Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula
Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula
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DOI：
10.1038/ki.2012.388
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发表时间：
2013-03-01
影响因子：
19.6
通讯作者：
Chehade, Hassib
中科院分区：
文献类型：
--
作者：
Gao, Anja;Cachat, Francois;Chehade, Hassib
用于估计儿童肾小球滤过率 (eGFR) 最广泛使用的公式是 Schwartz 公式。 2009 年使用碘海醇清除率进行了修订，测得的 GFR (mGFR) 范围在 15 至 75 ml/min x 1.73 m(2) 之间。在这里，我们使用菊粉清除率 (iGFR) 方法评估了 Schwartz 公式的准确性，以将 392 名儿童的 551 个 iGFR 与其 Schwartz eGFR 进行比较，以评估其对于肾功能损害较轻儿童的准确性。使用补偿贾菲法测量血清肌酐。为了找到iGFR和eGFR之间的最佳关系，拟合了线性二次回归模型并推导出更准确的公式。该二次公式为：0.68 x (身高 (cm)/血清肌酐 (mg/dl)) - 0.0008 x (身高 (cm)/血清肌酐 (mg/dl))(2) + 0.48 x 年龄（岁） - （男性为 21.53，女性为 25.68）。该公式使用分半交叉验证技术进行了验证，并且还通过 127 名儿童的新队列进行了外部验证。结果表明，Schwartz 公式在身高 (Ht)/血清肌酐值为 251 之前都是准确的，对应于 103 ml/min x 1.73 m(2) 的 iGFR，但对于更高的值则明显不可靠。对于 20% 的准确度，对于所有患者以及 Ht/血清肌酐等于或大于 251 的患者，二次公式明显优于 Schwartz 公式。因此，新的二次公式可以取代修订后的施瓦茨公式，该公式对于中度肾功能衰竭的儿童是准确的，但对于肾功能损害较轻或滤过过度的儿童则不准确。肾脏国际 (2013) 83, 524-530; doi：10.1038/ki.2012.388； 2012 年 12 月 19 日在线发布
The most widely used formula for estimating glomerular filtration rate (eGFR) in children is the Schwartz formula. It was revised in 2009 using iohexol clearances with measured GFR (mGFR) ranging between 15 and 75 ml/min x 1.73 m(2). Here we assessed the accuracy of the Schwartz formula using the inulin clearance (iGFR) method to evaluate its accuracy for children with less renal impairment comparing 551 iGFRs of 392 children with their Schwartz eGFRs. Serum creatinine was measured using the compensated Jaffe method. In order to find the best relationship between iGFR and eGFR, a linear quadratic regression model was fitted and a more accurate formula was derived. This quadratic formula was: 0.68 x (Height (cm)/serum creatinine (mg/dl)) - 0.0008 x (height (cm)/serum creatinine (mg/dl))(2) + 0.48 x age (years) - (21.53 in males or 25.68 in females). This formula was validated using a split-half cross-validation technique and also externally validated with a new cohort of 127 children. Results show that the Schwartz formula is accurate until a height (Ht)/serum creatinine value of 251, corresponding to an iGFR of 103 ml/min x 1.73 m(2), but significantly unreliable for higher values. For an accuracy of 20 percent, the quadratic formula was significantly better than the Schwartz formula for all patients and for patients with a Ht/serum creatinine of 251 or greater. Thus, the new quadratic formula could replace the revised Schwartz formula, which is accurate for children with moderate renal failure but not for those with less renal impairment or hyperfiltration. Kidney International (2013) 83, 524-530; doi:10.1038/ki.2012.388; published online 19 December 2012