Alaini Ahmed, Malhotra Deepak, Rondon-Berrios Helbert, Argyropoulos Christos P, Khitan Zeid J, Raj Dominic S C, Rohrscheib Mark, Shapiro Joseph I, Tzamaloukas Antonios H
Division of Nephrology, Department of Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87131, United States.
Division of Nephrology, Department of Medicine, University of Toledo School of Medicine, Toledo, OH 43614-5809, United States.
World J Methodol. 2017 Sep 26;7(3):73-92. doi: 10.5662/wjm.v7.i3.73.
The development of formulas estimating glomerular filtration rate (eGFR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease (CKD), which is based on eGFR values and albuminuria. This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based eGFR values and between eGFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all eGFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, ., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and, particularly, biomarkers of early renal tissue injury.
通过血清肌酐和胱抑素C估算肾小球滤过率（eGFR）并考虑某些影响这些生物标志物产生率的变量（包括种族、性别和年龄）的公式的发展，导致了目前基于eGFR值和蛋白尿诊断及分期慢性肾脏病（CKD）的方案。该方案已在不同人群中广泛应用，并得出了目前CKD患病率的估计值。此外，该方案还应用于评估CKD风险以及各种旨在改善其病程的干预措施疗效的临床研究中。在不同队列中已报道了基于肌酐的eGFR值与基于胱抑素的eGFR值之间以及eGFR值与实测GFR之间存在差异。这些差异是由于产生率的变化以及除GFR外影响肌酐和胱抑素C清除率的因素导致的。这些差异给目前已开发的所有eGFR公式带来了局限性。主要局限性在于在检测一些受试者（如那些存在超滤的受试者）的早期CKD时敏感性较低，以及对CKD病程的预测较差。目前CKD的研究工作致力于识别比现有生物标志物更能准确反映GFR的生物标志物，尤其是早期肾组织损伤的生物标志物。
