LIMITATIONS OF CREATININE AS A FILTRATION MARKER IN GLOMERULOPATHIC PATIENTS
LIMITATIONS OF CREATININE AS A FILTRATION MARKER IN GLOMERULOPATHIC PATIENTS
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DOI：
10.1038/ki.1985.205
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发表时间：
1985-11-01
影响因子：
19.6
通讯作者：
MYERS, BD
中科院分区：
文献类型：
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作者：
SHEMESH, O;GOLBETZ, H;MYERS, BD
为确定肌酐作为肾小球滤过率（GFR）衡量指标的可靠性，我们在171例患有各种肾小球疾病的患者中，比较了肌酐与三种不同大小的真实滤过标志物的同时清除率。以菊粉（半径[rs]=15埃）作为参照标志物，我们发现⁹⁹ᵐTc - DTPA（r₃ = 4埃）的分数清除率为1.02±0.14，而半径为19埃的葡聚糖的分数清除率为0.98±0.13，这两个值与1均无差异。相比之下，肌酐（rs = 3埃）相对于菊粉的分数清除率超过1，平均为1.64±0.05（P<0.001），但通过静脉注射西咪替丁急性阻断肾小管肌酐分泌，可使其降低至接近1。对所有171例患者的横断面分析显示，肌酐的分数分泌与GFR呈反比。在病情恶化（N = 28）或缓解（N = 26）的肾小球疾病患者个体中进行的纵向研究也证实了这种反比关系。结果，肌酐相对于菊粉清除率的变化明显减弱，甚至难以察觉。我们得出结论，半径小于20埃的真实滤过标志物，包括菊粉，在肾小球疾病中不受限制，并且随着疾病恶化，残余肾小管对肌酐的分泌逐渐增多。因此，试图将肌酐用作评估或监测肾小球疾病患者的标志物，将导致对GFR的严重且不可预测的高估。
To determine the reliability of creatinine as a measure of the glomerular filtration rate (GFR), we compared the simultaneous clearance of creatinine to that of three true filtration markers of graded size in 171 patients with various glomerular diseases. Using inulin (radius [rs] = 15 .ANG.) as a reference marker, wer found that the fractional clearance of 99mTc-DTPA (r3 = 4 .ANG.) was 1.02 .+-. 0.14, while that of a 19 .ANG. rs dextran was 0.98 .+-. 0.13, with neither value differing from unity. In contrast, the fractional clearance (relative to inulin) of creatinine (rs = 3 .ANG.) exceeded unity, averaging 1.64 .+-. 0.05 (P < 0.001), but could be lowered towards unity by acute blockade of tubular creatinine secretion by IV cimetidine. Cross-sectional analysis of all 171 patients revealed fractional creatinine secretion to vary inversely with GFR. This inverse relationship was confirmed also among individual patients with either deteriorating (N = 28) or remitting (N = 26) glomerular disease, who were studied longitudinally. As a result, changes in creatinine relative to inulin clearance were blunted considerably or even imperceptible. We conclude that true filtration markers with rs < 20 .ANG., including inulin, are unrestricted in glomerular disease, and that creatinine is hypersecreted progressively by remnant renal tubules as the disease worsens. Accordingly, attempts to use creatinine as a marker with which to evaluate or monitor glomerulopathic patients will result in gross and unpredictable overestimates of the GFR.