Decreased Renal Function Is an Independent Predictor of Severity of Coronary Artery Disease: An Application of Gensini Score

Coronary artery disease (CAD) is the leading cause of death in patients with chronic kidney disease (CKD).Although many studies have shown a higher prevalence of CAD among these patients, the association between the spectrum of renal dysfunction and severity of CAD remains unclear. In this study, we investigate the association between renal function and the severity of CAD. We retrospectively reviewed the medical records of 1,192 patients who underwent elective coronary angiography (CAG). The severity of CAD was evaluated by Gensini score according to the degree of luminal narrowing and location(s) of obstruction in the involved main coronary artery. In all patients, the estimated glomerular filtration rate (eGFR) was independently associated with Gensini score (β=-0.27, P < 0.001) in addition to diabetes mellitus (β=0.07, P = 0.02), hypertension (β=0.12, P < 0.001), low density lipoprotein (LDL)-cholesterol (β=0.08, P = 0.003), and hemoglobin (β=-0.07, P = 0.03) after controlling for other confounding factors. The result of this study demonstrates that decreased renal function is associated not only with the prevalence, but also the severity, of CAD.     

Outcome of early initiation of peritoneal dialysis in patients with end-stage renal failure

Recent studies reported that early initiation of hemodialysis may increase mortality. However, studies that assessed the influence of early initiation of peritoneal dialysis (PD) yielded controversial results. In the present study, we evaluated the prognosis of early initiation of PD on the various outcomes of end stage renal failure patients by using propensity-score matching methods. Incident PD patients (n = 491) who started PD at SNU Hospital were enrolled. The patients were divided into 'early starters (n = 244)' and 'late starters (n = 247)' on the basis of the estimated glomerular filtration rate (eGFR) at the start of dialysis. The calculated propensity-score was used for one-to-one matching. After propensity-score-based matching (n = 136, for each group), no significant differences were observed in terms of all-cause mortality (P = 0.17), technique failure (P = 0.62), cardiovascular event (P = 0.96) and composite event (P = 0.86) between the early and late starters. Stratification analysis in the propensity-score quartiles (n = 491) exhibited no trend toward better or poorer survival in terms of all-cause mortality. In conclusion, early commencement of PD does not reduce the mortality risk and other outcomes. Although the recent guidelines suggest that initiation of dialysis at higher eGFR, physicians should not determine the time to initiate PD therapy simply rely on the eGFR alone.     

High Peritoneal Transport Status is Not an Independent Risk Factor for High Mortality in Patients Treated with Automated Peritoneal Dialysis

We undertook this study to elucidate whether baseline peritoneal membrane transport characteristics are associated with high mortality in incident automated peritoneal dialysis (APD) patients. This retrospective study includes 117 patients who started APD at Yonsei University Health System from 1996 to 2008 and had a PET within 3 months of APD initiation. High transporters were significantly older and had a higher incidence of cardiovascular disease. Patient survival for years 1, 3, and 5 were 85%, 64%, and 35% for high transporter and 94%, 81%, and 68% for non-high transporter group (P<0.01). Multivariate analysis revealed that age, diabetes, cardiovascular disease, serum albumin level, and residual renal function were independently associated with high mortality in APD patients. In contrast, high transport status was not a significant predictor for mortality in this population when the other covariates were included. Even though high transport was significantly associated with mortality in the univariate analysis, its role seemed to be influenced by other comorbid conditions. These findings suggest that the proper management of these comorbid conditions, as well as appropriate ultrafiltration by use of APD and/or icodextrin, must be considered as protective strategies to improve survival in peritoneal dialysis patients with high transport.     

The Nationwide Incidence of Retinal Vein Occlusion Following Dialysis due to End-stage Renal Disease in Korea, 2004 through 2013

BackgroundWe investigated the incidence and risk of retinal vein occlusion (RVO) in end-stage renal disease (ESRD) patients on dialysis in Korea.MethodsIn this nationwide cohort study, we used Korean National Health Insurance Service data between 2004 and 2013 for analysis. ESRD patients who started dialysis from 2004 to 2013 and an equal number of controls were selected through propensity score matching. RVO incidence in both cohorts were calculated for 2004–2013 using washout data from 2003. The multivariable Cox proportional hazards model was used to assess the risk of RVO in dialysis cohort. The Kaplan-Meier method was used to generate the cumulative RVO incidence curve. Whether the dialysis modality affects the development of RVO was also evaluated.ResultsIn this study, 74,551 ESRD patients on dialysis and the same number of controls were included. The incidence of RVO was significantly higher in the dialysis cohort than in the control cohort (dialysis = 7.3/1,000 person-years [PY]; control = 1.9/1,000 PY; P < 0.001). The cumulative-incidence of RVO was also significantly higher in the dialysis cohort than in the control cohort (P < 0.001; log-rank test). However, there was no significant difference in the incidence of RVO between the two dialysis methods (P = 0.550; log-rank test).ConclusionThis study provided epidemiological evidence that receiving dialysis for ESRD could increase the risk of developing RVO. We also found a rapid increase in the incidence of RVO with a longer dialysis period. These results strengthen the relationship between retinal vascular disease and renal function.     

Glomerular Filtration Rate Measured by 51Cr-EDTA Clearance: Evaluation of Captopril-Induced Changes in Hypertensive Patients with and without Renal Artery Stenosis

INTRODUCTION:

Renal artery stenosis can lead to renovascular hypertension; however, the detection of stenosis alone does not guarantee the presence of renovascular hypertension. Renovascular hypertension depends on activation of the renin-angiotensin system, which can be detected by functional tests such as captopril renal scintigraphy. A method that allows direct measurement of the baseline and post-captopril glomerular filtration rate using chromium-51 labeled ethylenediamine tetraacetic acid (⁵¹Cr-EDTA) could add valuable information to the investigation of hypertensive patients with renal artery stenosis. The purposes of this study were to create a protocol to measure the baseline and post-captopril glomerular filtration rate using ⁵¹Cr-EDTA, and to verify whether changes in the glomerular filtration rate permit differentiation between hypertensive patients with and without renal artery stenosis.

METHODS:

This prospective study included 41 consecutive patients with poorly controlled severe hypertension. All patients had undergone a radiological investigation of renal artery stenosis within the month prior to their inclusion. The patients were divided into two groups: patients with (n=21) and without renal artery stenosis, (n=20). In vitro glomerular filtration rate analysis (⁵¹Cr-EDTA) and ^99mTc-DMSA scintigraphy were performed before and after captopril administration in all patients.

RESULTS:

The mean baseline glomerular filtration rate was 48.6±21.8 ml/kg/1.73 m² in the group wuth renal artery stenosis, which was significantly lower than the GFR of 65.1±28.7 ml/kg/1.73m² in the group without renal artery stenosis (p=0.04). Captopril induced a significant reduction of the glomerular filtration rate in the group with renal artery stenosis (to 32.6±14.8 ml/ kg/1.73m², p=0.001) and an insignificant change in the group without RAS (to 62.2±23.6 ml/kg/1.73m², p=0.68). Scintigraphy with technetium-99m dimercapto-succinic acid (DMSA) did not show significant differences in differential renal function from baseline to post-captopril images in either group.

CONCLUSIONS:

Captopril induced a decrease in the GFR that could be quantitatively measured with ⁵¹Cr-EDTA. The reduction is more pronounced in hypertensive patients with RAS.     

Serum Cystatin C is a Potential Endogenous Marker for the Estimation of Renal Function in Male Gout Patients with Renal Impairment

Serum creatinine level is the most commonly used indices for assessment of glomerular filtration rate (GFR), even though these indices have been shown to have some limitations in clinical practice. We investigated the diagnostic efficacy of serum cystatin C compared to that of serum creatinine levels and identified the relating factors associated with changes in serum cystatin C levels in gout patients with renal impairment. A total of 68 gouty patients with renal impairment were enrolled in this study. Diagnostic efficacy of serum cystatin C levels was evaluated through non-parametric receiver operating characteristic (ROC) analysis. The risk factors for changes in serum cystatin C levels were confirmed using multivariate regression analysis. With 24-hr urine creatinine clearance (Ccr) as the reference for GFR, 1/cystatin C (r=0.702, P<0.001) showed a significantly higher correlation with Ccr than 1/creatinine (r=0.665, P<0.001). Multivariate correlation analysis demonstrated that the clinical parameters for increased serum cystatin C are a higher stage of chronic kidney disease, older age, use of allopurinol, and lower high density lipoprotein-cholesterol. The area under the curve (AUC) at ROC plots identified that of serum cystatin C was significantly greater than that of serum creatinine (AUC 0.804 of cystatin C and AUC 0.745 of creatinine). The study suggests that serum cystatin C is a reliable endogenous marker for the assessment of renal function or GFR in gout patients with renal impairment.     

Elevated Serum Homocysteine Levels Were Not Correlated with Serum Uric Acid Levels,but with Decreased Renal Function in Gouty Patients

Hyperhomocysteinemia is one of the important factors of the cardiovascular disease, and gout is well known to be associated with cardiovascular disease. There are a few reports on the serum homocysteine (Hcy) levels in patients with gout, however, the results showed discrepancies. In this study, we measured Hcy levels in patients with gout and examined factors associated with the levels of serum Hcy. Ninety-one male patients with gout and 97 age-matched healthy male controls were enrolled in the study. Serum uric acid levels were not significantly different between gout and healthy control groups. However, serum Hcy levels were significantly higher in patients with gout compared to controls (13.96±4.05 µM/L vs 12.67±3.52 µM/L, P=0.035). In gout group, patients with 1-2 stages of chronic kidney disease (CKD) had significantly lower serum Hcy than those with 3-5 stages of CKD (13.15±3.46 µM/L vs 17.45±4.68 µM/L, P<0.001). Multivariate linear analysis revealed an inverse association between serum Hcy and estimated glomerular filtration rate (eGFR) (β=-0.107, P<0.001). In conclusion, serum Hcy was elevated in male patients with gout. Hyperhomocysteinemia was not correlated with serum uric acid, but it was inversely associated with impaired renal function.

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Benefits of a Continuous Ambulatory Peritoneal Dialysis (CAPD) Technique with One Icodextrin-Containing and Two Biocompatible Glucose-Containing Dialysates for Preservation of Residual Renal Function and Biocompatibility in Incident CAPD Patients

In a prospective randomized controlled study, the efficacy and safety of a continuous ambulatory peritoneal dialysis (CAPD) technique has been evaluated using one icodextrin-containing and two glucose-containing dialysates a day. Eighty incident CAPD patients were randomized to two groups; GLU group continuously using four glucose-containing dialysates (n=39) and ICO group using one icodextrin-containing and two glucose-containing dialysates (n=41). Variables related to residual renal function (RRF), metabolic and fluid control, dialysis adequacy, and dialysate effluent cancer antigen 125 (CA125) and interleukin 6 (IL-6) levels were measured. The GLU group showed a significant decrease in mean renal urea and creatinine clearance (-Δ1.2±2.9 mL/min/1.73 m², P=0.027) and urine volume (-Δ363.6±543.0 mL/day, P=0.001) during 12 months, but the ICO group did not (-Δ0.5±2.7 mL/min/1.73 m², P=0.266; -Δ108.6±543.3 mL/day, P=0.246). Peritoneal glucose absorption and dialysate calorie load were significantly lower in the ICO group than the GLU group. The dialysate CA125 and IL-6 levels were significantly higher in the ICO group than the GLU group. Dialysis adequacy, β₂-microglobulin clearance and blood pressure did not differ between the two groups. The CAPD technique using one icodextrin-containing and two glucose-containing dialysates tends to better preserve RRF and is more biocompatible, with similar dialysis adequacy compared to that using four glucose-containing dialysates in incident CAPD patients. [Clincal Trial Registry, ISRCTN23727549]

Graphical Abstract

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Comparison of Lipid-Related Ratios for Prediction of Chronic Kidney Disease Stage 3 or More in Korean Adults

Dyslipidemia is implicated in increased cardiovascular risk associated with chronic kidney disease (CKD) and in the progression of renal damage. This study compared 4 different lipid-related ratios (total cholesterol [TC]/high-density lipoprotein cholesterol [HDL-C], triglyceride [TG]/HDL-C, calculated low-density lipoprotein cholesterol [c-LDL-C]/HDL-C, and non-HDL-C/HDL-C ratio) for prediction of CKD stage 3 or more to investigate the association between them. This cross-sectional study included 8,650 adults who participated in the 2007-2008 Korean National Health and Nutrition Examination Survey. The overall prevalence of CKD stage 3 or more was 6.4%. For TG/HDL-C, the prevalence with CKD stage 3 or more increased with increasing quartile group in both sexes (P value for trend = 0.046 in men, 0.002 in women) while other lipid-related ratios showed increasing prevalence only in women. In comparison with the lowest quartile of the lipid-related ratios, only the fourth quartile of TG/HDL-C was associated with the prevalence of CKD stage 3 or more in both sexes after adjustment for multiple covariates (odds ratio [OR] for TG/HDL-C-Q₄, 1.82; 95% CI [confidence interval], 1.09-3.03 in men, OR 2.45; 95% CI, 1.52-3.95 in women). In conclusion, TG/HDL-C is the only lipid-related ratio that is independently associated with CKD stage 3 or more in both sexes of Koreans.     

Survival analysis of Korean end-stage renal disease patients according to renal replacement therapy in a single center

This study was to investigate clinical characteristics and any differential trends in survival among renal replacement therapy (hemodialysis [HD], peritoneal dialysis [PD], and kidney transplantation [KT]) in Korean end-stage renal disease (ESRD) population. We tried to analyze retrospectively the survival rate adjusted by risk factors and the relative risk stratified by key risk factors among 447 ESRD patients who began dialysis or had a kidney transplant at Ajou University Hospital from 1994 to 2004. In adjusted Cox survival curves, the KT patients had the best survival rate, and the HD patients had better survival than PD patients. The consistent trends in different subgroups stratified by age and diabetes were as following: 1) The risk of death for PD and HD was not proportional over time, 2) The relative risk of PD was similar or lower than that of HD for the first 12 months, but it became higher at later period. The significant predictors for mortality were age (over 55 yr), presence of diabetes, cerebrovascular accident at ESRD onset, and more than one time of hospitalization caused by malnutrition. Further large-scaled, multicenter-based comparative study is needed in Korean ESRD patients and more meticulous attention is required in high-risk patients.     

Glomerular filtration changes during renal artery infusion of various hypertonic solutions in the dog

Summary Effects of renal artery infusion of hypertonic equiosmolar solutions of NaCl, Na₂SO₄, urea, glucose and mannitol on the glomerular filtration rate (GFR) were studied in anesthetized dogs. GFR was determined as a product of the renal plasma flow—calculated from directly measured renal blood flow and hematocrit—and the extraction ratio of exogenous creatinine (RPF·E _cr).Hypertonic solutions of urea, glucose and mannitol depressed GFR while NaCl and Na₂SO₄ were without significant effect. The change in filtration was a linear function of the inhibition of the net absolute tubular reabsorption of water (T _{H 2}O) caused by hypertonic infusions. This relation was observed with all the infusates except Na₂SO₄ which depressed totalT _{H 2}O but did not affect GFR. It is suggested that a definite inhibition of proximal reabsorption, probably absent with Na₂SO₄ infusion, determines the fall in GFR in osmotic diuresis.     

腹膜透析患者体重指数与预后的关系

目的初步探讨体重指数(BMI)对腹膜透析(PD)患者预后的影响。方法119例1999年1月起始行PD治疗患者,按BMI分为低体重组(BMI<20kg/m2)、正常体重组(20≤BMI<25kg/m2)及超重肥胖组(BMI≥25kg/m2)。采集这些患者的年龄、性别、RRF、Kt/V、血清白蛋白(SA)、Hb、CRP、心血管并发症以及转归等,并进行回顾性分析。结果与正常体重的PD患者相比,低体重者死亡率较高(42.11%对21.67%,P<0.05),而超重肥胖患者预后更差(52.5%对21.67%,P<0.01)。超重肥胖的PD患者心血管并发症的死亡率明显高于正常体重者(P<0.01)。Pearson相关分析发现,这些PD患者的BMI与其CRP(r=0.79,P<0.01),SA(r=0.58,P<0.01),Hb(r=0.32,P<0.05)呈正相关,而与其Kt/V(r=-0.36,P<0.05)负相关。Cox比例风险模型显示,BMI≥25kg/m2与PD患者死亡率独立相关(风险比例,1.31;95%可信限,1.20￣1.54;P<0.05)。结论低体重、尤其是超重肥胖PD患者预后不佳,BMI≥25kg/m2是值得关注的死亡危险因素。     

Onodera's Prognostic Nutritional Index as a Risk Factor for Mortality in Peritoneal Dialysis Patients

The aim of this study was to evaluate the clinical relevance and usefulness of the Onodera''s prognostic nutritional index (OPNI) as a prognostic and nutritional indicator in peritoneal dialysis (PD) patients. Patients were divided into 3 groups based on the initial OPNI score: group A (n = 186, < 40), group B (n = 150, 40-45), and group C (n = 186, > 45). Group A was associated with a higher grade according to the Davies risk index than the other groups. Serum creatinine and albumin levels, total lymphocyte count, and fat mass increased with an increase in OPNI. According to the edema index, the correlation coefficient for OPNI was -0.284 and for serum albumin was -0.322. Similarly, according to the C-reactive protein (CRP), the correlation coefficient for OPNI was -0.117 and for serum albumin was -0.169. Multivariate analysis adjusted for age, Davies risk index, CRP, and edema index revealed that the hazard ratios for low OPNI, serum albumin, and CRP were 1.672 (P = 0.003), 1.308 (P = 0.130), and 1.349 (P = 0.083), respectively. Our results demonstrate that the OPNI is a simple method that can be used for predicting the nutritional status and clinical outcome in PD patients.     

Kidney transplantation in a patient with end stage renal disease after complete remission of acute promyelocytic leukemia

In general, a 2-yr disease-free duration is recommended before kidney transplantation (KT) in end-stage renal disease (ESRD) patients who also have acute leukemia. However, the optimal disease-free interval has not been specified for all subtypes of acute leukemia. Among these subtypes, acute promyelocytic leukemia (APL) shows a favorable prognosis and low relapse rate compared to other types of leukemia. We here report KT after complete remission (CR) of APL in an ESRD patient. Irreversible kidney injury developed in a 23-yr-old man with APL. First, we induced CR and subsequently performed KT 7 months after the achievement of CR. The patient's clinical course after KT was favorable, without allograft rejection or relapse of APL up to 1 yr after KT. On the basis of our clinical experience, it is suggested that a long wait may not be necessary before KT in patients with ESRD and APL.     

两种透析方法治疗终末期糖尿病肾病前后患者血管内皮生长因子和基质金属蛋白酶-9水平变化

目的:分析两种透析方法对终末期糖尿病肾病(ESDN)患者血清血管内皮生长因子(VEGF)和基质金属蛋白酶-9(MMP-9)水平的影响及临床意义。方法:80例ESDN患者,按照随机数字表法分为观察组(n=40)和对照组(n=40)。观察组采用维持性血液透析,对照组采用不卧床持续腹膜透析,均治疗6个月。观察两组患者治疗前后血压(BP)、血清白蛋白(SA)、血红蛋白(Hb)、VEGF、MMP-9水平变化和不良反应。结果:治疗前,两组患者上述各项指标差异均无统计学意义(P均0.05);治疗后,观察组上述各项指标较治疗前明显改善(P0.05或P0.01);对照组除SA、Hb外,其它指标均较治疗前好转(P0.05或P0.01)。观察组治疗后各项指标改善明显好于对照组(P0.05或P0.01)。两组不良反应发生率差异无统计学意义(P0.05)。结论:ESDN患者透析治疗可优先选择持续性血液透析。     

Clinical Characteristics of Renal Cell Carcinoma in Korean Patients with von Hippel-Lindau Disease Compared to Sporadic Bilateral or Multifocal Renal Cell Carcinoma

This study was done to analyze the clinical characteristics of renal cell carcinoma (RCC) in Korean patients with von Hippel-Lindau (VHL) disease. Between January 1996 and July 2008, 1,514 patients were diagnosed with RCC and 24 patients were diagnosed with VHL disease at our institute. We analyzed the clinical characteristics of the 24 patients diagnosed with VHL. The mean age of patients with VHL was 39.2±12.6 yr; the mean age of patients with both VHL and RCC was 42.5±10.3 yr. Among the 24 patients with VHL, 7 patients had retinal angiomas, 11 had RCC, 16 had renal lesions, 18 had pancreatic lesions and 21 had cerebellar hemangioblastomas. There was no significant difference between survival rates of patients with VHL alone and those with VHL and RCC. However, cancer-specific survival rates were significantly different between patients with both VHL and RCC and patients with sporadic bilateral or multifocal RCC. In our Korean study, the incidence of RCC in patients with VHL disease is 45.8% and the incidence of VHL disease in patients with RCC is 0.73%. Due to the low overall incidence of VHL in Korea, extended multi-institutional studies are needed to establish the true characteristics of VHL disease.     

尿液红细胞位相检测对肾脏疾病诊断意义

探讨尿液红细胞位相检测,判断早期肾脏疾病的肾小球性与非肾小球性血尿来源诊断意义.采用相差显微镜检测尿液红细胞的变形率,并与健康人进行对比分析.结果表明,尿液红细胞变形率对判断肾小球性与非肾小球性血尿来源阳性人数检出率,与临床诊断符合率达95.51%;各组比较有统计学意义(P＜0.01).采用相差显微镜检测尿液红细胞的变...     

血液透析与腹膜透析对终末期肾病患者血脂、氧化应激及炎症因子的影响

目的分析血液透析与腹膜透析对终末期肾病(ESRD)患者血脂、氧化应激及炎症因子的影响。方法选取2016年1月至2018年1月我院收治的终末期肾病患者200例为研究对象,采用随机数字表法将其分为观察组、对照组各100例,对照组予以血液透析治疗,观察组实施腹膜透析治疗,比较两组治疗前后血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白(HDL-C)、低密度脂蛋白(LDL-C)]、氧化应激指标[丙二醛(MDA)、髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)]、炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]水平、生存质量[健康状况调查简表(SF-36)]及并发症的情况。结果治疗后观察组血清TC、TG、HDL-C、LDL-C水平明显低于对照组(P <0.05);治疗后观察组血清MDA、MPO、hs-CRP、TNF-α、IL-6水平低于对照组,而SOD水平高于对照组(P <0.05);治疗3个月、治疗6个月观察组SF-36评分高于对照组(P <0.05);观察组治疗期间并发症发生率12.0%低于对照组24. 0%(P <0.05)。结论与血液透析相比,腹膜透析治疗ESRD疗效更好,可明显改善患者血脂、氧化应激及炎症因子水平,提高其生活质量,减少并发症,值得在临床推广实践。     

Development of glomerular filtration rate and electrolyte and osmolal clearance in the late-embryonic and newly hatched chicken

Summary Techniques have been developed for collection of urine in embryonic and newly hatched chickens for the purpose of studying the development of renal function.The reliability of EDTA-⁵¹Cr as a substitute for inulin-¹⁴C in the determination of GFR was studied. Since inulin and EDTA-⁵¹Cr clearances in the hatched chicken averaged 1.61±0.23 (S.E.) ml/min per kg body weight and 1.58±0.27 ml/min per kg body weight, respectively, EDTA-⁵¹Cr clearance was considered a suitable measure of GFR.GFR increased significantly in the first few days after hatching. Filtration rate was 0.068±0.008 (S.E.) ml/min per g kidney weight in the embryo and increased to 0.148±0.008 ml/min per g shortly after hatching. By nine days after hatching GFR had risen to 0.290±0.015 ml/min per g, a value comparable to that reported for the adult.Clearances of sodium, potassium, chloride and total osmolyte also increased with age. When these clearances were corrected for changing glomerular filtration rates the embryonic chicks were found to excrete a greater percentage of the filtered load. These results show that adult levels of glomerulo-tubular balance are not attained until after hatching.A preliminary report of this work has already been published [3].     

血清胱抑素C评价早期肾功能损害的临床意义探讨

目的 评价血清胱抑素C（Cys C）对早期肾功能损害诊断的临床意义.方法 应用免疫比浊法测定136例肾脏病患者血清Cys C浓度,用Jaffe法测定血清SCr.以内生肌酐清除率（Ccr）测得的肾小球滤过率（GFR）作为诊断评价的金指标,比较Cys C、SCr浓度与GFR的相关性,评估Cys C结果的临床敏感性、特异性和可靠性.结果 血清Cys C、SCr浓度与GFR均呈显著相关（P＜0.01）;以Cys C与GFR的相关程度最密切;且Cys C与SCr显著相关（P＜0.05）.结论 血清Cys C是一个准确、可靠的反映肾小球滤过功能的指标,对诊断肾脏病患者早期肾功能损害具有指导意义.