Hekmat Reza, Eshraghi Hamid, Esmailpour Maryam, Hassankhani Golnaz Ghayyem
Department of Nephrology, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Exp Clin Transplant. 2017 Feb;15(Suppl 1):104-109. doi: 10.6002/ect.mesot2016.O104.
Kinetic glomerular filtration rate estimation may have more power and versatility than the Modification of Diet in Renal Disease or Cockcroft-Gault formula for evaluating kidney function when plasma creatinine fluctuates rapidly. After kidney donation, glomerular filtration rate rapidly fluctuates in otherwise healthy patients. We compared 3 formulas for estimating glomerular filtration rate: kinetic, Modification of Diet in Renal Disease, and Cockcroft-Gault, for determining stages of acute kidney injury early after kidney donation.
In 42 living kidney donors, we measured serum creatinine, cystatin C, neutrophil gelatinase-associated lipocalin, and glomerular filtration rates before uninephrectomy and 3 days afterward. To estimate glomerular filtration rate, we used Cockcroft-Gault, Modification of Diet in Renal Disease, and kinetic equations. We sought the most accurate formula for staging acute kidney injury according to the risk, injury, failure, loss, and end-stage criteria.
The kinetic glomerular filtration rate model found more cases of stage 3 acute kidney injury than did the Modification of Diet in Renal Disease or Cockcroft-Gault formula. Receiver operating characteristic curves showed that the kinetic glomerular filtration rate model had more sensitivity and specificity than the Cockroft-Gault formula for discriminating among risk, injury, failure, loss, and end-stage criteria stages of acute kidney injury, based on serum creatinine changes. On day 2 after donation, a more sensitive marker with a shorter half-life (serum neutrophil gelatinase-associated lipocalin) was more significantly correlated with kinetic glomerular filtration rate estimation.
The kinetic glomerular filtration rate model was able to discriminate stages of acute kidney injury early after kidney donation according to risk, injury, failure, loss, and end-stage criteria better than the Modification of Diet in Renal Disease or Cockcroft-Gault formulas. The kinetic model detected failure-stage acute kidney injury ≥ 1 to 2 days earlier than the MDRD formula, CG formula detected no failure.
当血浆肌酐快速波动时，动态肾小球滤过率估计在评估肾功能方面可能比肾病饮食改良公式或Cockcroft - Gault公式更具效力和通用性。肾移植后，在其他方面健康的患者中，肾小球滤过率会迅速波动。我们比较了3种估计肾小球滤过率的公式：动态公式、肾病饮食改良公式和Cockcroft - Gault公式，以确定肾移植后早期急性肾损伤的阶段。
在42名活体肾供体中，我们在单侧肾切除术前及术后3天测量了血清肌酐、胱抑素C、中性粒细胞明胶酶相关脂质运载蛋白和肾小球滤过率。为了估计肾小球滤过率，我们使用了Cockcroft - Gault公式、肾病饮食改良公式和动态方程。我们根据风险、损伤、衰竭、丧失和终末期标准寻找用于急性肾损伤分期的最准确公式。
动态肾小球滤过率模型发现的3期急性肾损伤病例比肾病饮食改良公式或Cockcroft - Gault公式更多。受试者工作特征曲线表明，基于血清肌酐变化，动态肾小球滤过率模型在区分急性肾损伤的风险、损伤、衰竭、丧失和终末期标准阶段方面比Cockroft - Gault公式具有更高的敏感性和特异性。在捐献后第2天，半衰期较短的更敏感标志物（血清中性粒细胞明胶酶相关脂质运载蛋白）与动态肾小球滤过率估计的相关性更显著。
动态肾小球滤过率模型在根据风险、损伤、衰竭、丧失和终末期标准区分肾移植后早期急性肾损伤阶段方面比肾病饮食改良公式或Cockcroft - Gault公式表现更好。动态模型比MDRD公式早1至2天检测到衰竭期急性肾损伤，CG公式未检测到衰竭。
