Measurement and Estimation of Glomerular Filtration Rate in Children.

Measurement and Estimation of Glomerular Filtration Rate in Children.
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DOI:
10.1053/j.ackd.2017.09.011
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发表时间:
2017-11
影响因子:
2.9
通讯作者:
Schwartz GJ
Schwartz GJ
中科院分区:
医学4区
文献类型:
--
作者:
Mian AN;Schwartz GJ

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快速、准确和精确的肾功能测量对患者的日常管理至关重要。虽然血浆和尿液清除率为评估肾小球滤过率(GFR)提供了最大的准确性,但它们通常是不切实际的,特别是对儿童的护理。血清肌酐是最常用的内源性标志物,它简单、方便、实用,但由于非gfr决定因素的影响,如随着儿童年龄增长而增加的肌肉质量,使生长成为单独使用肌酐解释肾功能的混淆变量,因此准确性较低。已经为成人和儿童开发了GFR估计方程,通过考虑一些非GFR决定因素来提高内源性生物标志物(如肌酐和胱抑素C)的准确性,从而提高从业者评估GFR的能力。在稳定状态下,当身高被用作生长的替代品时,身高/SCr和GFR之间存在很强的相关性。目前的国家指南建议,对于成人,使用CKD-EPI肌酐为基础的公式和更新的Schwartz“床边”公式(CKiD 2009), GFR和肌酐值一起常规报告。
Rapid, accurate, and precise measures of kidney function are essential for the daily management of patients. While plasma and urinary clearances provide the greatest accuracy for assessing glomerular filtration rate (GFR), they are often impractical particularly for the care of children. Serum creatinine, the most commonly used endogenous marker, is simple, convenient, and practical but less accurate because of the influence of non-GFR determinants such as muscle mass which increases with age in children making growth a confounding variable in the interpretation of kidney function from creatinine alone. GFR estimating equations have been developed for adults and children to improve the accuracy of endogenous biomarkers, such as creatinine and cystatin C, by accounting for some of the non-GFR determinants thus enhancing the practitioner’s ability to assess GFR. In the steady state, when height is used as a surrogate for growth, there is a strong correlation between height/SCr and GFR. Current national guidelines recommend that the estimated GFR routinely be reported alongside the creatinine value for adults using the CKD-EPI creatinine-based formula and the updated Schwartz “bedside” formula (CKiD 2009) for children.
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