Possible risk of overestimation of renal function using cystatin C-based eGFR in testicular cancer survivors treated with cisplatin-based chemotherapy
Possible risk of overestimation of renal function using cystatin C-based eGFR in testicular cancer survivors treated with cisplatin-based chemotherapy
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DOI：
10.1007/s10157-017-1474-x
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发表时间：
2018-06-01
影响因子：
2.3
通讯作者：
Nishiyama, Hiroyuki
中科院分区：
文献类型：
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作者：
Ichioka, Daishi;Kawai, Koji;Nishiyama, Hiroyuki
慢性肾脏病(CKD)是以顺铂为主的化疗治愈的睾丸癌(TC)存活者的主要长期发病率。我们进行了这项研究，以阐明在这些患者中，基于胱抑素的估计肾小球滤过率(EGFRcys)和基于肌酐的EGFR(EGFRcreat)在诊断CKD中的有效性。测定了12例TC存活者和17例CKD内科疾病患者的24小时肌酐清除量(CrCl)，所有患者的eGFR均为60m/min/1.73m(2)。同时测定了尿β2-微球蛋白和白蛋白的浓度，eGFRcyt的平均值分别为67.9和95.2ml/min/1.73m(2)，明显低于eGFRcys(p<；0.05)。3-5期CKD的患病率因GFR估计方法不同而不同。EGFRcreat组为47.2%，eGFRcys组为7.5%。其中eGFRcreat=60ml/min/1.73m(2)21例，eGFRcys=60ml/min/1.73m(2)。在所有12名TC幸存者中，eGFRcys的值均高于eGFRcreat和GFR(24小时CrCl)。相比之下，17例内科疾病所致CKD患者的EGFR值无明显差异。在eGFRcreat；60ml/min/1.73m(2)和eGFRcys>；=60ml/min/1.73m(2)的21例患者中，有10例出现明显的β2-微球蛋白尿：其患病率高于两者均为60ml/min/1.73m(2)的患者。此外，在这些患者中，微量白蛋白尿的发生率往往很高。本研究表明，eGFRcys可能高估了以顺铂为基础的化疗治愈的TC幸存者的肾功能。
Chronic kidney disease (CKD) is a major long-term morbidity of testicular cancer (TC) survivors cured by cisplatin-based chemotherapy. We conducted the present study to elucidate the usefulness of cystatin-based estimated glomerular filtration rates (eGFRcys) for diagnosis of CKD compared to creatinine-based eGFR (eGFRcreat) in those patients.eGFRcys and eGFRcreat were measured in 53 TC survivors. The 24-h creatinine clearance (CrCl) was measured in 12 TC survivors and 17 CKD patients with medical disease; all of them had eGFRcreat < 60 m/min/1.73 m(2). Also, urinary beta2-microglobulin and albumin concentrations in spot urine specimens were measured.The mean eGFRcreat was significantly lower than eGFRcys, at 67.9 and 95.2 ml/min/1.73 m(2), respectively (p < 0.05). The prevalence of stage 3-5 CKD differed by GFR estimation methods. It was 47.2% with eGFRcreat and only 7.5% with eGFRcys. There were 21 patients with eGFRcreat < 60 ml/min/1.73 m(2) and eGFRcys >= 60 ml/min/1.73 m(2). In all 12 TC survivors, the eGFRcys values were higher than both eGFRcreat and GFR (24-h CrCl). In contrast, no difference was observed among eGFR values in the 17 patients with CKD due to medical disease. Ten of 21 patients with eGFRcreat < 60 ml/min/1.73 m(2) and eGFRcys >= 60 ml/min/1.73 m(2) showed significant beta2-microglobulinuria: a higher prevalence than that in patients with both eGFRs >= 60 ml/min/1.73 m(2). Also, the incidence of microalbuminuria tended to be high in those patients.The present study suggests that eGFRcys may overestimate renal function in TC survivors cured by cisplatin-based chemotherapy.