine, 24-hour creatinine clearance, cystatin, Hoek formula, and creatinine, cystatin, and combined CKD-EPI equations. Results. In the global assessment, creatinine CKD-EPI and combined CKD-EPI equations yielded the highest correlations with (99m)Tc-DTPA: ρ = 0.839, P < 0.0001 and ρ = 0.831, P < 0.0001. Intergroup analysis versus (99m)Tc-DTPA: control G, creatinine clearance ρ = 0.414, P = 0.013; G3, combined CKD-EPI ρ = 0.5317, P < 0.0001; G4, Hoek ρ = 0.618, P < 0.0001, combined CKD-EPI ρ = 0.4638, P < 0.0001; and G5, creatinine clearance ρ = 0.5414, P < 0.0001, combined CKD-EPI ρ = 0.5288, P < 0.0001. In the global assessment, proteinuria displayed the highest significant correlations with cystatin ( ρ = 0.5433, P < 0.0001) and cystatin-based equations (Hoek: ρ = -0.5309, P < 0.0001). When GFR < 60 mL/min: in stage 3, proteinuria-cystatin ( ρ = 0.4341, P < 0.0001); proteinuria-Hoek ( ρ = -0.4105, P < 0.0001); in stage 4, proteinuria-cystatin ( ρ = 0.4877, P < 0.0001); proteinuria-Hoek ( ρ = -0.4877, P = 0.0026). Conclusions. At every stage of GFR < 60 mL/min, cystatin-based equations displayed better correlations with (99m)Tc-DTPA. Proteinuria and cystatin-based equations showed strong associations and high degrees of correlation.

背景。准确估算肾小球滤过率（GFR）以及识别疾病进展标志物至关重要。我们将肌酐、胱抑素以及合并的慢性肾脏病流行病学协作组（CKD-EPI）方程与（99m）锝-二乙三胺五乙酸（DTPA）肾动态显像法进行比较，以测量GFR并将蛋白尿作为疾病进展的标志物。方法。一项横断面观察性研究，纳入300名受试者。通过（99m）Tc-DTPA肾动态显像法对慢性肾脏病进行分类。测定项目。肌酐、24小时肌酐清除率、胱抑素、霍克公式以及肌酐、胱抑素和合并的CKD-EPI方程。结果。在整体评估中，肌酐CKD-EPI方程和合并的CKD-EPI方程与（99m）Tc-DTPA的相关性最高：ρ = 0.839，P < 0.0001以及ρ = 0.831，P < 0.0001。与（99m）Tc-DTPA进行组间分析：对照组G，肌酐清除率ρ = 0.414，P = 0.013；G3期，合并的CKD-EPI方程ρ = 0.5317，P < 0.0001；G4期，霍克公式ρ = 0.618，P < 0.0001，合并的CKD-EPI方程ρ = 0.4638，P < 0.0001；G5期，肌酐清除率ρ = 0.5414，P < 0.0001，合并的CKD-EPI方程ρ = 0.5288，P < 0.0001。在整体评估中，蛋白尿与胱抑素（ρ = 0.5433，P < 0.0001）以及基于胱抑素的方程（霍克公式：ρ = -0.5309，P < 0.0001）显示出最高的显著相关性。当GFR < 60 mL/min时：在3期，蛋白尿-胱抑素（ρ = 0.4341，P < 0.0001）；蛋白尿-霍克公式（ρ = -0.4105，P < 0.0001）；在4期，蛋白尿-胱抑素（ρ = 0.4877，P < 0.0001）；蛋白尿-霍克公式（ρ = -0.4877，P = 0.0026）。结论。在GFR < 60 mL/min的各个阶段，基于胱抑素的方程与（99m）Tc-DTPA显示出更好的相关性。蛋白尿与基于胱抑素的方程显示出强关联和高度相关性。