Cumulative and acute toxicity of repeated high-dose tobramycin treatment in cystic fibrosis.

Forty-six patients with cystic fibrosis and chronic bronchopulmonary Pseudomonas aeruginosa infection entered a study of tobramycin-related chronic and acute nephro- and acousticovestibular toxicity. The patients (mean age, 15.7 years) had previously received 2-week courses of tobramycin therapy, for a mean cumulative total of 279 days each. The cumulative tobramycin dose ranged from 632 to 7,644 mg/kg. The patients were studied before and at the end of a 2-week course of treatment with tobramycin (10 to 20 mg/kg per day) to discriminate between acute and chronic toxicity. In patients studied at the beginning of the present course of treatment, the glomerular filtration rate, measured as 24-h creatinine clearance, did not correlate with the cumulative dose of tobramycin received during previous courses. Eighteen patients (39%) had a reduced glomerular filtration rate compared with normal values (mean, 12.5% reduction) but normal serum creatinine values. Two patients (5%) had a high-frequency hearing deficit (above 8 kHz), but only one deficit was possibly related to tobramycin. No chronic vestibular toxicity was observed. During the course of treatment, no patients developed acute nephrotoxicity. After 2 weeks of treatment 32% had a slightly reduced hearing threshold (15 to 30 dB) in two or more high frequencies, and 28% had a fall in vestibular response greater than 25% of the initial value but remained within normal limits. Thus, the acute and chronic toxicity of repeated high-dose tobramycin treatment in cystic fibrosis patients seems to be very mild.     

Pharmacokinetics of the Aminoglycoside Antibiotic Tobramycin in Humans

The pharmacokinetics, distribution, and plasma and renal clearance of a new aminoglycoside antibiotic, tobramycin, was studied in the treatment of 18 elderly male patients (average age, 69 years) with urinary tract infections. Ten of these patients had normal renal function and eight had impaired renal function of various degrees. After administration of 1 mg of tobramycin/kg of body weight every 6 to 8 h (two to three times the half-life), urine concentrations were found to be sufficient in the treatment of urinary tract infections caused by susceptible organisms. The renal clearance of tobramycin during constant intravenous infusion was also studied in eight patients. Good correlation was found between the patients serum creatinine and the half-life of tobramycin. The half-life of tobramycin in patients with normal renal function (serum creatine [Formula: see text] to 1.5 mg/100) was on the average 3 h. For practical purposes, therefore, the dosage of tobramycin in the treatment of urinary tract infections should be 1 mg/kg of body weight every 6 to 8 h in patients with normal renal function. For patients with impaired renal function, the dosage interval is calculated by multiplying the patients' serum creatinine by six. If the dosage intervals are kept unchanged, the dosage must be divided by the patients' serum creatinine. The initial loading dose should always be 1 mg/kg. The total renal clearance of tobramycin (92% of the glomerular filtration rate) was not influenced by the administration of probenecid, which indicates that tobramycin is excreted only by glomerular filtration.     

血清胱抑素C测定对糖尿病肾病早期诊断的临床意义

目的研究血清胱抑素C在2型糖尿病肾病早期诊断中的临床应用。方法收集115例2型糖尿病患者,根据24小时尿白蛋白排泄量,将患者分为单纯性糖尿病组、早期DN组、临床DN组。比较三组患者血清胱抑素C、血肌酐、肾小球滤过率、肌酐清除率检测出。肾功能异常的比例并分析血清胱抑素c与肾小球滤过率的相关性;根据肾小球滤过率的数值,将单纯性糖尿病组的患者分为eGFR％60ml／min／1．73m^2和eGFR≥60ml／min／1．73m^2组,对两组间血清胱抑素C等各项指标进行比较,进行统计学分析。结果 1.血清胱抑素C与肌酐清除率检出肾功能异常的比例相当,但均明显高于血肌酐及尿素氮。2．在24小时尿白蛋白排泄量〈30mg的患者中,eGFR〈60ml／min／1．73m^2组患者的胱抑素C的水平明显高于eGFR≥60ml／min／1．73m^2的患者。结论血清胱抑素C与肾小球滤过率有很好的相关性,且在正常蛋白尿的糖尿病患者中即可以提示早期肾小球滤过率的下降。     

肾病患者内源性肾小球滤过率的实验室评价

目的 :评估肾病患者内源性肾小球滤过率 (GFR)。方法 :测定了 5 7例肾病患者和 39例健康对照血中CystatinC(CysC )、尿素、肌酐和肌酐清除率浓度。结果 :患者尿素、肌酐、肌酐清除率和CysC浓度与健康对照组间均存在明显差异 (P <0 .0 0 1 ) ;相关分析表明CysC和肌酐清除率之间 (P <0 .0 1 )、CysC和肌酐之间 (P <0 .0 1 )存在明显的相关关系。而肌酐和尿素之间 (P >0 .0 5 ) ,以及肌酐和肌酐清除率之间 (P >0 .0 5 )无明显相关关系存在。结论 :肾病患者血中CysC浓度增高 ,对GFR功能早期受损的评估优于尿素、肌酐和肌酐清除率。     

Serum cystatin C level for better assessment of glomerular filtration rate in cystic fibrosis patients treated by amikacin

Background and objective: Monitoring of renal function in cystic fibrosis (CF) patients is essential. The dosage regimen of amikacin is regularly modified according to the patient’s glomerular filtration rate (GFR). The aim of the study was to evaluate the use of cystatin C (CyC) for monitoring amikacin therapy along with other markers of renal tubular and glomerular function, and damage [N‐acetyl‐β‐ d glucosaminidase (NAG), creatinine level and creatinine clearance]. Methods: We compared the GFR, estimated from the serum concentrations of creatinine (Cockcroft–Gault formula) and CyC (Grubb’s formula). Seventy‐one patients (mean age 12 years; range 4–28 years) with CF were treated by intermittent intravenous infusion of amikacin. Tubular nephrotoxicity was investigated by measurement of urine NAG/urine creatinine ratio (U‐NAG/U‐creatinine). Concentrations of all markers were measured before starting amikacin therapy and at days 3, 5, 7, 10 and 12. Fluorescence polarization analysis, turbidimetry, enzymatic phototometric creatinine deaminase method and fluorimetry were used for determination of serum amikacin, serum CyC, creatinine and urine NAG activity. Receiver operating characteristic (ROC) analysis was performed to assess the influence of GFR estimated from serum creatinine and serum CyC for the prediction of amikacin clearance during aminoglycoside therapy. Results: Significant differences in the rate of U‐NAG/U‐creatinine were noted before and after treatment with amikacin (P < 0·001). Serum creatinine levels and creatinine clearance at the end of amikacin therapy (12th day) did not show any significant differences in comparison with the levels measured before the start of therapy (0th day). At days 5, 7, 10 and 12, serum CyC levels showed a significant elevation (P < 0·001), and CyC clearance showed a significant decrease (P < 0·001) in comparison with the levels measured at day 0. The ratio of amikacin clearance/creatinine clearance decreased with therapy whereas the amikacin clearance/CyC and amikacin clearance/CyC clearance increased. Conclusion: We showed that the rate of U‐NAG/U‐creatinine is a suitable marker for monitoring tubular nephrotoxicity in CF patients. Serum creatinine and estimated creatinine clearance are modest predictors of GFR in CF patients. CyC appears to be a better marker of GFR than serum creatinine concentration or creatinine clearance in our study. Serum CyC levels and CyC clearance showed greater ability to predict amikacin clearance during therapy than creatinine clearance.     

亲属活体供肾移植中供者肾功能的评估

背景:肾移植前正确有效地评价供者双侧肾脏功能,对于亲属活体肾移植供者及受者的安全十分重要。目的:探讨亲属活体供肾移植中供者肾功能评估的指标。方法:173例亲属活体肾移植供者年龄分成老年组(≥55岁)和中青年组(<55岁),两组供者移植前血清肌酐、总肾小球滤过率、欲保留肾总肾小球滤过率、内生肌酐清除率、血尿素氮反应肾功能指标差异无显著性意义,分析比较移植前后肾功能各指标的变化。结果与结论:与移植前比较,移植后10d供者血清肌酐、血尿素氮增高,内生肌酐清除率降低(P<0.01);移植后1个月留存肾脏总肾小球滤过率增加(P=0.0000),但与移植前供者双肾比较下降。提示总肾小球滤过率可作为活体亲属肾移植供者肾功能评估的主要指标,但是仍应结合血清肌酐、内生肌酐清除率等指标综合分析。     

Predictors of renal function in diabetic and non-diabetic renal disease

Forty-two patients with renal disease due to diabetic nephropathy (14 patients), tubulointerstitial disease (14 patients) and glomerular disease (14 patients) underwent measurement of glomerular filtration rate (GFR) by the 51Cr-EDTA 'one-shot' method and simultaneous serum beta 2-microglobulin, serum creatinine and creatinine clearance estimation. Serum creatinine was a significantly better predictor of GFR than serum beta 2-microglobulin in patients with diabetic nephropathy, whereas both methods were equally useful predictors of GFR in non-diabetic renal disease. Serum creatinine measurement remains the best method for detecting early reduction of GFR on a serum sample.     

Iopentol in patients with chronic renal failure: its effects on renal function and its use as glomerular filtration rate parameter.

Iopentol (mean dose 0.42 g I kg-1) was administered for abdominal aortography and pelvic angiography in 10 patients with advanced non-diabetic chronic renal failure (S-creatinine 672 +/- 259 mumol l-1, mean +/- SD). Renal glomerular function measured as creatinine clearance and plasma clearance of [99Tcm]-diethyl-enetriaminepentaacetic acid (DTPA) was unchanged by iopentol, as also was urinary excretion of the renal tubular enzymes N-acetyl-beta-glucosaminidase (NAG) and alkaline phosphatase (ALP). The elimination of iopentol from serum and urine was delayed, and detectable serum and urine concentrations were found 5 days after administration of the contrast medium. Creatine clearance was 47% higher than the corresponding renal iopentol clearance. Plasma iopentol clearance, measured as the total area under the plasma concentration curve, was 40% higher than renal iopentol clearance because of extrarenal elimination of iopentol. We conclude that abdominal aortography with iopentol can be performed without effects on renal glomerular or tubular function parameters in patients with advanced renal failure. If iopentol is used for measurement of glomerular filtration rate (GFR) in this group of patients, one should measure renal clearance, as plasma clearance overestimates GFR.     

水化治疗预防不同肾功能水平病人造影剂相关肾损伤的临床观察

[目的]探讨水化治疗预防不同肾小球滤过率（GFR）病人行冠状动脉介入术后造影剂相关肾损伤的效果,以便指导临床工作。[方法]将血肌酐正常的冠状动脉介入术后139例病人,根据GFR不同分为正常组和异常组,两组病人术后行常规水化治疗。比较两组术前、术后血肌酐、肾小球滤过率、血尿素氮、血清β2-微球蛋白、尿微量白蛋白、24 h出入量情况。[结果]两组术后均未发生造影剂肾病,术后6 h、12 h尿量差异有统计学意义（P〈0.05）;两组血尿素氮、β2-微球蛋白水平比较差异有统计学意义（P〈0.05）;术后第2天尿微量白蛋白与术前差值比较,差异有统计学意义（P〈0.05）。[结论]血肌酐正常的病人中有一部分潜在或已存在肾功能异常,术前应常规计算肾小球滤过率,临床可通过加强水化治疗预防不同肾小球滤过率的冠状动脉介入术后病人造影剂相关肾损伤。     

Assessment of renal function by serum creatinine and creatinine clearance: glomerular filtration rate estimated by four procedures

We compared creatinine concentrations in serum and urine and creatinine clearances determined by two Jaffé (Beckman's "Astra," Boehringer Mannheim Diagnostics) and two enzymatic (Kodak, Boehringer Mannheim Diagnostics) methods. Serum creatinine and creatinine clearances determined by each method were also compared with the glomerular filtration rate as measured with use of sodium [125I]iothalamate in patients with a wide range of renal function. Results between methods correlated excellently, but we saw clear method-dependent biases of up to 2.9 mg/L for serum. The highest serum creatinine values and the lowest creatinine clearances were obtained with Boehringer Mannheim Diagnostics' Jaffé method. The reciprocal of the serum creatinine and the creatinine clearance also correlated well with the glomerular filtration rate, but all methods over-estimated the glomerular filtration rates to varying degrees. Appropriate standardization of methods appears to be as important as method principle for establishing an accurate relationship between creatinine determinations and glomerular filtration rate.     

Determination of the production rate and non-renal clearance of cystatin C and estimation of the glomerular filtration rate from the serum concentration of cystatin C in humans

Cystatin C has been proposed as an endogenous marker for measuring glomerular filtration rate (GFR) and is regarded as being equivalent to or better than creatinine. However, there are no published data on the production rate (Cys(pr)) or on the non-renal clearance of cystatin C (CL(nr)) in humans, which are essential parameters for GFR calculation. GFR was determined by measuring the plasma clearance of iohexol. Cystatin C, creatinine, urea and albumin were determined on the same serum samples as iohexol; 381 patients with a GFR range of 12-151 ml/min/1.73 m2, and 70 patients on haemodialysis were evaluated. Renal clearance of cystatin C (CLr) equals GFR * S (the sieving coefficient). Plasma clearance (CL) = CLr + CLnr. The relationship between Cys(pr) and the elimination rate (CL * serum-cystatin C) can be expressed as Cys(pr) = (S * GFR+CLnr) * serum-cystatin C. Assuming that the unknown values of Cys(pr) and CLnr are independent of GFR, the equation can be solved from GFR (iohexol clearance) and serum cystatin C (s-Cys) patient data. For S=1, we found Cys(pr) = 0.124 +/- 0.023 mg/min/1.73 m2 and Cl(nr)=22.3 ml/min/1.73 m2. For S = 0.94, found in rats, the values will be Cys(pr) = 0.117 mg/min/1.73 m2 and Cl(nr) = 21 ml/min/1.73 m2 and S-Cys in 70 patients on chronic haemodialysis was found to be 5.74 +/- 1.15 mg/l, in agreement with a calculated value of 5.56 mg/l (s-Cys=124/22.3) for GFR=zero. The mean value of the calculated Cl(nr) for the 70 patients was 22.7 +/- 6.6 ml/min/1.73 m2, which confirms the calculated level and indicates its biological variation. We thus propose the following formula for calculating GFR using the values found for CLnr and Cys(pr) in this study: GFR=124/s - Cys - 22.3 ml/min/1.73 m2, where serum cystatin C concentration is given as mg/l.     

Nephrotoxicity of cis-platinum (II) dichlorodiammine.

The renal function of 15 patients receiving cis-platinum (II) dichlorodiammine (CPDD) was examined prospectively in detail to elucidate early evidence of nephrotoxicity. Patients were given a total of 49 couses of CPDD at 20 mg/m2/day for 5 days with 1,000 ml of saline prehydration. Renal function was monitored by serial determinations of serum creatinine and glomerular filtration rate (measured as 125I-iothalamate clearance) and by measurement of parameters of tubular function, including tubular reabsorption of phosphorus, urine-to-serum glucose ratio, total protein, and total free immunoglobulin light chain excretion, serum electrolytes, and urine pH and specific gravity. There was no significant change in mean serum creatinine within a course of treatment, nor was there a cumulative increase in the serum creatinine. In 9 of 19 evaluable courses there was a small transient fall in glomerular filtration rate with prompt recovery. There was no cumulative decrease in glomerular filtration rate through 3 courses of treatment. Four of the patients with preexisting renal insufficiency suffered no significant additional nephrotoxicity. There was no tubular dysfunction demonstrable in any of the patients. This study represents the first prospective detailed examination of multiple parameters of renal function in patients treated with CPDD and reveals that the only parameter to show any change with this schedule of drug administration was the glomerular filtration rate.     

Comparative nephrotoxicity of gentamicin and tobramycin: pharmacokinetic and clinical studies in 201 patients.

A total of 201 critically ill patients were studied during 267 courses of gentamicin or tobramycin treatment (139 gentamicin courses and 128 tobramycin courses). Of these 267 courses, pharmacokinetic and clinical data were obtained for 240 (120 gentamicin and 120 tobramycin). The data collected for pharmacokinetic analysis included measurements of serial blood and urine levels, urinary excretion of beta 2-microglobulin, protein levels, and granular casts. A two-compartment model was used to assess tissue accumulation, and in 89 courses the predicted accumulation was confirmed by cumulative urine collection or postmortem tissue analysis. As groups, the patients given gentamicin and tobramycin did not differ in age, weight, creatine clearance, total dose given, duration of treatment, initial aminoglycoside through serum levels, number of dosage adjustments, concurrent use of furosemide, or concurrent cephalosporins. Previous aminoglycoside treatment (usually gentamicin) had occurred more frequently in the tobramycin treated patients (P less than 0.01), and more males than females received tobramycin (P less than 0.05). Pharmacokinetic assessments of renal damage were based on both changes in glomerular filtration rate (serum creatinine levels, creatinine clearance) and renal tubular damage (beta 2-microglobin, casts), but only patients with elevated aminoglycoside tissue levels leading to renal tubular damage and subsequent creatinine clearance decreases were considered to have experienced aminoglycoside nephrotoxicity. In the pharmacokinetic analysis of nephrotoxicity, 29 gentamicin courses (24%) and 12 tobramycin courses (10%) were complicated by nephrotoxicity (P less than 0.01). The 201 study patients were also evaluated independently for clinical nephrotoxicity (defined as a serum creatinine level increase of 0.5 mg/dl or more). Clinical nephrotoxicity occurred at rates of 37% in the gentamicin-treated group and 22% in the tobramycin-treated group (P less than 0.02). In these similar groups of critically ill patients, tobramycin was less nephrotic than gentamicin.     

Diagnostic value of serum cystatin C for evaluation of hepatorenal syndrome

BACKGROUND: The evaluation of renal function in patients with decompensated cirrhosis is important for prognosis, dosage assessment of potentially nephrotoxic drugs and recognition of changes in glomerular filtration rate (GFR) to decide paracentesis and diuretic therapy. Patients with many different disorders of hepatic function can present with various abnormalities of renal function in the absence of other known causes of renal failure which has been called hepatorenal syndrome (HRS). Some reports have pointed out that serum creatinine levels frequently failed to rise above normal levels even when glomerular filtration rate (GFR) is very low in cirrhotic patients with hepatorenal syndrome. The aim of this study was to determine if estimation of serum cystatin C could replace creatinine clearance in routine GFR determinations for patients with cirrhosis. METHODS: Serum cystatin C, creatinine clearance (Clcr), and 99mTc-DTPA clearance were determined in 26 patients with cirrhosis. According to Child-Pugh's classification, 21 patients were in group C and 5 were in Group B. RESULTS: Pearson correlation analyses showed that correlation between serum cystatin C and 99mTc-DTPA clearance was r=-0.522, p=0.006, between serum creatinine and 99mTc-DTPA was r=-0.373, p=0.06. The results of our study demonstrated that neither serum creatinine nor creatinine clearance (Clcr) were good indicators of hepatorenal syndrome because the mean value for Clcr was found to be higher than Tc-DTPA clearance, and there was no correlation between these two parameters (r=0.059). Additionally, the mean value of serum creatinine was found to be within the normal range, whereas the mean DTPA clearance level was lower than normal range. CONCLUSIONS: This finding could be explained by the fact that cirrhotic patients with poor nutrition may have decreased protein intake, low muscle mass and lack of converting capacity of creatine to creatinine. Thus, we suggest that serum cystatin C assay, which has good analytical performance, could replace or at least be added to creatinine measurement for GFR assessment in patients with cirrhosis.     

Cystatin C对心脏手术患者肾功能的评估价值

目的 评价胱氨酸蛋白酶抑制荆C（Cystatin C）在心脏手术患者肾功能评估的应用价值。方法测定并统计心脏外科手术患者术前的Cystatin C、血清肌酐、手术后次晨的血清肌酐，并对部分患者手术前进行24h尿内生肌酐清除率的检查，分析Cystatin C、24h尿内生肌酐清除率及与手术前后血清肌酐变化之间的关系。结果Cystatin C对术后肌酐异常的敏感性为68．3％，特异性为16．6％，诊断符合率为68．9％。24h尿肌酐清除率的相关指标为62．5％、55．6％和66．7％。两者比较差异有显著性（P〈0．01）。两者联合应用，则相关指标分别为66．7％、77．8％和74．1％。结论Cystatin C是肾小球滤过率监测中的一个较敏感的指标。联合应用Cystatin C和24h尿内生肌酐清除率可以更准确地评估肾功能。     

Vancomycin enhancement of experimental tobramycin nephrotoxicity.

The influence of vancomycin on tobramycin nephrotoxicity was assessed in male Fischer rats. Treatment groups included controls receiving diluent and groups receiving vancomycin alone at a dosage of 200 mg/kg (body weight) per day, tobramycin alone at a dosage of 80 mg/kg per day, and a combination of vancomycin and tobramycin at the above dosages. All regimens were injected on a twice-a-day schedule. The animals were sacrificed on days 1, 3, 10, 14, 17, and 21. When compared with controls, animals receiving vancomycin alone exhibited no detectable renal toxicity. Compared with the case with controls, tobramycin alone was toxic, as manifested by lower mean animal weights, increased blood urea nitrogen concentrations on days 14 and 17 (P less than 0.005), increased serum creatinine concentrations on days 17 and 21 (P less than 0.005), and the presence of renal cortical tubular necrosis and regeneration. When compared with tobramycin alone, the combination of vancomycin and tobramycin caused earlier and more severe toxicity. By day 10, the magnitude of weight loss, the rise in blood urea nitrogen, and the increase in serum creatinine concentration were all greater in the rats given the combination of vancomycin plus tobramycin than in the animals given tobramycin alone (P less than 0.005). In addition, there was more proximal tubular necrosis and regeneration in rats given vancomycin plus tobramycin compared with those given tobramycin alone. In this animal model, vancomycin alone caused no detectable renal injury, tobramycin alone produced minimal proximal tubular damage, and the combination of vancomycin and tobramycin resulted in a greater degree of kidney injury than observed with tobramycin alone.     

Alterations in renal structure and function in a rat model of cyclosporine nephrotoxicity

Adult male Sprague-Dawley rats maintained on a low sodium diet were administered 100 mg of cyclosporine per kg b.wt. per day s.c. for 4 to 10 days. Serum urea nitrogen was significantly elevated by day 4 and continued to rise, whereas serum creatinine was not elevated above control until day 10. Morphologic examination of perfusion-fixed kidneys from cyclosporine-treated rats revealed focal areas of tubular atrophy and interstitial fibrosis in the outer cortex and a generalized increase in interstitial cells in the outer medulla. No areas of acute tubular necrosis were identified. The effect of this dose of cyclosporine on renal hemodynamics was examined in conscious restrained rats. Renal blood flow, measured by microsphere injection, was 70% of control after four daily doses and remained near this level after eight daily doses. The glomerular filtration rate, measured by iodothalamate clearance, was 70% of control after four doses but fell to 34% of control after eight doses. [3H]Thymidine incorporation into renal DNA was used as a sensitive index of renal cell proliferation after cyclosporine administration (100 mg/kg/day). [3H]Thymidine incorporation was increased over control 3-fold in the outer cortex, 7-fold in the inner cortex and 11-fold in the medullary-papillary regions of the kidney after eight daily doses of cyclosporine. Histoautoradiographic examination of renal sections revealed an increase in the number of labeled nuclei in all three regions of the kidney from rats treated with cyclosporine. Morphometric analysis demonstrated that the majority of proliferating cells were located in the interstitium and not in renal tubules.(ABSTRACT TRUNCATED AT 250 WORDS)     

血清胱抑素C：一种简便测定肾小球滤过率的标志物

目的 :评价测定肾小球滤过率 (GFR)的一种简便方法—血清胱抑素C检测的临床意义。方法 :对 5 0例不同肾病患者及70名正常人同时测定血清胱抑素C及内生肌酐清除率、血肌酐值 ,并对两组结果进行相关分析。结果 :血清胱抑素C与内生肌酐清除率及血肌酐值有高度相关性 (r值分别为r =- 0 .83 4 ,p <0 .0 0 1和r =0 .867,p <0 .0 0 1)。结论 :血清胱抑素C检测是一种简便、可靠测定GFR的标志物     

血清胱抑素C（CysC）对轻中度肾损伤的诊断价值

目的探讨血清胱抑素C（Cys C）对轻中度肾脏损伤的诊断价值。方法收集临床及实验室证实有肾脏损害的患者和正常体检者血清,分别测量血清胱抑素C（Cys C）、β2微球蛋白（β2-MG）、血清肌酐（SCr）、尿素氮（BUN）、尿酸（UA）浓度,并计算出肌酐清除率（CCr）。根据肾小球滤过率（GFR）分三组,比较各个标志物与肾脏损伤的相关性。结果 Cys C、β2-MG与GFR呈负相关。肾脏受到中度损伤时BUN、UA才开始升高,而Cys C在常规肾功能检测指标没有改变时就已升高,两组间有统计学差异,说明Cys C能早期发现肾脏受损。结论血清Cys C能更敏感、特异地反映早期肾脏损伤,是轻中度肾脏损害理想的诊断指标。     

亲属活体供肾移植中供者肾功能的评估

背景：肾移植前正确有效地评价供者双侧肾脏功能,对于亲属活体肾移植供者及受者的安全十分重要。目的：探讨亲属活体供肾移植中供者肾功能评估的指标。方法：173例亲属活体肾移植供者年龄分成老年组（≥55岁）和中青年组（〈55岁）,两组供者移植前血清肌酐、总肾小球滤过率、欲保留肾总肾小球滤过率、内生肌酐清除率、血尿素氮反应肾功能指标差异无显著性意义,分析比较移植前后肾功能各指标的变化。结果与结论：与移植前比较,移植后10d供者血清肌酐、血尿素氮增高,内生肌酐清除率降低（P〈0.01）;移植后1个月留存肾脏总肾小球滤过率增加（P=0.0000）,但与移植前供者双肾比较下降。提示总肾小球滤过率可作为活体亲属肾移植供者肾功能评估的主要指标,但是仍应结合血清肌酐、内生肌酐清除率等指标综合分析。