Davenport A, Jones S R, Goel S, Astley J P, Hartog M
Department of Renal Medicine, Southmead Hospital, Westbury-on-Trym, Bristol, UK.
Lancet. 1993 Jun 26;341(8861):1614-7. doi: 10.1016/0140-6736(93)90757-8.
Detection of carbamylated haemoglobin, measured as valine hydantoin per g haemoglobin (VH/g Hb), may be useful in differentiating between patients with acute or chronic renal failure. To assess this test, we measured carbamylated haemoglobin prospectively in 42 consecutive patients referred to the regional renal unit with a serum creatinine in excess of 500 mumol/L and a provisional diagnosis of acute renal failure (ARF). Patients were subsequently classed on clinical criteria as having ARF (20) or acute on chronic renal failure (AonCRF, 22). 24 patients with stable chronic renal failure (CRF), matched for degree of renal impairment, were also studied. Standard biochemical tests and haemoglobin were similar among the three groups. Patients with ARF of 10 or less days duration had a lower median (interquartile range [IQR]) carbamylated haemoglobin concentration than those with a longer duration of ARF (29 [27-35] vs 72 [60-83] micrograms VH/g Hb; p < 0.01). Carbamylated haemoglobin concentration was lower in the ARF group than in the AonCRF or CRF groups (42 [31-67], 116 [83-119], and 148 [122-210] micrograms VH/g Hb, respectively; p < 0.001). All patients with a degree of acute and potentially, reversible renal failure (ARF and AonCRF) had a carbamylated haemoglobin concentration below 190 micrograms VH/g Hb (sensitivity 100%, positive predictive value 62% for this cut-off). When the ratio of carbamylated haemoglobin to serum creatinine was calculated, to correct for degree of renal failure, a value of less than 0.2 had a 100% sensitivity and 80% positive predictive value for dividing patients with potentially reversible renal failure from those with CRF. Measurement of carbamylated haemoglobin was useful in identifying patients with acute and potentially reversible forms of renal failure. This test could be of clinical value in deciding which patients require urgent referral for further management and treatment in hospitals without specialist nephrological care.
以每克血红蛋白中缬氨酸乙内酰脲（VH/g Hb）来衡量的氨甲酰化血红蛋白检测，可能有助于区分急性或慢性肾衰竭患者。为评估此项检测，我们对连续42例转诊至地区肾脏科、血清肌酐超过500 μmol/L且初步诊断为急性肾衰竭（ARF）的患者进行了前瞻性氨甲酰化血红蛋白检测。随后根据临床标准将患者分类为患有ARF（20例）或慢性肾衰竭急性发作（AonCRF，22例）。还研究了24例稳定的慢性肾衰竭（CRF）患者，这些患者在肾功能损害程度上相匹配。三组患者的标准生化检测和血红蛋白水平相似。病程持续10天或更短的ARF患者，其氨甲酰化血红蛋白浓度中位数（四分位间距[IQR]）低于病程较长的ARF患者（29 [27 - 35] 对72 [60 - 83] μg VH/g Hb；p < 0.01）。ARF组的氨甲酰化血红蛋白浓度低于AonCRF组或CRF组（分别为42 [31 - 67]、116 [83 - 119]和148 [122 - 210] μg VH/g Hb；p < 0.001）。所有急性且可能可逆性肾衰竭程度的患者（ARF和AonCRF），其氨甲酰化血红蛋白浓度均低于190 μg VH/g Hb（此临界值的敏感性为100%，阳性预测值为62%）。为校正肾衰竭程度而计算氨甲酰化血红蛋白与血清肌酐的比值时，小于0.2的值对于区分可能可逆性肾衰竭患者与CRF患者具有100%的敏感性和80%的阳性预测值。氨甲酰化血红蛋白检测有助于识别急性且可能可逆形式的肾衰竭患者。此项检测在决定哪些患者需要紧急转诊至无专科肾脏病护理的医院进行进一步管理和治疗方面可能具有临床价值。
