Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium; Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Nuclear Medicine & Molecular Imaging, University Hospital Leuven, Leuven, Belgium; and Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Department of Public Health and Primary Care, KU Leuven Campus Kulak Kortrijk, Kortrijk, Belgium; Exploration Fonctionnelle Rénale, Groupement Hospitalier Edouard Herriot, Hospices Civils de Lyon, Lyon, France; Department of Nuclear Medicine & Molecular Imaging, University Hospital Leuven, Leuven, Belgium; and Nephrology-Dialysis-Transplantation, University of Liège, CHU Sart Tilman, Liège, Belgium.
Adv Chronic Kidney Dis. 2018 Jan;25(1):57-66. doi: 10.1053/j.ackd.2017.10.002.
The bedside Schwartz equation has long been and still is the recommended equation to estimate glomerular filtration rate (GFR) in children. However, this equation is probably best suited to estimate GFR in children with chronic kidney disease (reduced GFR) but is not optimal for children with GFR >75 mL/min/1.73 m. Moreover, the Schwartz equation requires the height of the child, information that is usually not available in the clinical laboratory. This makes automatic reporting of estimated glomerular filtration rate (eGFR) along with serum creatinine impossible. As the majority of children (even children referred to nephrology clinics) have GFR >75 mL/min/1.73 m, it might be interesting to evaluate possible alternatives to the bedside Schwartz equation. The pediatric form of the Full Age Spectrum (FAS) equation offers an alternative to Schwartz, allowing automatic reporting of eGFR since height is not necessary. However, when height is involved in the FAS equation, the equation is essentially equal to the Schwartz equation for children, but there are large differences for adolescents. Combining standardized biomarkers increases the prediction performance of eGFR equations for children, reaching P10 ≈ 45% and P30 ≈ 90%. There are currently good and simple alternatives to the bedside Schwartz equation, but the more complex equations combining serum creatinine, serum cystatin C, and height show the highest accuracy and precision.
床边 Schwartz 方程长期以来一直是推荐用于估计儿童肾小球滤过率 (GFR) 的方程。然而，该方程可能最适合估计慢性肾脏病 (GFR 降低) 儿童的 GFR，但对于 GFR >75 mL/min/1.73 m 的儿童则不是最佳选择。此外，Schwartz 方程需要儿童的身高，而这些信息通常在临床实验室中不可用。这使得无法自动报告估计的肾小球滤过率 (eGFR) 以及血清肌酐。由于大多数儿童（甚至被转介到肾病科诊所的儿童）的 GFR >75 mL/min/1.73 m，因此评估 Schwartz 方程的可能替代方案可能会很有趣。全年龄谱 (FAS) 方程的儿科形式提供了 Schwartz 的替代方案，由于不需要身高，因此可以自动报告 eGFR。然而，当身高包含在 FAS 方程中时，该方程对于儿童基本上等同于 Schwartz 方程，但对于青少年则存在很大差异。结合标准化生物标志物可提高儿童 eGFR 方程的预测性能，达到 P10≈45%和 P30≈90%。目前有许多简单的替代床边 Schwartz 方程的方法，但结合血清肌酐、血清胱抑素 C 和身高的更复杂方程显示出最高的准确性和精密度。
