糖尿病肾病患者肾小球滤过率测定及意义

本文对 3 7例 2型糖尿病早期肾病患者进行了肾小球滤过率 (ＧＦＲ)测定 ,以早期发现ＤＮ患者的肾功能变化 ,有效指导临床治疗。临床资料1　病例　 1型或 2型糖尿病患者 3 7例 ,为我院住院及门诊病人 ,糖尿病诊断符合 (ＡＤＡ1 997)标准。男 2 1例 ,女 1 6例 ;平均年龄 (49± 1 2 )岁。根据ＵＡＥＲ分为二组 ,即正常白蛋白尿组 (ＵＡＥＲ<2 0 μｇ/ｍｉｎ)和微量白蛋白尿组 (2 0 μｇ/ｍｉｎ≤ＵＡＥＲ≤ 2 0 0 μｇ/ｍｉｎ)。2　正常对照　健康人 1 6例 ,男 1 0例 ,女 6例 ;年龄 2 0岁～ 6 0岁 (3 9 7± 1 0 9岁 )。无心、肝、肾疾病及高血…     

肾小球滤过率估算公式在60岁以上老年慢性肾脏病患者中的应用

目的:比较几种基于血肌酐计算的估算肾小球滤过率（estimated glomerular filtration rate,eGFR）公式在60岁以上老年慢性肾脏病（chronic kidney disease,CKD）患者中应用的优劣。方法:入选2012年1月至2017年10月在北京医院就诊、年龄≥60岁的CKD患者为...     

冠心病患者CKD-EPI公式估算的肾小球滤过率与冠状动脉狭窄相关性分析

目的：研究分析行冠脉造影检查提示冠脉狭窄患者中估计的肾小球滤过率（estimated glomerular filtration rate,eGFR）与冠状动脉狭窄程度的相关性.方法：这项回顾性研究共纳入的537例患者初次行选择性冠脉造影的患者,排除能明确提供既往冠脉疾病史、泌尿系统感染、严重心功能不全、恶性肿瘤、有风湿性疾病史、肾衰竭或透析的患者,冠心病定义：标准冠脉造影左主干、左前降支、左旋支、右冠脉任一支出现狭窄.冠状动脉狭窄评估根据主要冠状动脉内径的狭窄程度、采用Gensini评分系统,对每支血管病变程度进行定量评定,肾功能的评估使用的是慢性肾脏病流行合作（CKD-EPI）公式.结果：按照Gensini积分分成两组,A为大于0的一组,B为等于0的一组,两组肾小球滤过率差异有统计学意义（P＆lt;0.05）,分析A组,按照肾小球滤过率进行慢性肾脏病（CKD）分期,采用Pearson 相关性对CKD分期与Gensini积分值大小相关性进行分析,分析呈正相关（P=0.003）,同时采用方差分析对A组慢性肾脏病5个分期进行差异检验（P=0.04）,计算A组基本指标及生化指标在慢性肾脏病不同分期的大小,年龄、收缩压、血肌酐、尿酸、胱抑素C、血红蛋白、性别在不同分期中差异有统计学意义（P＆lt;0.05）,根据Gensini积分大于0,等于0分为A、B组,对各影响因素进行单因素筛选,差异具有统计学意义的指标共7项指标,分别为年龄、舒张压、低密度脂蛋白、空腹血糖、性别、糖尿病、CKD分期.采用多因素logistic回归分析对相关因素进行分析,采用进入法,在步骤3中仅年龄、舒张压、低密度脂蛋白、糖尿病、性别进图回归方程,P值小于0.01,年龄、低密度脂蛋白、糖尿病为危险因素（OR=1.035、1.493、2.006）.结论：血管造影证实的冠心病患者的CKD发病率较高,估算的肾小球滤过率与狭窄的冠状动脉血管呈正相关,慢性肾脏病是冠状动脉疾病的一个重要的危险因素.     

不同肾小球滤过率估算公式在老年人肾功能评估中适用性的比较

目的比较不同肾小球滤过率估算公式在老年人肾功能状况评估中的适用性及其与内生肌酐清除率（Ccr）的相关性。方法选择720例老年内科患者,应用Cockcroft-Gault（C-G）公式、肾脏病膳食改良试验（MDRD）7（M7）公式、MDRD（Ma）公式及我国改良MDRD（Me）公式计算估计肾小球滤过率（eGFR）。分析C-G公式与其他公式计算的eGFR值与年龄和Ccr值的相关性。结果Ccr值和C-G公式计算的eGFR值均随年龄增长明显下降,与年龄呈显著负相关;其他公式计算的eGFR值与年龄均无相关性。本组患者的总体Ccr值为（50．32±23．64）ml·min-1·（1．73m2）-1;C-G公式计算的eGFR值为（45．45±18．46）ml·min-1·（1．73m2）-1,与Ccr值最为接近;其他公式的测定值均显著高于Cer值。在总体和CKD3～4期患者,C-G公式计算的eGFR值与Ccr值的相关性均高于其他公式。结论C-G公式计算的eGFR值与年龄和Ccr值的相关性最好,C-G公式可代替Ccr评估老年人的肾功能状况。     

肾小球滤过率的检测及研究进展

GFR是评价肾脏滤过功能的直接相关指标,目前可通过测定某种滤过标志物的肾脏清除率、血浆清除率获得,或者以肾动态显像法(仅适用于放射性核素)及评估方程推算得到.其中以血肌酐值及胱抑素值推算出的GFR临床上最为常用,因为结果相对准确,且经济实用、耗时耗材少.不同国家、不同地区通过大量的临床试验研究证实了不同血肌酐方程、胱抑素方程及两者的联合方程推算GFR的最佳适用条件及准确性.在各种滤过标志物中,目前菊粉清除率是评价GFR的金标准,碘海醇及99mTc-DTPA等其它放射性核素测得的GFR亦可作为参考标准,根据血肌酐及胱抑素的测得值,通过相应的方程可推算出相对准确的GFR,内生肌酐清除率可大致反映GFR.     

不同公式估算慢性肾脏病患者肾小球滤过率的结果评价

目的探讨不同估算公式估算慢性肾脏病（CKD）患者肾小球滤过率（GFR）在肾功能评价中的价值。方法选择CKD患者239例,所有患者同步检测99锝-二乙烯三胺五乙酸（^99mTc-DTPA）、GFR、血肌酐（SCr）等。将^99mTc-DTPA测定的GFR作为参照,并用肾脏病膳食改良试验（MDRD）公式、Cockcroft-Gault公式、简化MDRD公式及慢性肾脏病流行病合作研究（cKD-EPI）公式计算估测GFR,比较不同CKD分期中各估算公式估算的GFR的准确性。结果各估算公式估算的GFR值均高于^99mTc-DTPA,MDRD公式偏离程度最大;各估算公式估算的GFR值与^99mTc-DTPA检查的GFR结果有相关性,CKD-EPI公式相关性最高。结论CKD-EPI公式估算肾功能更接近^99mTc-DTPA的结果,但仍需进一步校正。     

肾小球滤过率测量值分布对估计公式中种族系数的影响

目的 探讨肾小球滤过率（GFR）估计公式中种族系数是否会受到不同研究中GFR测量值分布不同的影响。 方法 本研究包括MDRD研究中的1405例白种美籍患者,321例非洲裔美国患者和中国eGFR调查研究中的684例中国CKD患者。首先,白种美籍患者和中国CKD患者的数据库合并,将GFR、年龄（age）、血肌酐（Pcr）进行log转换,令log[GFR]为应变量,log[Pcr]、log[age]、性别和种族为自变量进行线性回归,计算不加权的种族系数（uRC）;然后按照白种美籍患者的CKD各期比例予中国CKD患者GFR测量值进行加权,使之与白种美籍患者的CKD分期分布一致,计算加权后的种族系数（wRC）。白种美籍患者和非裔美籍患者的数据合库,使非裔美籍患者的CKD分期分布分别与中国患者和白种美籍患者一致,计算相应的种族系数。 结果 中国患者的uRC为1.197（1.180~1.211）,wRC为1.130（1.117~1.143）。与中国患者和白种美籍患者CKD分期一致后,非裔美籍患者的种族系数则分别为1.205（1.191~1.219）和1.233（1.219~1.247）。 结论 用于开发GFR公式的人群的GFR测量值的分布不同可以导致种族系数的差异。为得到真正的种族系数需要国际合作,应用相同的GFR测量方法和Pcr测量方法,同时也需要GFR测量值分布一致。     

肾小球滤过率计算公式研究进展:从Cockcroft-Gault公式到FAS公式

准确测定肾小球滤过率(glomerular flitration rate,GFR)可以帮助临床医生精确评估患者肾功能,避免慢性肾脏病(chronic kidney disease,CKD)的误判和漏诊,制定合理的治疗方案,改善CKD患者的预后和生存质量。本文就近几年来国际及国内权威的GFR计算公式的研究进展展开综述。     

三种FAS公式估算的肾小球滤过率对冠心病监护室患者全因死亡的预测价值

目的比较三种FAS公式估算的肾小球滤过率(estimated glomerular filtration rate, eGFR)对冠心病监护室(Coronary Care Unit, CCU)患者全因死亡的预测价值。方法回顾性分析2014年1月1日至2015年6月1日武汉大学中南医院CCU收治的369例患者的临床资料,使用三种FAS公式分别计算eGFR(eGFR_(FASScr),eGFR_(FASCysC),eGFR_(FASScr-CysC)),采用Cox回归分析CCU患者全因死亡的影响因素,绘制受试者工作特征曲线(receiver operating characteristic curve, ROC),评估影响因素对CCU患者全因死亡的预测价值。结果 369例CCU患者中,93例发生全因死亡事件(25.2%)。单因素COX回归分析显示,年龄、发生急性肾损伤(acute kidney injury, AKI)、手术、使用血管活性药物、使用呼吸机、血红蛋白、白蛋白、血清胱抑素C(cystatin C,CysC)、血肌酐(serum creatinine, Scr)、超敏C反应蛋白、急性生理与慢性健康状况(acute physiology and chronic health evaluationⅡ,APACHEⅡ)评分、慢性肾脏病病史、eGFR_(FASScr)、eGFR_(FASCysC)、eGFR_(FASScr-CysC)与CCU患者全因死亡相关(均P0.05);多因素COX回归分析显示,eGFR_(FASCysC)(HR=0.960,95%CI:0.928～0.992,P=0.016)是患者全因死亡的独立影响因素。eGFR_(FASCysC)预测CCU患者全因死亡的ROC曲线下面积较大(AUC:0.842,P0.001)。结论 eGFR_(FASCysC)是CCU患者全因死亡的独立预测因子。     

Comparison of different equations for estimated glomerular filtration rate in patients with chronic kidney disease

Objective To compare different equations for estimated glomerular filtration rate (eGFR) in patients with chronic kidney disease (CKD). Methods Hospitalized patients with CKD from the nephrology department of the First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital) were recruited between December 2014 and May 2015. The calculations of eGFR and 24 h creatinine clearance rate (Ccr) were accomplished in three days after admission. The eGFRs were calculated separately using the 24 h creatinine clearance rate adjusted by the standard body surface area (Ccr_BSA), Cockcroft-Gault equation adjusted by the standard body surface area (eCcr_BSA), CKD-EPI creatinine equation (EPI_Cr), CKD-EPI cystatin C equation (EPI_CysC), CKD-EPI creatinine-cystatin C equation (EPI_Cr_CysC), simplified MDRD (MDRD) and China MDRD equations. The EPI_Cr_CysC equation was used as the standard and the precision and accuracy of the other six equations were compared and analyzed. Results A total of 403 CKD participants were enrolled in the study, with 228 male patients and a mean age of (54.9±18.4) years. The main primary diseases were chronic glomerulonephritis (43.7%) and diabetic nephropathy (13.2%). The median concentration of serum creatinine and cystatin C were 117.5 (69.7, 242.4) μmol/L and 1.80 (1.13, 3.31) mg/L, respectively. The median values of Ccr_BSA, eCcr_BSA, MDRD, China MDRD, EPI_Cr, EPI_CysC and EPI_Cr_CysC equations were 50.8 (21.1, 96.2), 51.9 (23.3, 93.2), 53.6 (23.0, 97.4), 52.2 (22.4, 94.1), 53.2 (22.1, 97.3), 35.1 (15.4, 67.0) and 49.1 (22.8, 82.3) ml?min-1?(1.73 m2)-1, respectively. There was well agreement among MDRD, China MDRD and EPI_Cr equations, while there were large differences between equations derived from CysC (EPI_Cr_CysC and EPI_CysC) and equations derived only from creatinine (EPI_Cr, MDRD, China MDRD, eCcr_BSA, Ccr_BSA equations). Compared with EPI_Cr_CysC equation (the reference equation), EPI_Cr equation showed the highest accuracy [percentage of other eGFR equation calculations that were ＞30% of the reference equation calculations (1-P30), 30.8%] while Ccr_BSA equation showed the lowest (1-P30, 42.4%). EPI_CysC equation showed the highest precision [inter-quartile range (IQR) of the difference, 11.7 ml?min-1?(1.73 m2)-1] while Ccr_BSA equation showed the lowest [IQR of the difference, 22.8 ml?min-1?(1.73 m2)-1]. Conclusions The agreement among equations derived only from creatinine is better; while it exhibits some differences between equations with cystatin C and equations derived only from creatinine. The accuracy of EPI_Cr equation is second only to EPI_Cr_CysC equation and it is currently the most suitable eGFR equation for clinical popularization of renal glomerular function assessment.     

Bias and precision of estimated glomerular filtration rate in children

Determining true glomerular filtration rate (GFR) using an exogenous marker is time-consuming and cumbersome. Therefore, creatinine-based estimates of GFR are used. Recent papers using new population-specific/local parameters in their prediction equations, standardizing creatinine determination or adding other endogenous surrogate markers of GFR, like cystatin C, could demonstrate an improvement of bias inherent in the results of the prediction equations. Precision, however, is still poor. Currently, we have to accept a precision (as defined in the so-called Bland-Altman plot) of ±20% in adults and ±30–40% in children. This problem of poor precision/uncertainty is especially bothering in the higher, near normal GFR range. Caution should be exercised when applying prediction equations in individuals in need of an accurate GFR determination. In that case, a real clearance procedure has to be performed. In the long run, the true clearance procedure should be simplified using new exogenous GFR markers and developing new devices, allowing GFR measurements to be performed, for example, transcutaneously. Such a procedure would be more acceptable for both patients and physicians.     

Effect of estimated glomerular filtration rate on periprocedural myocardial infarction in patients undergoing elective percutaneous coronary intervention

Abstract

Backgrounds: Little is known about the effect of the estimated glomerular filtration rate (eGFR) on the periprocedural myocardial infarction (PMI). The aim of this study was to determine an eGFR value that is related with PMI development in patients with stable angina undergoing elective percutaneous coronary intervention (PCI). Method: A retrospective analysis was conducted of 257 consecutive PCI patients with stable angina pectoris. The patients were divided into three groups according to eGFR: Group 1: eGFR?>?90?mL/min/1.73?m², Group 2: eGFR?=?60–89?mL/min/1.73?m², and Group 3: eGFR?=?30–59?mL/min/1.73?m². Cardiac biomarkers were measured before, at 8, and at 24?h after the procedure. Results: Periprocedural myocardial infarction occurred in 19% of the study patients. The frequency of PMI was 13.8% in group 1, 15.2% in group 2, and 35% in group 3 (p?=?0.002). There was an inverse relationship with increasing cardiac biomarkers and decreasing eGFR values. Multiple regression analysis showed that an eGFR value between 30 and 59?mL/min/1.73?m² was an independent variable that significantly affected PMI development after PCI. Conclusions: An estimated glomerular filtration rate between 30 and 59?mL/min/1.73?m² is a predictor of developing PMI after elective PCI in patients with stable angina pectoris.     

Expressing glomerular filtration rate in children

We have reviewed the studies that provide the current standards of reference for glomerular filtration rate (GFR) in normal children from 14 days to 12 years of postnatal age. These standards currently are presented as ml/min per 1.73 m², i.e., adjusted to average adult body surface area. Children from birth to 1 year of age have adjusted values below the adult range, making comparisons of observed to reference values difficult. Currently, there is no accepted way of obtaining reference values that vary smoothly with age. An analysis of the absolute GFR values in normal children taken from published studies led to an equation that estimates average GFR in relation to weight and term-adjusted age from-2 months (7 months gestational age) to 12 years in children at least 14 days post delivery. When these data are transformed to percentage of normal (% nl) for age and weight (i.e., percentage of the estimated average), it is possible to describe approximate apparent lower limits of normal GFR as is now done for adults and older children. For children with loss of renal mass, GFR expressed as % nl for age and weight provides a convenient standardization which has several useful applications. First, results expressed as % nl for children of different ages, particularly under 1 year of age, can be combined with those of older children for summary purposes. Second, the course of GFR measured serially in children is more appropriately described using this method for expressing GFR. Reporting GFR in absolute values is also useful, particularly in patients whose body mass is significantly distorted or whose absolute GFR is low.     

Inaccuracy of estimated creatinine clearance for prediction of iothalamate glomerular filtration rate

The clinical practice of estimating creatinine clearance (Ccr) from a patient's serum creatinine value by use of various nomograms and prediction formulas is widespread. The predictive accuracy of such Ccr estimates as substitutes for measured values of glomerular filtration rate (GFR) has not been determined. In addition, the effect of patient physical parameters on GFR prediction accuracy has not been assessed. To investigate these issues, 500 predicted Ccr values from each of four versions of the formula of Cockcroft and Gault were statistically compared with GFR values measured by sodium iothalamate clearance (Cio) in 394 human subjects representing every level of renal function. We conclude that (1) the original formula of Cockcroft and Gault is an inaccurate predictor of GFR; (2) correction of the formula for patient physical parameters does improve its accuracy for GFR prediction; (3) the best formula is not accurate enough to replace laboratory measurement of GFR; and (4) GFR prediction inaccuracy is more often associated with extremes in patient age, weight, serum creatinine, body surface area, and measured GFR but may occur for any value of each of these parameters.     

Estimating absolute glomerular filtration rate in children

Normal values of glomerular filtration rate (GFR) in children are often expressed in a value adjusted to adult ideal body surface area. These values work well for many clinical situations, but in infants and children, especially those with atypical body mass, they may not accurately reflect renal function. Most body composition values in children are expressed in developmentally appropriate ranges. Absolute GFR (ml/min) also changes during childhood increasing rapidly in infancy and then gradually with age and body size. Previously, we developed a bedside equation for estimating GFR (ml/min) in children that accounted for changes with age and body size, and which correlated well with steady-state cold iothalamate GFR (ml/min) measurements: GFR (ml/min) = k_*sqrt[(age(months) + 6)*wt (kg)/serum Cr (mg/dl)], where k=0.95 for females and 1.05 for males. In the present study GFR (ml/min) measured by iothalamate infusion was compared by correlation analysis with estimates calculated from the above equation in 566 children. This equation provides clinicians with a simple bedside method to estimate absolute GFR (ml/min).     

2型糖尿病患者不同蛋白尿期肾小球滤过率的变化及影响因素

目的 研究2型糖尿病（DM）患者不同蛋白尿期的肾小球滤过率并探讨其影响因素。 方法 根据尿白蛋白量（24 h）把630例2型糖尿病住院患者分成正常白蛋白尿组（A组）、微量白蛋白尿组（B组）及大量白蛋白尿组（C组），用放射性核素(99m Tc-DTPA)肾动态显像测定肾小球滤过率(GFR), 同时测定其体质量指数、血压、血糖、糖化血红蛋白、肾功能、血脂及尿白蛋白量（24 h）。 结果 （1）A组GFR值平均为（99.8±26.3） ml/min；B组为（96.1±31.2） ml/min；C组为（69.7±29.8） ml/min。C组的GFR显著低于A组和B组（P < 0.01）。（2）3组患者的GFR均与年龄呈负相关（A组r = -0.533，B组r = -0.612，C组r = -0.412，均P < 0.01）。（3）有高血压史者的GFR平均值均低于同组无高血压史者（P均< 0.05）。（4）控制年龄后的偏相关分析结果显示，在B组及C组，GFR与尿白蛋白量（24 h）呈负相关（r = -0.283 及-0.240，均P < 0.05）。多元逐步回归分析结果显示，尿白蛋白量（24 h）是影响异常蛋白尿组患者GFR的主要因素。 结论 放射性核素肾动态显像法测定GFR，同时联合尿白蛋白量检测，能更全面准确地评估糖尿病肾病的进展。应积极控制蛋白尿，尤其在微量白蛋白尿期。     

Effect of cyclosporin A on glomerular filtration rate in children with minimal change nephrotic syndrome

Cyclosporin A (CyA) is now commonly used in the management of children with steroid-dependent nephrotic syndrome. In order to assess nephrotoxicity related to CyA therapy, we measured glomerular filtration rate (GFR) on 123 occasions in 24 children with minimal change nephrotic syndrome receiving CyA. GFR was estimated from the plasma clearance of⁵¹chromium-EDTA every 3 months during CyA therapy of up to 27 months duration. There was a significant reduction in GFR after 3 months of CyA therapy [118±33 (SD) to 93±24 ml/min per 1.73 m²] but no further fall thereafter, although the reduction in GFR was sustained for the duration of CyA therapy. This reduction in GFR appeared to be reversible upon cessation of CyA, but careful monitoring of renal function is necessary in such patients to prevent the development of longer term nephrotoxic sequelae.     

Glomerular filtration rate and its influential factors in type 2 diabetes mellitus at different stages of albuminuria

Objective To study the characteristics of glomerular filtration rate (GFR) and its influential factors in type 2 diabetes mellitus at different stages of albuminuria. Method GFR was measured in 630 cases of type 2 diabetes mellitus between 2002 and 2005 by plasma disappearance of 99m-techmetium-diethylene- triamine- penta-acetic acid (99mTc-DTPA). Body mass index (BMI), blood pressure, plasma glucose, HbA1c, Scr, BUN, uric acid (UA), profile of plasma lipid and 24 h-urinary albumin excretion (24 h-UAE) were also measured. All the patients were divided into 3 groups according to their 24 h-UAE: normoalbuminuric group (group A, 24 h-UAE<30 mg), microalbuminuric group (group B, 24 h-UAE from 30 mg to 300 mg) and macroalbuminuric group (group C, 24 h-UAE>300 mg). Results (1) The mean GFR was (99.8±26.3) ml/min, (96.1±31.2) ml/min and (69.7±29.8) ml/min in A, B and C groups respectively. The GFR in group C was significantly lower than that in group A and group B(P<0.01). (2) Negative correlations were found between GFR and age in all these groups (group A r= -0.533, group B r=-0.612 and group C r=-0.412，respectively, P<0.01）. (3) In each group, GFR of patients with hypertension was significantly lower than that of patients without hypertension（P<0.05）. (4) The Pearson correlation analysis adjusted by age showed that GFR was negatively correlated with 24 h-UAE in group B and group C (r=-0.283 and -0.24 respectively, all P<0.05). The multiple stepwise regression analysis showed that 24 h-UAE was the major influential factor of GFR in these 2 groups. Conclusions Measurement of both GFR performed by non-traumatic plasma disappearance of 99mTc-DTPA method and UAE provides a more precise evaluation on the the development and progression of diabetic nephropathy. Albuminuria should be controlled, especially in microalbuminuric stage.