Bergamo R R, Laidlaw S A, Kopple J D
Department of Medicine, Harbor-UCLA Medical Center, Torrance 90509.
Am J Kidney Dis. 1993 Dec;22(6):814-21. doi: 10.1016/s0272-6386(12)70340-2.
When a patient presents with renal failure, it is often difficult to ascertain whether the individual is suffering from acute or chronic renal failure. Fingernail creatinine might help to differentiate between the two. To test this possibility, the relationship between the fingernail creatinine and the serum creatinine obtained concurrently or 1 or more months previously was examined in 22 normal adults, nine patients with acute renal failure, seven patients with chronic renal failure not undergoing dialysis, 16 maintenance hemodialysis patients, and 33 patients with a functioning renal transplant who had been transplanted 0.2 to 3.9 months (n = 21) or 4.3 to 33 months previously (n = 12). Fingernail creatinine was significantly greater than normal in the patients with chronic renal failure, patients undergoing maintenance hemodialysis, and patients who had a functioning renal transplant implanted 0.2 to 3.9 months previously. In contrast, fingernail creatinine was not different from normal in the patients with acute renal failure and in patients who had a functioning renal transplant placed 4.3 to 33 months previously. In the maintenance hemodialysis patients, fingernail creatinine showed the strongest correlation with the serum creatinine obtained between 5 and 10 months previously, with the highest correlation at 9 months. In the renal transplant recipients, the fingernail creatinine decreased to normal or near normal values within approximately 90 to 120 days after transplantation. These findings indicate that fingernail creatinine may reflect the serum creatinine values several months previously. The fingernail creatinine may help to identify whether patients have recent onset as compared with longstanding renal failure.
当患者出现肾衰竭时，往往难以确定其患的是急性肾衰竭还是慢性肾衰竭。指甲肌酐可能有助于区分这两者。为了验证这种可能性，研究人员在22名正常成年人、9名急性肾衰竭患者、7名未接受透析的慢性肾衰竭患者、16名维持性血液透析患者以及33名肾移植功能良好的患者中，检测了指甲肌酐与同期或1个月及以上之前测得的血清肌酐之间的关系。这些肾移植患者中，21名移植时间为0.2至3.9个月，12名移植时间为4.3至33个月。慢性肾衰竭患者、维持性血液透析患者以及移植后0.2至3.9个月肾移植功能良好的患者，其指甲肌酐显著高于正常水平。相比之下，急性肾衰竭患者以及移植后4.3至33个月肾移植功能良好的患者，其指甲肌酐与正常水平无差异。在维持性血液透析患者中，指甲肌酐与5至10个月前测得的血清肌酐相关性最强，在9个月时相关性最高。在肾移植受者中，指甲肌酐在移植后约90至120天降至正常或接近正常水平。这些发现表明，指甲肌酐可能反映数月前的血清肌酐值。指甲肌酐可能有助于确定患者肾衰竭是近期发病还是长期存在。
