Assessment of renal function in clinical practice at the bedside of burn patients
Assessment of renal function in clinical practice at the bedside of burn patients
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DOI：
10.1111/j.1365-2125.2006.02807.x
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发表时间：
2007-05-01
影响因子：
3.4
通讯作者：
Saivin, S.
中科院分区：
文献类型：
--
作者：
Conil, J. M.;Georges, B.;Saivin, S.
目的本研究的目的是评估在正常范围内，单次血清肌酐测量和考虑血清肌酐、年龄、体重和性别的肾小球滤过的三个预测方程是否可以正确评估烧伤患者的肾功能。方法本研究是一项前瞻性研究，选取36例在烧伤后第二或第三周内血清肌酐< 120 mu mol l（-1）的成人烧伤患者。采用血清肌酐、24小时尿CL（CR）、Cockcroft-Gault、Robert、Kirkpatrick和简化MDRD方程评估肾功能。结果尽管所有患者血清肌酐浓度正常，但大量患者CL（CR）降低。9例（25%）患者尿CL < 80 ml(-1) min(-1) 1.73 m(-2)， 5例（14%）患者尿CL < 60 ml(-1) min(-1) 1.73 m（-2）。在CL（CR）低于或大于80 ml(-1) min(-1) 1.73 m（-2）的组之间，性别、烧伤指数、机械通气患者百分比或住院时间没有差异，但年龄存在差异。最高CL(CR) (> 140 ml(-1) min（-1) 1.73 m(-2)）在13例年龄小于40岁的患者中发现。回归分析、残差和Bland-Altman图显示，Cockcroft-Gault、Robert、Kirkpatrick和sMDRD方程都不足以评估肾功能。结论在高代谢期血清肌酐正常的烧伤患者中，血清肌酐和基于肌酐的预测方程在评估肾功能时不准确。
Aims The aim of this study was to evaluate whether the renal function of burn patients could be correctly assessed using a single serum creatinine measurement, within normal limits, and three prediction equations of glomerular filtration taking into account, serum creatinine, age, weight and sex.Methods This was a prospective study comprising 36 adult burn patients with a serum creatinine < 120 mu mol l(-1), within the second or third week following the burn injury. Renal function was assessed using serum creatinine, 24 h urinary CL(CR), and the Cockcroft-Gault, Robert, Kirkpatrick and simplified MDRD equations.Results Despite normal serum creatinine concentrations in all patients, a significant number had a decreased CL(CR). The urinary CL(CR) was < 80 ml(-1) min(-1) 1.73 m(-2) in nine patients (25%), and < 60 ml(-1) min(-1) 1.73 m(-2) in five patients (14%). Between the groups having a CL(CR) lower or greater than 80 ml(-1) min(-1) 1.73 m(-2) there were no differences in gender, burn indices, percentage of mechanically ventilated patients or length of hospital stay, but a difference in age. The highest CL(CR) (> 140 ml(-1) min(-1) 1.73 m(-2)) was found in 13 patients younger than 40 years. Regression analysis, residual and Bland-Altman plots revealed that neither the Cockcroft-Gault, Robert, Kirkpatrick nor sMDRD equations were specific enough for the assessment of renal function.Conclusions In burn patients with normal serum creatinine during the hypermetabolic phase, serum creatinine and creatine based predictive equations are imprecise in assessing renal function.