Pelander Lena, Häggström Jens, Larsson Anders, Syme Harriet, Elliott Jonathan, Heiene Reidun, Ljungvall Ingrid
Department of Clinical Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden.
Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
J Vet Intern Med. 2019 Mar;33(2):630-639. doi: 10.1111/jvim.15445. Epub 2019 Feb 21.
Early detection of decreased glomerular filtration rate (GFR) in dogs is challenging. Current methods are insensitive and new biomarkers are required.
To compare overall diagnostic performance of serum symmetric dimethylarginine (SDMA) and serum cystatin C to serum creatinine, for detection of decreased GFR in clinically stable dogs, with or without chronic kidney disease (CKD).
Ninety-seven client-owned dogs: 67 dogs with a diagnosis or suspicion of CKD and 30 healthy dogs were prospectively included.
Prospective diagnostic accuracy study. All dogs underwent physical examination, systemic arterial blood pressure measurement, urinalysis, hematology and blood biochemistry analysis, cardiac and urinary ultrasound examinations, and scintigraphy for estimation of glomerular filtration rate (mGFR). Frozen serum was used for batch analysis of SDMA and cystatin C.
The area under the curve of creatinine, SDMA, and cystatin C for detection of an mGFR <30.8 mL/min/L was 0.98 (95% confidence interval [CI], 0.93-1.0), 0.96 (95% CI, 0.91-0.99), and 0.87 (95% CI, 0.79-0.93), respectively. The sensitivity of both creatinine and SDMA at their prespecified cutoffs (115 μmol/L [1.3 mg/dL] and 14 μg/dL) for detection of an abnormal mGFR was 90%. The specificity was 90% for creatinine and 87% for SDMA. When adjusting the cutoff for cystatin C to correspond to a diagnostic sensitivity of 90% (0.49 mg/L), specificity was lower (72%) than that of creatinine and SDMA.
Overall diagnostic performance of creatinine and SDMA for detection of decreased mGFR was similar. Overall diagnostic performance of cystatin C was inferior to both creatinine and SDMA.
早期检测犬肾小球滤过率（GFR）降低具有挑战性。目前的方法不敏感，需要新的生物标志物。
比较血清对称二甲基精氨酸（SDMA）和血清胱抑素C与血清肌酐对临床稳定的犬（无论有无慢性肾脏病[CKD]）GFR降低的总体诊断性能。
前瞻性纳入97只客户拥有的犬：67只诊断或怀疑患有CKD的犬和30只健康犬。
前瞻性诊断准确性研究。所有犬均接受体格检查、全身动脉血压测量、尿液分析、血液学和血液生化分析、心脏和泌尿系统超声检查以及用于估计肾小球滤过率（mGFR）的闪烁扫描。冷冻血清用于SDMA和胱抑素C的批量分析。
肌酐、SDMA和胱抑素C检测mGFR<30.8 mL/min/L的曲线下面积分别为0.98（95%置信区间[CI]，0.93 - 1.0）、0.96（95%CI，0.91 - 0.99）和0.87（95%CI，0.79 - 0.93）。肌酐和SDMA在其预定临界值（115 μmol/L[1.3 mg/dL]和14 μg/dL）时检测异常mGFR的敏感性均为90%。肌酐的特异性为90%，SDMA的特异性为87%。当将胱抑素C的临界值调整为对应诊断敏感性90%（0.49 mg/L）时，特异性低于肌酐和SDMA（72%）。
肌酐和SDMA检测mGFR降低的总体诊断性能相似。胱抑素C的总体诊断性能低于肌酐和SDMA。
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