Renal Function - Estimation of Glomerular Filtration Rate

Open access

Funkcija Bubrega - Procena Brzine Glomerularne Filtracije

Brzina glomerularne filtracije (GFR) je široko prihvaćena kao najbolja opšta mera funkcije bubrega. Vodiči američke Nacionalne fondacije za bubreg definišu hroničnu bubrežnu bolest (HBB) bilo sa vrednošću GFR koja je manja od 60 mL/min/1,73 m2 ili sa prisustvom oštećenja bubrega, bez obzira na uzrok, u toku 3 ili više meseci i klasifikuju stadijume težine HBB prema GFR. GFR se može meriti kao urinarni ili plazma klirens egzogenih filtracionih markera kao što je inulin. Međutim, zbog teškoća u primeni, troškova i radijacionog izlaganja, ove metode imaju ograničenu upotrebu u rutinskim laboratorijama. Klirens kreatinina može biti korisna alternativa kada egzogeni markeri nisu dostupni, ali sakupljanje urina u vremenskim intervalima nije pogodno za pacijente i osetljivo je na grešku pri sakupljanju. GFR se često procenjuje klinički iz serumskih koncentracija egzogenog kreatinina ili cistatina C. Cistatin C u serumu još uvek nije adekvatno procenjen kao indeks GFR, a na kreatinin u serumu utiču GFR i faktori nezavisni od GFR, uključujući godine, pol, rasu, telesnu veličinu, ishranu, izvesne lekove i laboratorijske analitičke metode. Prema kliničkim vodičima Nacionalne fondacije za bubreg, kliničke laboratorije bi trebalo da izdaju >>procenjenu<< GFR (estimated GFR), izračunatu iz prediktivnih jednačina, kao dodatak izveštavanja vrednosti markera u serumu. Trenutno preporučena jednačina za procenu je razvijena iz MDRD (Modification of Diet in Renal Disease) studije. Ova jednačina koristi godine, pol, rasu (afro-američka prema ne-afro-američkoj) i koncentraciju kreatinina u serumu, a ne zahteva varijablu za telesnu težinu zato što normalizuje GFR za standardnu telesnu površinu od 1,73 m2. Da bi se postigla poboljšana tačnost preračunate GFR sa ovom jednačinom, preporučuje se da komercijalne metode za kreatinin budu kalibrisane prema sertifikovanim referentnim materijalima i sledljive sa IDMS (isotope dilution mass spectrometry) metodologijom. Za MDRD jednačinu je pokazano da je korisna za pacijente sa HBB, ali njena upotreba je još uvek nejasna za ljude sa niskim vrednostima kreatinina u serumu i visokim vrednostima za GFR, uključujući zdrave pojedince, decu i trudnice. Validacione studije su u razvoju kako bi se procenila MDRD jednačina za druge etničke grupe i različita bolesna stanja.

If the inline PDF is not rendering correctly, you can download the PDF file here.

  • El Nahas AM Bello AK. Chronic kidney disease: the gloal challenge. Lancet 2005; 365: 331-40.

  • Thomas L Huber AR. Renal function - estimation of glomerular filtration rate. Clin Chem Lab Med 2006; 44 (11): 1295-302.

  • Sarnak MJ Levey AS Schoolwerth AC et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease High Blood Pressure Research Clinical Cardiology and Epidemiology and Prevention. Hypertension 2003; 42: 1050-65.

  • National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation clas sification and stratification. Am J Kidney Dis 2002; 39: Suppl 1: S1-S266.

  • Stevens LA Coresh J Greene T Levey AS. Assessing kidney finction - measured and estimated glomerular filtration rate. N Engl J Med 2006; 354: 2473-83.

  • Thomas L. Creatinine. In: Thomas L editor. Clinical laboratory diagnostics. Frankfurt: TH Books 1998: 366-71.

  • Lo SC Tsai KS. Glucose interference in Jaffe creatinine method: effect of calcium from peritoneal dialysate. Clin Chem 1994; 40: 2326-7.

  • Koumantakis G Wyndham L. Fluorescein interference with urinary creatinine and protein measurements (Letter). Clin Chem 1991; 37: 1799.

  • Myers GL Miller WG Coresh J Fleming J Greenberg N Greene T et al. Recommendarions for improving serum creatinine measurement: a report from the laboratory working group of the National Kidney Disease Educarion program. Clin Chem 2006; 52: 5-18.

  • Carobene A Ferrero C Ceriotti F Modenese A Besozzi M De Giorgi E et al. Creatinine measurement proficiency testing: assignment of matrix-adjusted ID GSMS target values. Clin Chem 1997; 43: 1342-7.

  • Panteghini M Myers GL Miller WG Greenberg N. The importance of metrological traceability on the validity of creatinine measurement as an index of renal function. Clin Chem Lab Med 2006; 44: 1287-92.

  • Ross JW Miller WG Myers GL Praestgard J. The accuracy of laboratory measurements in clinical chemistry: a study of 11 chemistry analytes in the College of American Pathologists Survey with fresh frozen serum definitive methods and reference methods. Arch Pathol Lab Med 1998; 122: 587-608.

  • Seccombe DW Tholen D Jacobson BE. Standardization of creatinine: a pre-requisite for implementing the MDRD formula for the estimation of glomerular filtration rate (eGFR). Clin Chem 2005; 51 (Suppl): A44.

  • Miller WG Myers GL Ashwood ER Killeen AA Wang E Thienpont LM et al. Creatinine measurement: state of the art in accuracy and inter-laboratory harmonization. Arch Pathol Lab Med 2005; 129: 297-304.

  • Newman DJ Thakkar H Edwards RG Wilkie M White T Grubb AO et al. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine for glomerular filtration rate. Kidney Int 1995; 47: 312-8.

  • Stevens LA Levey AS. Chronic kidney disease in the elderly. How to assess risk? (Editorial). N Engl J Med 2005; 352: 2122-4.

  • Schwartz GJ Haycock GB Edelmann CM Jr. Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976; 51: 259-63.

  • Counahan R Chantler C Ghazali S Kirkwood B Rese F Barratt TM. Estimation of glomerular filtration rate from plasma creatinine concentration in children. Arch Dis Child 1976; 51: 875-8.

  • Cockcroft DW. Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-41.

  • Cirillo M Anastasio P De Santo NG. Relationship of gender age and body mass index to errors in predicted kidney function. Nephrol Dial Transplant 2005; 20: 1791-8.

  • Levey AS Bosch JP Lewis JB Greene T Rogers N Roth D et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 1999; 130: 461-70.

  • Lewis J Agodoa L Cheek D Greene T Middleton J O'Connor D et al. African-American Study of Hypertension and Kidney Disease. Comparison of crosssectional renal function measurements in African Americans with hypertensive nephrosclerosis and of primary formulas to estimate glomerular filtration rate. Am J Kidney Dis 2001; 38: 744-53.

  • Hoek FJ Kemperman FA Krediet RT. A comparison between cystatin C plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18: 2024-31.

  • Grubb A Nyman U Björk J Lindström V Rippe B Sterner G et al. Simple cystatin C based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem 2005; 51: 1420-31.

  • Tan GD Lewis AV James TJ Altman P Taylor RP Levy JC. Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes. Diabetes Care 2002; 25: 2004-9.

  • Clinical and Laboratory Standards Institute. Preparation and validation of commutable frozen human serum pools as secondary reference materials for cholesterol measurement procedures; approved guideline. CLSI doument C37-A. Wayne PA: CLSI 1999.

  • Rainey PM. Automatic reporting of estimated glomerular filtration rate - jumping the gun? Clin Chem 2006; 52: 2184-7.

  • Levey AS Stevens LA Hostetter T. Automatic reporting of estimated glomerular filtration rate - just what the doctor ordered. Clin Chem 2006; 52: 2188-93.

Search
Journal information
Impact Factor

IMPACT FACTOR 2018: 2.000
5-year IMPACT FACTOR: 1.075

CiteScore 2018: 1.47

SCImago Journal Rank (SJR) 2018: 0.523
Source Normalized Impact per Paper (SNIP) 2018: 0.581

Cited By
Metrics
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 221 134 3
PDF Downloads 101 72 1