Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate.
Establishing the presence or absence of chronic kidney disease: Uses and limitations of formulas estimating the glomerular filtration rate.
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DOI：
10.5662/wjm.v7.i3.73
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发表时间：
2017-09-26
期刊：
影响因子：
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通讯作者：
Tzamaloukas AH
中科院分区：
文献类型：
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作者：
Alaini A;Malhotra D;Rondon-Berrios H;Argyropoulos CP;Khitan ZJ;Raj DSC;Rohrscheib M;Shapiro JI;Tzamaloukas AH
根据血清肌酐和胱抑素C估计肾小球滤过率(EGFR)的公式的发展，并考虑了影响这些生物标志物产生速率的某些变量，包括种族、性别和年龄，导致了目前的慢性肾脏疾病(CKD)的诊断和分期方案，该方案基于EGFR值和蛋白尿。这一方案已在不同人群中广泛应用，并导致了目前对慢性肾脏病流行率的估计。此外，该方案还应用于临床研究，评估慢性肾脏病的风险和旨在改善其病程的各种干预措施的有效性。在不同的队列中，基于肌酐和基于胱抑素的EGFR值之间以及EGFR值和测量的GFR之间的不一致已经被报道。这些分歧是产量和除GFR以外影响肌酐和胱抑素C去除率的因素不同的结果。这些分歧对迄今开发的所有EGFR配方都造成了限制。主要的局限性是在几个受试者中检测早期CKD的敏感性低，例如，那些有高滤过性的患者，以及对CKD病程的预测不佳。CKD的研究目前正致力于识别比目前更好的GFR指标的生物标志物，特别是早期肾组织损伤的生物标志物。
The development of formulas estimating glomerular filtration rate (eGFR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease (CKD), which is based on eGFR values and albuminuria. This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based eGFR values and between eGFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all eGFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and, particularly, biomarkers of early renal tissue injury.