血清胱抑素C:一种简便的肾小球滤过率指标

肾小球滤过率(glomerular filtration rate,GFR)是反映肾功能最重要的指标.目前临床上常用来反映肾小球滤过功能的指标如血肌酐(Scr)、内生肌酐清除率(Ccr)等都有一定的局限性,且不同程度地受到一些肾内或肾外因素的干扰.为此寻找新方法来测定肾功能,是众所关心的问题.近年来,测定血清胱抑素C(Cystatin C)来反映GFR水平,受到人们关注.     

经皮肾镜对复杂性肾结石患者术后早期肾功能的影响

目的探讨经皮肾镜碎石取石术(PCNL)对复杂性肾结石患者术后早期肾功能的影响,并评估患者术后肾功能恶化的危险因素。方法将77例自2017年1月至2018年8月在我院行PCNL的复杂性肾结石患者,根据术前基线肾功能分为肾功能正常(血肌酐<115μmol·L^-1)的A组和肾功能异常(血肌酐≥115μmol·L^-1)的B组,每组又根据手术通道数目,分为单通道组(通道数目=1)和多通道组(通道数目≥2),记录患者术前及术后24 h内的血肌酐及其他评价肾功能的指标,以此对患者术后肾功能进行评估。同时记录并评估可能对肾功能改变产生影响的相关因素。结果 A组中,仅在多通道患者中术后胱抑素C水平较术前升高,且差异有统计学意义(P<0.05)。其他指标几乎保持稳定状态(P>0.05)。B组中,单通道患者与A组相似,各指标基本保持稳定(P>0.05)。多通道患者术后血肌酐及胱抑素C水平显著上升,估算肾小球滤过率显著下降,差异有统计学意义(P<0.05)。导致肾功能恶化的独立危险因素包括术前高浓度血肌酐、多通道、糖尿病和高血压。结论多通道PCNL对肾功能不全患者的肾功能早期影响较大,多通道、术前肾损伤、糖尿病及高血压是肾功能减退的潜在危险因素。     

血清胱抑素-C是反映肾小球滤过功能的敏感指标

目的探讨测定血清胱抑素C(Cystatin C)浓度来判断肾小球滤过率的准确性与敏感性。方法对32例各种原因可能或已经肾功能轻-中度受损的患者，应用乳胶颗粒增强比浊法(PET)测定其血清CystatinC浓度，采用^99Tc-DTPA血浆清除率测定其肾小球滤过率(GFR)，同时测定血尿素氮(BUN)、血肌酐(SCr)，并根据Cockcroft-Cault公式计算肌酐清除率。结果血清Cystatin C浓度与上述指标均有相关性，并有显著性意义。血清Cystatin C比SCr与用^99Tc-DTPA测定的GFR有更好的一致性。结论血清Cystatin C浓度是一个反映肾小球滤过功能准确、敏感的指标。     

保留肾单位术与根治性肾切除术对肾功能影响的比较

目的比较保留肾单位手术和根治性肾切除手术治疗早期局限性肾癌术后肾功能的变化,同时探讨不同的肾功能指标在临床中的指导作用。方法回顾性分析了南京鼓楼医院2013年6月至2014年10月期间63例早期肾肿瘤患者的临床资料和术后随访资料。35例患者接受保留肾单位术(保肾组),28例患者行根治性肾切除术(根治组),所有的患者均随访满两年,随访期间患者的血肌酐、尿酸、估算肾小球滤过率、胱抑素C、尿微量白蛋白及尿β2微球蛋白被搜集并记录下来。结果 63例患者术后肾功能均有不同程度的变化,术后早期肾功能的损伤表现更为明显。随着随访时间的延长,大部分患者肾功能可逐渐恢复。保肾组术后急性肾功能不全的发生率为34%,根治组急性肾功能不全的发生率为79%,两组差异具有统计学意义(P0.01)。术后总体随访结果显示估测肾小球滤过率、胱抑素C及β2微球蛋白变化差异具有统计学意义(P0.05),而血肌酐、尿酸及尿微量白蛋白差异无统计学意义。虽然两组的尿酸及微量白蛋白水平差异无统计学意义,但保肾组的平均水平低于根治组。在术后肾功能异常的早期检测方面,各指标的独立检测阳性率均较低,尤其是血肌酐、尿酸及估测肾小球滤过率等传统肾功能指标。当各指标互相联合后,肾功能异常的检测阳性率明显提高,保肾组及根治组的联合检测阳性率分别达37.1%和71.4%。结论在早期局限性肾肿瘤的治疗中,保留肾单位手术较根治性手术对患者肾功能的损伤更小。胱抑素C、尿微量白蛋白、尿β2微球蛋白对于发现术后肾功能的早期异常更敏感,可与肌酐、尿酸、估测肾小球滤过率起协同作用。     

肾移植术后随访中检测受者血清胱抑素C的临床价值

目的 探讨血清胱抑素C(SCys C)浓度检测能否作为肾移植受者随访中移植肾功能测定的理想指标.方法 选择肾移植术后接受长期随访的受者70例,于随访当日检测受者SCys C和血清肌酐(SCr)水平,同时用99mTc-DTPA肾动态显像测定肾小球滤过率(GFR),比较SCys C和SCr与GFR的相关性,并应用受试者工作特征曲线(ROC曲线)评价两者在诊断移植肾功能轻度损伤(GFR＜1 ml/s)中的效果.结果 随访的肾移植受者中,SCys C和SCr与GFR均呈负相关,相关系数分别为-0.82和-0.66(P＜0.01).SCys C用于诊断移植肾功能轻度损伤的敏感度、特异度和阳性预测值(PPV)均高于SCr.SCys C的ROC曲线下面积高于SCr(分别为0.935和0.877),但两者比较,差异无统计学意义(P＞0.05).结论 在肾移植术后的随访中,受者SCys C与GFR的相关性比SCr更高,可作为评估移植肾功能的较理想指标.     

支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的影响

目的 评价支架移植物裸区跨越肾动脉对腹主动脉瘤患者肾功能的中、短期影响.方法 回顾性分析2005年3月至2009年12月290例接受腔内修复术的腹主动脉瘤患者的临床资料,根据移植物近端裸区是否超越肾动脉将患者分为肾上组和肾下组.肾上组173例,平均年龄(72±8)岁,男性占85.0%;肾下组117例,平均年龄(71±9)岁,男性占90.6%.记录两组患者术前,术后1周及术后1、3、6、12个月血清肌酐和胱抑素C的检测结果,并依据胱抑素C和血清肌酐计算肾小球滤过率.统计分析两组间及各组不同时间点的肾功能差异.结果 所有患者腔内修复均采用Talent或Zenith支架移植物,其中肾上组有67例使用Talent支架,106例使用Zenith支架;肾下组则分别有25例和92例,两组差异有统计学意义(P＜0.05).两组患者其他术前及术中资料差异无统计学意义.肾上组和肾下组术后1周的血清肌酐为(98±11)μmol/L和(95±13)μmol/L,12个月时为(91±15)μmol/L和(90±12)μmol/L;1周时胱抑素C为(1.01±0.15)mg/L和(0.99±0.10)mg/L,12个月时为(1.03±0.20)mg/L和(1.02±0.21)mg/L,较术前升高,而肾小球滤过率降低(P＜0.05).术后6个月,仅表现胱抑素C升高,肾上组(0.93±0.17)mg/L,肾下组(0.92±0.31)mg/L,依据胱抑素C计算的肾小球滤过率降低(P＜0.05).术后各阶段两组间患者肾功能无差异.结论 与肾动脉开口远端放置支架修复腹主动脉瘤的方式相比,支架移植物裸区覆盖肾动脉开口不会更明显地损害患者肾功能.     

碘海醇血浆清除率测定肾小球滤过率与临床常用的估算肾小球滤过率方法的比较

目的采用碘海醇血浆清除率测定肾小球滤过率(mGFR)与临床常用方法评估估算肾小球滤过率(eGFR)的准确性比较。方法选取2019年6月至2020年6月在本院自愿参加测试的145例研究对象, 根据eGFR值进行分组:1期[eGFR≥90 mL·(min·1.73 m2)-1, 37例]、2期[eGFR 60～90 mL·(min·1.73 m2)-1, 39例]、3期[eGFR 30～60 mL·(min·1.73 m2)-1, 47例]、4期[eGFR 15～30 mL·(min·1.73 m2)-1, 17例]、5期[eGFR <15 mL·(min·1.73 m2)-1, 5例], 所有研究对象通过静脉注射碘海醇5 mL后, 在注射后0、2 h和4～6 h间取血浆样本3次, 测量血浆清除率, 进行肾功能评估, 并与常用的肾功能评估公式[MDRD、内生肌酐清除率(Ccr)、CKD-EPI、Cockcroft-Gault]进行比较。结果 Ccr、MDRD公式计算eGFR值高于采用碘海醇血浆清除率计算的mGFR值(均P<0.05), 而Cockcroft-Gault、CKD-...     

亲属活体肾移植供者的安全性分析

目的 分析亲属活体肾移植供者手术前后的相关指标变化,探讨活体供者的安全性.方法对132例亲属活体供肾者进行心理和生理分析,包括尿常规、血生化、肾小球滤过率(GFR)、内生肌酐清除率(CCr)和生活质量等指标.结果 132例供肾者的生活质量评分与正常人群比较差异无统计学意义(P＞0.05).供肾切取术前供者血肌酐(SCr)为(78.33±15.94)μmol/L,术后7 d为(108.49±19.88)μmol/L(P=0.000);术后6个月为(112.47±20.38)μmol/L,与术后7 d比较差异无统计学意义(P=0.109).供肾切取术前供者CCr为(95.80±20.92)ml/min,术后7 d为(57.36±14.92)ml/min,与术前比较P=0.017;术后6个月为(65.49±8.25)ml/min,与术后7 d比较差异无统计学意义(P=0.619).术前双肾GFR为(74.08±18.51)ml/min,右肾GFR为(38.43±10.33)ml/min,供肾切取术后6个月保留右肾GFR为(56.49±13.01)ml/min,与术前双肾GFR比较,P=0.000;保留右肾GFR与术前自身比较代偿性增加47.0%.手术并发症包括脾脏包膜下出血1例,降结肠破裂1例,切口脂肪液化5例. 结论 术前对供肾者进行充分系统的医学心理学和生理学评估,严格履行风险告知义务,供受者术中规范操作,围手术期合理管理和建立严密的随访制度,可以有效提高亲属活体移植供肾者的心理和生理安全性.     

供肾切除后短期和长期非供肾功能变化

活体亲属供肾能获得最佳移植效果,供者肾切除后的安全性既往主要依据人寿保险统计资料和存活率——单侧肾切除未表明死亡率增高。过去对供肾切除后非供肾功能的评价依据肌酐清除率,而本文用放射性核素肾扫描准确评定非供肾有效肾血浆流量(ERPF),比较非供肾术前与术后1周、1年和10年ERPF的变化以及各年龄组(小于30岁、30～49岁、大于50岁)和性别间ERPF的变化。作者回顾分析两组供体肾功能:Ⅰ组55例(男19、女36)术前均行肾扫描,术后1周和1年测ERPF;Ⅱ组20例(男7、女13)为10年随访ERPF的病人,该组大多术后1周和1年也测定了ERPF。所有病人开始行分泌性尿路造影、肾动脉造影、12小时肌酐清除率和放射性核素肾扫描(用碘~(131)——邻碘马     

胱抑素C对评价慢性肾脏病患者代谢指标的应用价值

目的 研究胱抑素C对慢性肾脏病患者代谢指标及心脏疾病患病率的评价作用.方法 制作慢性肾脏病患者估算肾小球滤过率、血清肌酐、胱抑素C分别与血红蛋白、血钾、碳酸氢根、血磷散点图,并行直线回归相关分析.使用完全随机设计的单因素ANOVA分析胱抑素C与慢性肾脏病患者心脏疾病关系.结果 胱抑素C在评价慢性肾脏病患者贫血程度、高钾血症、高磷血症中的作用优于估算肾小球滤过率及血清肌酐.胱抑素C及血清肌酐在评价慢性肾脏病患者代谢性酸中毒的作用优于估算肾小球滤过率.胱抑素C水平高低与慢性肾脏病患者的心脏疾病的患病率成正相关(P＜0.05).结论 通过估算肾小球滤过率和血清肌酐,胱抑素C在评价慢性肾脏病患者代谢指标方面及评估患者心脏疾病患病率方面存在优势.     

Study of Renal Function in Living Kidney Donors: Estimated or Measured Glomerular Filtration

IntroductionIn living kidney donations the accuracy of renal function is fundamental, especially for potential donors who have limited renal function (creatinine clearance levels [CCr] <90 mL/m/1.73 m²), are >50 years old, and who have cardiovascular risk factors that might favor the development of kidney diseases.ObjectiveTo compare the direct measured glomerular filtration (mGFR) using 51Cr-EDTA and the estimations based on creatinine (estimated glomerular filtration rate [eGFR]): CCr with 24-hour urine, and estimated using Cockroft-Gault (adjusted using body surface area, Mosteller formula), modification of diet in renal disease–4 (MDRD-4), MDRD-6, and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) to determine the usefulness of different methods to evaluate the kidney function.Patients and MethodsThe kidney function evaluation was performed for 37 potential kidney donors using the 51Cr-EDTA method. The GFR obtained through the 51Cr-EDTA was compared with the CCr values in 24-hour urine and eGFR based on creatinine (Cockcroft-Gault, MDRD-4, MDRD-6, and CKD-EPI).ResultsUsing the Bland Altman graph, the most dispersed results were obtained with the eGFR using CCr in 24-hour urine and CKD-EPI. By means of Passing and Bablok, MDRD-4 and MDRD-6 showed the highest approximation to the reference method proposed to be substituted, whereas CCr showed a high dispersion.ConclusionThe eGFR using MDRD-4 and MDRD-6 formulas revealed the best adjustment to the measure by 51Cr-EDTA. This might represent the best option if a direct eGFR measure is not available.     

Glomerular filtration rate estimation in renal transplant patients based on serum cystatin-C levels: comparison with other markers of glomerular filtration rate

PURPOSE: The assessment of glomerular filtration rate (GFR) is the most commonly used test of renal function. Cystatin-C, a cysteine protease inhibitor, which can be measured by light-scattering immunoassay, possesses many of the attributes required of the ideal GFR marker. Conversely, many endogenous markers that are widely used for the estimation of GFR such as serum creatinine (SCr) are not ideal. The present study was undertaken to evaluate the clinical application of serum cystatin-C (CysC) as a new marker of GFR in renal transplant patients. METHODS: Eighteen patients (9 men) were enrolled in the study (mean age: 46.35, range: 31-67 years) to measure serum CysC levels and compare them, with SCr, creatinine clearance (CCr), as well as the Cockcroft-Gault equation (CG) or the MDRD as indicator of GFR. Spearman's correlation coefficient was used to determine the relationship between CysC and other markers. RESULTS: There was a significant negative correlation between serum CysC and CCr (r = -0.768). Moreover, the CysC level was negatively correlated with CG (r = -0.854), positively correlated with SCr (r = 0.629), and negatively correlated with MDRD (r = -0.604). CONCLUSIONS: These results indicate that measurement of serum cystatin-C was useful and accurate to estimate GFR in renal transplant patients. The recent literature confirms our data although there are concerns about nonrenal influence on this test. Although serum CysC can generally be recommended as a marker for GFR, our study is still in progress seeking to validate the conclusions in a larger number of patients.     

肾移植术后患者血清半胱氨酸蛋白酶抑制物水平与肾功能的关系

目的 探讨肾移植术后患者血清半胱氨酸蛋白酶抑制物(CyC)的水平变化与移植肾功能的相关性.方法选择193例使用他克莫司(FK506)加霉酚酸酯(MMF)加泼尼松(Pred)三联免疫抑制剂肾移植患者术后的血、尿标本,测定血清CyC和血、尿肌酐.经统计学分析,与常规的血清肌酐(SCr)浓度及尿肌酐清除率(CCr)和内生肌酐清除率(CkCCr)作相关性比较,评估CyC判断移植肾肾小球滤过功能的敏感性和特异性.结果 193例肾移植患者术后第5天血清CyC、SCr和CCr、CkCCr分别为(1.91±1.28)mg/L、(174.2±129.1)μmol/L、(67.9±27.3)ml/min、(68.1±27.8)ml/min.其中CyC浓度＜1.25 mg/L者42例,1.25～2.00 mg/L者102例,＞2.0 mg/L者49例;SCr浓度＜125/μmol/L者62例,125～200μmol/L者83例,＞200/μmol/L者48例;CkCCr＞80ml/min者52例,80～60 ml/min者96例,＜60 ml/min者45例.CyC与SCr呈正相关(r=0.886,P＜0.001),与CkCCr呈负相关(r=-0.907,P＜0.001);SCr与CkCCr呈负相关(r=-0.889,P＜0.001).非参数受试者工作特征曲线分析CyC、SCr、CCr、CkCCr曲线下面积分别为0.877、0.771、0.832、0.909,其诊断敏感性和特异性分别为91.6%、69.3%,52.2%、96.1%,67.5%、77.1%和84.6%、71.3%. 结论 肾功能轻度损害时,血清CyC比SCr先一步增高,有可能成为评定肾移植患者移植肾功能的敏感性标志物.     

Validation of an Experimental Model to Study Less Severe Chronic Renal Failure

Purpose: The 5/6 nephrectomy, mimics the stages of human chronic renal failure (CRF), but the procedure causes severe renal functional and morphological damage that could interfere with the evaluation of therapies for slowing the progression of the disease. This study summarizes the results of renal function, histology, and immunohistochemical findings in rats undergoing a 2/3 nephrectomy. Methods: The rats were distributed in groups according to the type of nephrectomy: CRF5/6: induced by a 5/6 renal mass reduction and CRF2/3: less severe CRF. The body weight and blood pressure were monitored, and the serum creatinine (SCr), creatinine clearance (CCr), urine osmolality, and 24-h proteinuria (PT24h) were measured. CRF progression was evaluated by the rate of decline of CCr (RCCr). Histology and immunohistochemistry were performed in the remnant kidneys. Statistical analysis was done by unpaired t-test, and a P-value < 0.05 was taken as a statistical significance. Results: Compared to the CRF5/6 group, the CRF2/3 model had a lower SCr, PT24h, CCr, and variations of the SCr from baseline. The disease progression was also significantly slower. The renal histopathological findings revealed fewer chronic lesions in rats with CRF2/3. Similarly, we observed less macrophage accumulation as well as lower proliferative activity and expression of fibronectin and a-smooth muscle-actin in the CRF2/3 model. Conclusions: The CRF2/3 model presented with a pattern of less severe CRF, functionally and morphologically, compared to the classical CRF5/6 model, and the CRF2/3 model may be useful for evaluating therapeutic interventions that target the early stages of CRF.     

Echographic Renal Dimensions Can Predict Glomerular Filtration Rate of Potential Living Kidney Donors

In potential living kidney donors, glomerular filtration rate (GFR) is often evaluated from the creatinine clearance (Ccr) or is predicted using formulas based on serum creatinine (SCr) or cystatin C (SCys) concentration. Ultrasonography is used to evaluate renal structure and dimensions. The objective of the present study was to evaluate the possibility of estimation of GFR from echographic renal dimensions in 66 potential live kidney donors (46 women and 20 men; age range, 25-73 years). The GFR was measured as the renal clearance of technetium 99m diethylenetriamine pentaacetic acid. The GFR was also estimated from the SCr concentration using the Cockcroft-Gault (CG-Ccr) and Modification of Diet in Renal Disease (MDRD-GFR) formulas and from SCys (Cys-GFR). Renal diameters were measured using conventional gray-scale renal ultrasound to estimate total and parenchymal renal volume using ellipsoid formulas. The GFR was predicted from renal dimensions on the basis of their relationship to measured GFR. Estimates of GFR obtained using renal volume more close correlated with measured GFR than did CG-Ccr, MDRD-GFR, or Cys-GFR. The mean difference from measured GFR was null. The GFR estimated from renal volume demonstrated better agreement with measured GFR and a lower prediction error vs values from the other prediction formulas (18.3 vs 22-34 mL/min). The GFR values predicted from renal volume were quite accurate as indicators of GFR less than 80 mL/min. In potential living kidney donors, sonographic renal volume provided more accurate estimates of GFR, with lower prediction error, compared with formulas based on SCr or SCys.     

Living Kidney Transplantation: Evaluation of Renal Function and Morphology of Potential Donors

The evaluation of potential living kidney donors requires an accurate study of renal function and morphology. The gold standard to assess renal function is the measurement of glomerular filtration rate (GFR). However, GFR is often estimated from serum creatinine (SCr), cystatin C (SCys), or creatinine clearance (CCr). Otherwise, GFR is predicted using formulas based on SCr or SCys. Ultrasound scanning evaluates morphology and dimensions, while scintigraphy provides information on morphofunctional symmetry of kidneys. The aim of this study in 79 potential donors was to assess the accuracy of the tests employed to estimate GFR and the utility of renal ultrasound and scintigraphy for morphofunctional evaluation of potential donors. GFR (clearance of ^99mTc-DTPA) was compared with estimates obtained with Cockcroft and Gault (CG-CCr) and Modification of Diet in Renal Disease (MDRD-GFR) formulas, and from SCys (Cys-GFR). The correlation with GFR was statistically significant for SCys and for all estimates, but not for SCr. CCr showed a poor agreement with GFR, with a large range of agreement and a marked and significant overestimation of GFR (33.8 mL/min). The accuracy of CG-CCr and MDRD-GFR as indicators of a GFR < 80 mL/min was better than that of Cys-GFR and CCr. However, their mean prediction errors versus GFR were relevant. Renal dimensions, particularly renal volume, showed a good correlation with GFR. The correlation was higher than that of all prediction equations. The direct measurement of GFR remains the reference method to assess renal function in potential kidney donors. The measurement of renal dimensions can provide useful information also on renal function.     

Estimation of glomerular filtration rate in South Asian healthy adult kidney donors

Aim:   We evaluated the performance of serum creatinine based equations to estimate glomerular filtration rate (GFR) in South Asian healthy renal donors.
Methods:   GFR by 99mTc-diethylenetriamine pentaacetic acid (DTPA) renogram (mGFR) in 599 renal donors was measured. GFR was estimated using a six variable modification of diet in renal disease formula (MDRD1), a four variable MDRD formula (MDRD2), Cockcroft-Gault creatinine clearance (CG CrCl), Cockcroft-Gault glomerular filtration rate (CG GFR) and the Mayo Clinic formula (Mayo GFR). The performance of various prediction equations was compared for global bias, precision (R²) and accuracy (percentage of estimated GFR (eGFR) falling within 15% and 30% of mGFR).
Results:   The mean age was 37.4 ± 11 years and 48.2% were male. The mGFR was 95.5 ± 11.6 mL/min per 1.73 m². The bias (mL/min per 1.73 m²) was 7.5 ± 0.9, −9.0 ± 0.75, 13.1 ± 0.9, 7.5 ± 0.9 and 23.4 ± 0.76 for CG CrCl, CG GFR, MDRD1, MDRD2 and Mayo GFR, respectively. R² was 0.082 for CG CrCl and MDRD1, 0.081 for CG GFR and MDRD2 and 0.045 for Mayo GFR. The percentages of eGFR falling within 15% and 30% of mGFR were 50.5 and 80.1 for CG CrCl, 65.8 and 84 for CG GFR, 50 and 74 for MDRD1, 54.3 and 80.1 for MDRD2 and 32 and 63.4 for Mayo GFR. Overall CG GFR performed better in estimating GFR in all subjects.
Conclusion:   The CG GFR equation was better than other equations to estimate GFR in South Asian healthy renal donors. We propose a new equation derived from the regression model in our study population to estimate GFR in a South Asian healthy adult population.     

The Utility of Combined Urine Urea and Creatinine Clearance for Pretransplant Renal Function Assessment

BackgroundEvaluation of donor renal function as glomerular filtration rate (GFR) is a crucial part of pretransplant workup. Most guidelines recommend measured GFR (mGFR) using exogenous markers with creatinine clearance (CrCl) as an alternative. However, exogenous markers are difficult to obtain and perform, and CrCl may overestimate GFR.ObjectiveWe explore the use of CrCl and combined urea and creatinine clearance as an alternative for GFR assessment.MethodsA retrospective study involving 81 kidney donors from 2007 to 2020, with mGFR collected by chromium 51-labeled ethylenediaminetetraacetic acid (⁵¹Cr-EDTA) and CrCl and combined urea and creatinine clearance. We analyzed the performance of CrCl and combined urea and creatinine clearance against ⁵¹Cr-EDTA. Adequacy of urine volume was taken into consideration.ResultsA total of 81 candidates with a mean age of 44.80 ± 10.77 years were enrolled. Mean mGFR from ⁵¹Cr-EDTA was 123.66 ± 26.91 mL/min/1.73 m², and combined urea and creatinine clearance and CrCl were 122.13 ± 47.07 and 133.40 ± 36.32 mL/min/1.73 m², respectively. CrCl overestimated ⁵¹Cr-EDTA. Though combined urea and creatinine clearance had minimal bias, it had a lower correlation coefficient (0.25 vs 0.43), lower precision (49.51 vs 38.10), and slightly lower accuracy within 30% of ⁵¹Cr-EDTA (74.07% vs 76.54%).ConclusionsCombined urea and creatinine clearance did not improve the performance of CrCl. Nevertheless, it can potentially be used as first-line GFR assessment, followed by mGFR in selected donors, to ascertain threshold of safe kidney donation. A stringent urine collection method is essential to ensure accurate measurement.     

Nephrectomy Elicits Impact of Age and BMI on Renal Hemodynamics: Lower Postdonation Reserve Capacity in Older or Overweight Kidney Donors

Renal functional reserve could be relevant for the maintenance of renal function after kidney donation. Low‐dose dopamine induces renal vasodilation with a rise in glomerular filtration rate (GFR) in healthy subjects and is thought to be a reflection of reserve capacity (RC). Older age and higher body mass index (BMI) may be associated with reduced RC. We therefore investigated RC in 178 consecutive living kidney donors (39% males, age 48 ± 11 years, BMI 25.5 ± 4.1). RC was determined as the rise in GFR (¹²⁵I‐iothalamate), 4 months before and 2 months after donor nephrectomy. Before donor nephrectomy, GFR was 114 ± 20 mL/min, with a reduction to 72 ± 12 mL/min after donor nephrectomy. The dopamine‐induced rise in GFR of 11 ± 10% was reduced to 5 ± 7% after donor nephrectomy (p < 0.001). Before donor nephrectomy, older age and higher BMI did not affect reserve capacity. After donor nephrectomy, the response of GFR to dopamine independently and negatively correlated with older age and higher BMI. Moreover, postdonation reserve capacity was absent in obese donors. The presence of overweight had more impact on loss of RC in younger donors. In conclusion, donor nephrectomy unmasked an age‐ and overweight‐induced loss of reserve capacity. Younger donors with obesity should be carefully monitored.     

亲属活体肾移植（附3例报告）

本报告3例尿毒症病人接受了父亲或母亲提供的肾脏而行肾移植，移植方式同尸体肾。供肾取自左侧或右侧，术前对供的肾功能进行系统检查并行肾动脉造影，HLA配型。免疫抑制剂使用与尸体肾大致相同。随访3月～6月。结果表明3例供体围手术期平稳渡过，9～10天出院，复查肾功能各项指标均未发现异常，现已恢复正常生活、工作。3例受均于开放肾血流后2min内泌尿，2例术后3天内血肌酐达正常水平，肌酐清除率3周时80ml／min；1例术后当天出现短暂肾功能延迟，术后1周血肌酐达正常值，3周时肌酐清除率60ml／min。因而认为亲属活体肾移植供体是安全的，且生存质量良好。受肾功能恢复快，质量稳定。亲属供肾扩大了肾源，可选择性实施。