Cystatin C and acute changes in glomerular filtration rate
Cystatin C and acute changes in glomerular filtration rate
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DOI：
10.5414/cn107324
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发表时间：
2012-07-01
影响因子：
1.1
通讯作者：
Cherney, David
中科院分区：
文献类型：
--
作者：
Odutayo, Ayodele;Cherney, David
确定一个有效的急性肾功能变化的标志物是临床肾脏病学的优先事项。虽然血清肌酐是肾小球滤过率（GFR）最广泛使用的替代物，但其对非肾小球清除率的脆弱性导致GFR的偏倚估计，并可能延迟急性变化的识别。另外，半胱氨酸蛋白酶抑制剂C（CysC）已被认为是一个有前途的GFR标志物。在糖尿病、蛋白质诱导的肾小球超滤和极端运动中的对照生理学研究表明，CysC的急性变化比血清肌酐提供了更好的GFR近似值。检查造影剂肾病、急性肾损伤和肾移植的临床研究也证明了CysC在准确测量GFR和早期诊断肾功能不全方面的几个可能优势。CysC测量还提供辅助益处，例如改善对患者结果和预后的预测。我们的目的是回顾CysC在几天、几周和几个月内的短期变化的文献，以探讨CysC在急性环境中的临床应用。基于现有的证据，CysC可以提高临床医生检测肾功能急性变化的能力。
The identification of an effective marker of acutely changing kidney function is a priority in clinical nephrology. While serum creatinine is the most widely used surrogate for glomerular filtration rate (GFR), its vulnerability to non-glomerular clearance results in biased estimates of GFR and may delay the identification of acute changes. Alternatively, cystatin C (CysC) has been recognized as a promising marker of GFR. Controlled physiological studies in diabetes, protein-induced glomerular hyperfiltration and extreme exercise demonstrated that acute changes in CysC provide a better approximation of GFR than serum creatinine. Clinical studies examining contrast induced nephropathy, acute kidney injury, and kidney transplantation have also demonstrated several possible advantages of CysC with respect to accurately measuring GFR and early diagnosis of renal dysfunction. CysC measurements also provide ancillary benefits such as improved prediction of patient outcomes and prognosis. Our aim was to review the literature on short-term changes in CysC over days, weeks and months to explore the clinical utility of CysC in the acute setting. Based on existing evidence, CysC may improve clinicians' ability to detect acute changes in kidney function.