Height: the missing link in estimating glomerular filtration rate in children and adolescents.
Height: the missing link in estimating glomerular filtration rate in children and adolescents.
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身高：估计儿童和青少年肾小球滤过率的缺失环节。
DOI：
10.1093/ndt/gft530
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Schwartz,GeorgeJ
中科院分区：
文献类型：
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作者：
Schwartz,GeorgeJ
肾小球滤过率(GFR)是反映肾功能和肾脏疾病进展的最有用的指标。GFR的测量在临床上是费力的，因为它既耗时又昂贵，对于医院和门诊中遇到的许多临床情况来说，结果的周转时间太慢了。因此，开发由内源性生物标志物衍生的GFR估算公式是非常有兴趣的。这也适用于那些在GFR研究中表现可能更困难的儿童。成人的EGFR公式几乎被普遍接受和应用，这些公式源于血肌酐(Scr)[1，2]，这些公式除了Scr外，还包括性别、种族和年龄，以优化准确性。然而，这种应用在儿童中并不是很有用，因为在正常肾功能的情况下，Scr的成熟增加。如前所述[3-5]，在儿科，SCR随着生长发育而增加，并且在青春期之后表现出性别差异。因此，儿童肾小球滤过率估算公式的发展侧重于更好地估计肾功能的额外参数。此前，我们表明，参数的身高/SCRE可以解释儿童肾小球滤过率变异性的70%以上(图1a)[6]。尽管已经对其他参数进行了研究，但高度/SCR在建立GFR估计方程中仍占有关键地位[6-8]。GFR与身高/SCR之间的比例关系包含在系数k中，该系数最初被发现为每1.73平方米每厘米0.55毫克/分钟[6]。随后的研究表明，青春期男孩的k值较高[7，9]，可能是因为这组人每公斤体重的肌肉质量较高。这些关系是在比色法Jaffe反应适用于自动化学分析仪的时代产生的；通过加入透析步骤和在样品之间插入空白，与快速动力学分析相比，减少了干扰并提高了准确性[7，10]。然而，随着更准确的酶促血清肌酐测定和国际同位素稀释质谱学(IDMS)参考标准的发展[1，11]，比例常数k减少了约25%，至
Glomerular filtration rate (GFR) is the most useful indicator of kidney function and kidney disease progression. Measurement of GFR is laborious to perform clinically, as it is time-consuming and costly, with turn-around time for results being too slow for many clinical situations encountered in the hospital and outpatient setting. Thus, there is great interest in developing GFR estimating formulas derived from endogenous biomarkers. This applies also to children in whom performance of GFR studies is likely to be more difficult. There is nearly universal acceptance and application of adult eGFR formulas derived from serum creatinine (Scr)[1, 2], and these formulas incorporate, in addition to Scr, sex, race and age to optimize accuracy. However, such an application is not as useful in children because of the maturational increase in Scr in the setting of normal renal function. As has been shown previously [3-5], Scr increases in pediatrics with growth and development, and after puberty shows a gender-dependent divergence. Thus, the development of GFR-estimating formulas in children has focused on additional parameters to better estimate kidney function.Previously, we showed that the parameter ‘height/Scre could explain more than 70% of the variability of GFR in children (Figure 1 a)[6]. Whereas other parameters have been investigated, height/Scr has retained its key place in building GFR estimating equations [6-8]. The proportionality relationship between GFR and height/Scr is subsumed in the coefficient k, which was originally found to be 0.55 mg/min per cm per 1.73 m2 [6]. Subsequent studies showed a higher k value for adolescent boys [7, 9] probably due to the higher muscle mass per kg body weight in this group. These relationships were generated during the era when the colorimetric Jaffe reaction was adapted to an automated chemical analyzer; by incorporating a dialysis step and interposing blanks between samples, there was reduced interference and improved accuracy compared with the rapid kinetic assays [7, 10]. However, with the development of the more accurate enzymatic serum creatinine assay and international isotope dilution mass spectroscopy (IDMS) reference standards [1, 11], the proportionality-constant k was reduced by some 25% to