Horio Masaru
Rinsho Byori. 2015 Feb;63(2):259-64.
Evaluation of the renal function is fundamental for the diagnosis and treatment of kidney diseases. It is also important for adjustment of the doses of drugs that are excreted by the kidney. The incidence of contrast-induced nephropathy is high in subjects with a low GFR. Assessment of the renal function is required prior to contrast medium injections. Renal inulin clearance with continuous venous injection is the gold standard for measuring GFR. However, the method is time-consuming. The recent Japanese CKD guide and KDIGO guidelines for CKD management recommended the use of the estimated GFR based on serum creatinine (eGFRcreat) or serum cystatin C (eGFRcys). Because the serum creatinine level is affected by the muscle mass, eGFRcreat is under- or overestimated in subjects with a high or low muscle mass, respectively. The serum cystatin C concentration is less influenced by the muscle mass. Assessment of the renal function by eGFRcys may be useful in subjects with a low or high muscle mass. Recently, it was reported that the association between eGFRcys and the risk of all-cause mortality was much closer compared with eGFRcreat. eGFRcys may be useful for detecting a high risk of complications in a general population and in subjects with CKD.
肾功能评估对于肾脏疾病的诊断和治疗至关重要。对于调整经肾脏排泄的药物剂量也很重要。在肾小球滤过率（GFR）低的受试者中，对比剂肾病的发生率很高。在注射造影剂之前需要评估肾功能。持续静脉注射菊粉清除率是测量GFR的金标准。然而，该方法耗时。最近的日本慢性肾脏病指南和改善全球肾脏病预后组织（KDIGO）的慢性肾脏病管理指南推荐使用基于血清肌酐的估算肾小球滤过率（eGFRcreat）或血清胱抑素C的估算肾小球滤过率（eGFRcys）。由于血清肌酐水平受肌肉量影响，在肌肉量高或低的受试者中，eGFRcreat分别被低估或高估。血清胱抑素C浓度受肌肉量的影响较小。通过eGFRcys评估肾功能可能对肌肉量低或高的受试者有用。最近有报道称，与eGFRcreat相比，eGFRcys与全因死亡率风险之间的关联更为密切。eGFRcys可能有助于检测普通人群和慢性肾脏病患者的高并发症风险。
