Renal functional reserve after acute poststreptococcal glomerulonephritis

 We evaluated renal functional reserve (RFR) in 36 patients aged 5 – 21 years, who had recovered from an acute episode of poststreptococcal glomerulonephritis (PSGN) 1 – 16 years previously, without apparent sequelae, as evidenced by normal serum creatinine, blood pressure, and urinary sediment. The control group consisted of 12 children aged 2 – 12 years with recurrent urinary tract infections or nocturnal enuresis, without active infection or anatomical anomalies. The basal creatinine clearance was similar in the PSGN and control groups: 140.0±27.4 ml/min per 1.73 m² and 142.9±15.5 ml/min per 1.73 m², respectively. The RFR in the PSGN group was significantly reduced compared with that of the control group: 18.6±12.9 ml/min per 1.73 m² and 41.1±25.3 ml/min per 1.73 m², respectively (P <0.02). In 7 PSGN patients (19.4%), no RFR was found. In 69% of patients who had recovered from PSGN more than 10 years before the protein loading tests, a significantly reduced RFR (less than 10% of baseline) was found. The same degree of reduction in RFR was found in only 26% of patients who had suffered from PSGN less than 10 years ago. Received May 23, 1996; received in revised form November 11, 1996; accepted November 27, 1996     

Measurement of renal functional reserve in children

Renal functional reserve was measured during 89 studies in 78 children as the difference between the baseline glomerular filtration rate (GFR) and that following a protein meal. GFR was measured using creatinine as the filtration marker in children pre-treated with cimetidine. The children had been on a diet free of meat, fish, and fowl for 24 h. The protein meal to stimulate GFR was derived from milk, cheese, eggs, and baked goods. The increase in GFR following the protein meal was due mainly to an increase in the glomerular filtration of creatinine, with a small contribution by decreased serum creatinine concentration. This study confirmed that renal functional reserve can be measured using a meat-free protein meal to stimulate GFR. The protocol employed is a relatively noninvasive and inexpensive procedure for identifying glomerular hyperfiltration in children.     

Renal functional reserve in children with a previous episode of haemolytic-uraemic syndrome

Renal function [creatinine clearance (C _Cr)] and renal functional reserve (RFR) was measured in 16 children who had had haemolytic-uraemic syndrome (HUS) an average of 6.6±0.72 years previously. All patients had normal plasma creatinine and blood pressure and only 3 had proteinuria, which was mild in every instance. Patients were studied whilst ingesting three diets which provided an average of 1.5, 2.1 and 3.1 g protein/kg body weight per day, respectively. Diets were administered over three consecutive periods of 7 days each andC _Cr was measured on the 7th day of each diet. Values tended to correlate with protein intake. They were in the normal range when patients were taking 1.5 and 2.1 g protein diets and increased markedly in 13 of the 16 patients (P<0.001) when they ingested the high-protein diet (3.1 g). The effect on glomerular filtration rate (GFR)-measured byC _Cr and inulin clearance (C _in)-of an acute oral protein load was studied in 12 of the HUS patients and four control subjects. In the control periods, prior to the protein load, values forC _Cr were similar in the HUS and control subjects (104.0±11.0 vs 121.6±10.1 ml/min per 1.73 m², NS). HoweverC _in values were significantly reduced in HUS patients (59.5±9.2 vs 102.7±12.4 ml/min per 1.73 m², (P<0.025). TheC _Cr/C _in ratio in the patients averaged 2.10 compared with 1.13 in controls. Acute protein loading was accompanied by an increase inC _in in all controls but in only 8 of the 12 patients. Baseline values forC _in did not correlate with the presence or absence of protein-stimulated enhancement ofC _in. TheC _Cr/C _in ratios after protein loading remained twice as high in HUS patients as in controls. The data indicate thatC _Cr is not an accurate indicator of GFR in children who have had acute renal injury. Tubular secretion of creatinine represents a greater proportion of excreted creatinine in these children, may maintain serum creatinine in the normal range and mask the decrease in GFR. The study also emphasizes the problems of measuring RFR in these children.     

Renal Functional Reserve in Patients with IgA Glomerulopathy

Seven patients with histologically proven IgA nephropathy and modest impairment of renal function, and 2 patients with IgA nephropathy and nephrotic syndrome were investigated, compared to a control group of 9 healthy individuals, to study the effects of amino acids on glomerular and tubular function, and to evaluate renal functional reserve in IgA nephropathy with different clinical course. Inulin and PAH clearances were used to evaluate glomerular filtration rate (GFR) and effective renal plasma flow (ERPF); proximal and distal tubular fluid delivery and reabsorption were measured by lithium clearance, before and after submission of a standardized amino acid solution. GFR and ERPF increased significantly during amino acid load in healthy individuals and patients without nephrotic syndrome, while filtration fraction (GFR/ERPF) remained constant. Lithium clearance (C_Li) and fractional lithium excretion (C_Li/GFR) rose significantly in both groups, whereas the reabsorbed volume of fluid in the proximal tubule did not change. In the distal tubule, fractional volume excretion decreased significantly during amino acid load whereas the reabsorbed volume significantly increased. Baseline values of the two groups did not differ significantly. Two patients with nephrotic course of IgA nephropathy showed a distinct decrease in glomerular and tubular function, and a loss of renal functional reserve after amino acid load. Conclusions: Despite distinct alterations in renal biopsy, IgA nephropathy without nephrotic course presents with a still adequately preserved kidney function and renal functional reserve. A single determination of renal function with noninvasive functional tests does not give valid prognostic information concerning glomerular and tubular function. Therefore, a repeated measurement of renal function at defined intervals might reveal clinical progression of renal disease. The results of the lithium clearance might indicate an increase in tubular function after amino acid load, indicating a tubular adaptation in state of hyperfiltration.     

Renal Functional Reserve in Pregnancy

Creatinine clearance has been evaluated under baseline conditionsand after acute protein load in five normal and 29 pregnantwomen at different stages of pregnancy without evidence of renaldisease. After a 3-h period in which creatinine clearance wasmeasured hourly (resting GFR), a meal containing 80 g of proteinswas administered and creatinine clearance was measured hourlyfor 4 h (test GFR). Resting GFR in normal sub jects averaged104±22.5 ml/min per 1.73m², the wide variation beingdue to different dietary, protein intake (from 0.3 to 1.2 gof protein per kg body weight). In the pregnant women the resting GFR increased progressivelyfrom the first month (99.8±12.8m1/min per l.73m²) tothe last month of gestation (149.6±12.5 ml/min per 1.73m²) All subjects showed a significant increase of GFR afterprotein load although the greatest difference between the restingand the test GFR was detected in the first trimester. Inulinclearance was also measured in seven subjects after proteinloading to compare creatinine and inulin clearance values. Thetwo clearance values did not differ significantly, showing thatcreatinine can be safely used as a reliable marker for measuringGFR. Test GFR averaged 163.3±4.1 mI/min per 1.73 in normalsubjects and l63.8±6.5 ml/min per l.73m² in pregnantwomen without any relationship with the stage of pregnancy.The identity of test GFR both in normal subjects and in pregnantwomen suggests that this parameter is likely to be related tothe functioning renal mass, and represents the filtration capacityof the kidney. The difference between the test GFR and the resting GFR representsthe renal functional reserve. The progressive increase of theresting GFR during pregnancy suggests a progressive utilisationof the renal functional reserve under the stimuli of gestation.It is evident that only subjects with intact renal functionalreserve may increase their GFR during pregnancy, under specificmetabolic requirements. Acute protein load might be used, therefore,as a simple test to evaluate renal functional reserve and topredict the renal response during future pregnancies. Sincethe test may detect the existence of renal disease even in theearly phases when the reduction of the functioning nephronsis not clinically evident, it might be utilised in some casesto prevent or predict possible pregnancies at risk.     

Dynamic renal function testing by compartmental analysis: assessment of renal functional reserve in essential hypertension.

BACKGROUND: In essential hypertension, acute haemodynamic changes due to dietary protein load cause patterns of acute changes in renal function that are fundamentally different from changes in normal controls. METHODS: Renal clearances of sinistrin, an inulin-like polyfructosan, and p-aminohippurate were determined before and after protein ingestion. These tests were performed in healthy controls and in patients with essential hypertension (mean arterial pressure of 112+/-2 mmHg, age, 52+/-2 years; mean+/-SEM) within a washout period, and after long-term treatment with carvedilol and fosinopril, respectively. RESULTS: In 15 healthy volunteers, protein ingestion increased glomerular filtration rate (GFR) from 110.3+/-3.6 to 120. 6+/-4.4 ml/min (P=0.0006; two-tailed pairwise t-test). In contrast, it led to an acute decrease in GFR in 16 hypertensive patients, from 111.8+/-2.9 to 103.6+/-3.3 ml/min (P=0.0010). The eight patients who were randomized to receive carvedilol improved in their renal response to protein (GFR increased from 101.4+/-6.4 to 107.1+/-5.4 ml/min; P=0.04), whereas the eight other patients randomized to receive fosinopril exhibited no change in GFR (final value 105+/-4.9 ml/min). In the patients, the acute shifts in renal plasma flows were not significant. Mean arterial blood pressure of the patients decreased from 112+/-2 to 100+/-3 mmHg (P=0.0015). CONCLUSIONS: In essential hypertension an acute protein load induces a decrease in GFR that may normalize under antihypertensive treatment. The acute changes in GFR can be reliably monitored by the here-described compartmental analysis method of renal functional reserve.     

Renal hemodynamic changes and renal functional reserve in children with type I diabetes mellitus

Increased glomerular filtration rate (GFR) has been implicated in the development of diabetic nephropathy. Large normal interindividual variations of GFR hamper the diagnosis of renal hemodynamic alterations. We examined renal functional reserve (RFR) in children with type 1 diabetes mellitus to assess whether hyperfiltration occurs. The renal hemodynamic response following dopamine infusion was examined in 51 normoalbuminuric diabetic children (7.7 ± 3.6 years) with a mean duration of diabetes of 6.2 years and compared them with 34 controls. Mean baseline GFR in diabetic children did not differ from the control population (130.7 ± 22.9 vs. 124.8 ± 25 ml/min per 1.73 m²), whereas renal plasma flow was significantly lower (463.7 ± 103.9 vs. 587.2 ± 105 ml/min per 1.73 m², p < 0.001), and filtration fraction was increased (29 ± 8 vs. 21 ± 2%, p < 0.001), compared with controls. The mean RFR was lower (p < 0.001) than in control subjects (−0.77 ± 23 vs. 21 ± 8 ml/min per 1.73 m²). This study documents an increased filtration fraction and reduced or absent RFR in children with type 1 diabetes mellitus in the stage before apparent nephropathy. GFR values were within normal range. Although the reduced RFR and increased filtration fraction indicate the presence of hemodynamic changes, their relevance to the development of hyperfiltration and subsequent diabetic nephropathy remains unknown.     

Renal functional reserve and renal hemodynamics in hypertensive patients

The renal functional reserve (RFR) is the ability of the kidneys to increase renal plasma flow and glomerular filtration rate (GFR) in response to protein intake. It is a measure of functional and anatomic integrity of nephrons. It is not known what relation between RFR and kidney Doppler parameters. We aimed to study the relation between the RFR and renal hemodynamic parameters in hypertensive patients with and without nephropathy who had normal kidney function. Twenty-four hypertensive subjects with nephropathy (HTN-n, n?=?10) and hypertension without nephropathy (HTN, n?=?14) were included in the study. Control group included 11 healthy subjects. Baseline GFR (GFR1) and GFR after intake of egg protein 1?mg/kg of body weight were determined (GFR2). RFR was calculated by the following formula: (GFR2-GFR1)/GFR1?×?100%. Doppler ultrasonography was performed. Arterial blood pressure (BP), body mass index (BMI), and estimated GFR were also recorded. HTN and HTN-n groups had impaired levels of RFR compared with controls (p?<?0.05), significantly decreased value of flow velocity parameters (Vmax, Vmin), and increased RRI compared with controls. There was significant negative correlation of RFR with blood pressure levels (sBP, r?=??0.435, p?=?0.009; dBP, r?=??0.504, p?=?0.002), RRI (r?=??0.456, p?=?0.008), micro albuminuria (MAU, r?=??0.366, p?=?0.031) and positive correlation with Vmax and Vmin (r?=?0.556, p?=?0.001 and r?=?0.643, respectively, p?<?0.001). Linear regression showed that RRI and MAU were independent predictors of decreased RFR. RFR is lower in hypertensive patients despite near-normal level of kidney function and is related to particular level of BP. RRI and MAU were independent predictors of decreased RFR.     

Renal function following kidney transplantation in children treated with cyclosporine

The study was performed to evaluate the longterm renal function of children treated with cyclosporine after kidney transplantation. Renal function was determined with clearances of inulin and aminohippurate sodium for evaluating glomerular filtration rate (GFR) and effective renal plasma flow (ERPF). Thirty-six children aged 0.4–16.2 (median 6.9) years at transplantation were examined within 5 months of transplantation and then yearly over 0.3–7.1 years. Twenty-five children and young adults, 1.5–20 (median 7.7) years of age, with solitary kidneys because of renal agenesis or nephrectomy, served as controls. The GFR and ERPF within 1 year of transplantation were significantly lower than those of controls (65±19 and 345±88 vs 96±12 and 474±91 ml/min per 1.73 m², respectively). GFR remained constant 4 years after transplantation, but ERPF decreased significantly. Significant inverse correlations were found between GFR within 5 months of transplantation and the mean cyclosporine concentration and the number of rejection episodes. The frequency of hypertension decreased from 82% within 5 months of transplantation to 0% after 4 years. The absolute GFR increased during follow-up. In conclusion, kidney transplantation results in a reduced renal function compared with that of solitary native kidneys. The reduction in renal function correlated with the number of rejection episodes and the cyclosporine load. The increase in absolute GFR during follow-up suggests a remaining capacity for growth and/or compensatory hypertrophy.     

Renal functional reserve in transplanted and native single kidneys of children and adults

Renal functional reserve (RFR) after an oral protein load was evaluated in 36 cyclosporine-treated children following kidney transplantation (Tx), in 15 kidney donors (Don), and in 15 children with single kidneys (Nx/Ag). Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were determined by clearances of inulin (and creatinine) and para-aminohippurate during water diuresis. Baseline and stimulated GFR and ERPF were determined and RFR was calculated as the difference between stimulated and baseline values. Baseline GFR and ERPF in Tx were lower than in Don and Nx/Ag. Both GFR and ERPF increased significantly in all groups from baseline to stimulated values. RFR GFR was 23%±3%, 20%±3% and 15%±3% in Tx, Don, and Nx/Ag and RFR ERPF 35%±4% in Tx, which was significantly higher than 20%±4% and 15%±3% in the two other groups respectively. Stimulated GFR and ERPF in Tx correlated with kidney length. No differences were seen in recipient-donor pairs, except for higher fractional increases of ERPF in recipients. There was no correlation between RFR measured by clearance of creatinine and clearance of inulin. In conclusion, cyclosporine-treated children following renal Tx were found to have a renal reserve capacity. Received September 19, 1995; received in revised form September 16, 1996; accepted October 1, 1996     

Glomerular volume and renal function in children with different types of the nephrotic syndrome

Glomerular hypertrophy has been suggested to be an important factor in the pathogenesis of focal glomerular sclerosis. The aim of the present study was to analyse retrospectively the renal biopsies of 58 children (0.2–16.1 years of age) with different types of the nephrotic syndrome, minimal change nephrotic syndrome (MCNS), diffuse mesangial proliferation (DMP) and focal segmental glomerulosclerosis (FSGS). Glomerular surface area was measured and glomerular volume was calculated and related to steroid responsiveness and to renal function, measured by clearances of inulin and para-aminohippuric acid. Glomerular volume correlated with body surface area (BSA) and age. Because of this, patients with FSGS and DMP were matched according to BSA and age, with corresponding MCNS patients. Glomerular volumes of FSGS and DMP patients were significantly larger than those of MCNS patients. In the MCNS patients, significant correlations were found between glomerular volumes and glomerular filtration rate and effective renal plasma flow. Steroid-dependent and steroid-resistant patients showed larger glomeruli than the steroid-responsive children. We suggest that hyperfiltration and hyperperfusion, among other factors, may contribute to glomerular hypertrophy, mesangial proliferation and glomerulosclerosis.     

Long-term follow-up of renal function in recipients and donors following pediatric kidney transplantation

Of 125 children undergoing kidney transplantation (tx), 87 received their grafts from living donors. Renal function of recipients (R) and donors (D) was assessed by glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) determined by clearances of inulin and para-aminohippuric acid. Rs were investigated yearly and Ds on alternate years. Within 5 months of tx, absolute GFR and ERPF (ml/min) were significantly lower in R than in D, and the differences in absolute GFR and ERPF between D and R were directly related to the difference in body surface area (BSA) between the two subjects. R and D pairs were repeatedly followed for 4, 6, and 8 years and the absolute GFR of R did not change during follow-up, while relative GFR decreased. Relative GFR decreased most in R, with the greatest difference in BSA between D and R at tx. In the donors, however, both absolute and relative GFR increased significantly up to 8 years. In conclusion, renal function of the two kidneys from the donor, i.e., the grafted kidney in the R and the single native kidney of the D, differed. The native kidney showed a capacity to increase its absolute and relative function with time. The grafted kidney, however, did not show an increase in absolute GFR, resulting in decrease in relative GFR, and the greater difference in BSA between D and R at tx, the greater fall in relative GFR of the R. Received: 7 June 2001 / Revised: 30 July 2001 / Accepted: 30 July 2001     

Urinary protein excretion and renal function in children with IgA nephropathy

Renal haemodynamics and the pattern of urinary protein excretion were studied in 38 children (21 boys, 17 girls) with biopsy-proven IgA nephropathy (IgAN), 0.4–16.8 (median 5.3) years after onset of the disease. Glomerular filtration rate (GFR) and effective renal plasma flow (ERPF) were evaluated by clearances of inulin and para-aminohippuric acid. Serum and urinary albumin, IgG and beta₂-microglobulin (2) were determined and the excretion rates, clearances, and fractional clearances were calculated. The patients were grouped according to the type and the amount of proteinuria. Mean GFR and ERPF were significantly decreased (107±3 and 580±17 ml/min per 1.73 m², respectively) versus controls (119±2 and 627±14 ml/min per 1.73 m², respectively). Grouped according to albumin excretion rates, non-albuminuric patients had normal GFR, while mean GFR was reduced in patients with micro-albuminuria (106±3 ml/min per 1.73 m²) and albuminuric patients (92±7 ml/min per 1.73 m²). IgG excretion increased with increasing albuminuria, but the selectivity index was lower in albuminuric patients than in patients with micro-albuminuria. Albuminuric patients had also higher blood pressure than those with micro-albuminuria. 2 excretion did not discriminate between patients with impaired renal function. The results suggest that childhood IgAN is not a benign kidney disease. After a median duration of 5 years of the disease a number of children had impaired renal function. Mean GFR was reduced most in the albuminuric patients but was also decreased in micro-albuminuric patients, indicating that micro-albuminuria may be a predictor of more severe disease.     

Growth charts for prepubertal children with chronic renal failure due to congenital renal disorders

Despite the high prevalence of and therapeutic attention to growth failure in children with chronic renal failure (CRF), systematic evaluation of spontaneous growth in CRF are lacking. Therefore, we collected retrospectively longitudinal growth and biochemical data in 321 prepubertal patients treated for CRF due to congenital renal disorders. Data were recorded at 3-month intervals during the first 2 years of life and 6-monthly thereafter, up to the age of 10 years. Around 100 measurements were available per age interval. Mixed-longitudinal percentile curves of height and height velocity were constructed. Moreover, a statistical comparison with the heights and height velocities of healthy children and an evaluation of the effect of biochemical parameters on growth was performed. The CRF children had normal heights at birth but dropped below the 3rd normal percentile during the first 15 months of life. Thereafter, growth patterns usually were percentile parallel, with a mean height standard deviation score (SDS) of –2.37±1.6. Height velocities were consistently lower in patients with glomerular filtration rates (GFRs) below onethird of the lower normal limit (25 ml/min per 1.73 m² for patients >1 year) than in patients with better renal function. This difference in growth rates resulted in a mean height SDS of –1.65±1.5 SDS and –2.79±1.4 SDS (age 1–10 years) in the subgroups with relatively better and worse GFR, respectively. Regression analysis confirmed that GRF was a weak but significant predictor of height velocity SDS in most age groups.Study group members: I. Rätsch (Ancona), K. Michelis, T. Kapogiannis (Athens), F. Jung, T. Lennert (Berlin I), S. Gellert (Berlin II), T. Tulassay, P. Sallay (Budapest), T. von Lilien, D. Michalk (Cologne), M.-A. von Wendt-Göknur (Erlangen), K. E. Bonzel (Essen), R. Gusmano, E. Verrina (Genova), G. Offner (Hannover), O. Mehls, A.-M. Wingen, C. Fabian-Bach (Heidelberg, coordinators), A. Appiani, A. Bettinelli (Milan), J. Feber (Prague), G. Rizzoni, S. Picca (Rome), H. J. Stolpe, M. Wigger (Rostock), J. Kist-van Holthe, E. Wolff (Rotterdam, coordinators for the centers Amsterdam, Antwerp, Groningen, Nijmegen, Rotterdam), U. Berg (Stockholm), M. Fischbach (Strasbourg), E. Dobos (Szeged), E. Balzar (Vienna), T. Neuhaus (Zurich).     

活体肾移植供肾肾小球滤过率对受体早期肾功能的影响

目的 探讨活体肾移植供肾肾小球滤过率( GFR)对受体早期肾功能的影响.方法 2006年至2011年在本中心接受活体肾移植172例为研究对象,其中亲属供肾166例(96.5％),夫妻供肾5例(2.9％),帮扶供肾1例(0.6％).术前应用放射性核素99mTC-DTPA肾动态显像测定供体左右肾GFR.供体的双肾GFR为62～148 ml/min,将对象分为供肾GFR≤45ml/min受体76例和供肾GFR＞45 ml/min 96例.两组受体的透析情况、冷、热缺血时间、抗体诱导及免疫抑制方案、HLA错配率等基本资料相似.评价患者术后早期肾功能变化情况.结果 两组患者术后急性排斥反应以及肾功能延迟恢复( DGF)发生率差异无统计学意义.与供肾GFR≤45 ml/min组比较,供肾GFR＞45 ml/min组的Scr在术后1周、1个月、3个月、1年均较低,其中术后1周的差异有统计学意义(P＜0.05);术后1个月、3个月、1年的差异均无统计学意义.重复测量的方差分析显示术后1年内两组受体Scr变化差异无统计学意义.结论 活体肾移植供肾GFR高低对受体术后1周Scr下降水平有影响,供肾GFR高者受体术后1周Scr水平低,但是对受体术后早期(1年内)的Scr整体水平及变化趋势无显著影响.     

Serum and urine cystatin C levels in children with post-pyelonephritic renal scarring: a pilot study

Aim We aimed to investigate in children with a history of acute pyelonephritis the influence of unilateral post-pyelonephritic renal scarring detected by DMSA scan on serum (S_CysC) and urine cystatin C (U_CysC) as well as upon other traditional markers of renal damage. Methods Children with DMSA proven pyelonephritis (n = 28) were grouped as either scar [+] (n = 19, unilateral renal scarring) or scar [−] (no scarring, n = 9). The scar [+] group was further divided into scar-1 (differential DMSA uptake, Δ_DMSA ≤ 10%; n = 8) and scar-2 (Δ_DMSA > 10%, n = 11) subgroups. S_CysC, serum creatinine, urine NAG, microalbumin, protein, fractional sodium excretion (FE_Na), tubular phosphate reabsorption (TPR), and U_CysC/Cr were evaluated in all patients. Results Neither S_CysC nor U_CysC were affected by age, height, and weight. scar [+] versus scar [−] groups and scar-1 versus scar-2 subgroups were not different with regard to all studied parameters. S_CysC did not increase in children with post-pyelonephritic unilateral renal scarring. However, 11 children with slightly increased (>0.95 mg/l) S_CysC levels in scar [+] group tended to have higher Δ_DMSA, albeit not significantly. Furthermore, U_CysC/Cr correlated well with urine microalbumin, NAG, and FE_Na in all children and the scar [+] group (P < 0.05). Conclusion S_CysC and U_CysC did not differ among pediatric patients with and without unilateral post-pyelonephritic renal scarring. However, Δ_DMSA uptake between the two kidneys tended to be raised in children with S_CysC levels higher than the reference ranges. Additionally, U_CysC/Cr exhibits parallelism with tubular functions.     

终末期肾病患者开始透析时肾功能及相关因素分析

目的提供我国中等城市终末期肾病(ESRD)患者开始透析时肾功能水平的准确数据并分析相关因素,为选择合适的透析时机提供依据。方法查阅1998年1月至2004年8 月期间长沙市两大透析中心所有首次透析的终末期肾病住院患者的病案,其中514例数据齐全而人选并按不同条件分组。计算整组病例及各分组的平均Scr值、GFR预测值(eGFR)及其他统计指标,以及比较组间差异并与国外资料比较。结果 (1)男性较女性多;45岁以下患者占 50．4％;自费患者最多(55．4％),但比例逐年下降;医保患者占17．7％,而比例则逐年增高; 91．8％的患者选择血液透析为首次治疗方式;首位病因仍是肾小球肾炎(59．7％),其次为高血压肾病(10．9％)和糖尿病肾病(6．8%),肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。(2)平均Scr浓度为(1121．92±458．24)μmol／L;平均eGFR为 (4．98±2．24)ml·min-1·(1．73 m2)-1。(3)年轻人、无费用保障的患者、无业或农民、在职人员、学生、选择血液透析的患者、原发病为非糖尿病的患者中,Scr值较高而eGFR值则较低,组间差异均有统计学意义(P<0．01)。男性患者的Scr和eGFR值均高于女性(P<0．01,P<0．05)。(4) 低白蛋白血症患者占总例数的53．1％。当eGFR<8．4 ml·min-1·(1．73 m2)-1时,eGFR与血清白蛋白(Salb)呈正线性相关(r=0．093,P<0．05)。(3)与美国1999年资料比较,本组514例患者的eGFR预测值低于美国患者(P<0．01)。结论本组以年轻男性患者多见。肾小球肾炎患者所占比例逐年下降,而高血压和糖尿病患者的比例则逐年增高。相当多的患者在肾功能非常差时才开始透析。患者普遍存在低白蛋白血症,eGFR下降到一定水平以后,Salb随eGFR下降而下降。本组514例ESRD患者开始透析的时机要较美国患者晚。