Ocena glomerulne filtracije - primerjava serumskega kreatinina, serumskega citatina C in enačb za izračun očistka kreatinina

Radovan Hojs (Author), Sebastjan Bevc (Author), Robert Ekart (Author), Maksimiljan Gorenjak (Author), Ludvik Puklavec (Author)

Abstract

Izhodišča V želji po zgodnejšem odkrivanju in zdravljenju kronične ledvične bolezni (KLB) je ocena glomerulne filtracije (GF) pridobila na pomenu. Za oceno GF najpogosteje uporabljamo serumsko koncentracijo kreatinina, v zadnjem času tudi cistatina C ter Cockcroft-Gaultovo (C&G) enačbo in enačbo MDRD (Modification of Diet in Renal Disease) raziskave za izračun očistka kreatinina. V naši preiskavi smo med seboj primerjali različne označevalce GF glede na zlati standard, očistek [zgoraj]51CrEDTA. Bolniki in metode Vključili smo 468 bolnikov s stopnjo 2 do 5 KLB (216 žensk in 252 moških; povprečna starost 60,4 +/- 14,3 leta), ki so imeli določen očistek [zgoraj] 51CrEDTA. Ob odvzemu krvi za določitev očistka [zgoraj]51CrEDTA smo izmerili serumsko koncentracijo kreatinina in cistatina C ter na podlagi C&G enačbe in enačbe MDRD raziskave izračunali kreatininski očistek. Rezultati Ugotovili smo povezavo med očistkom [zgoraj]CrEDTA in serumsko koncentracijo kreatinina (r=-0,889), recipročno vrednostjo serumskega kreatinina (r=0,866), serumsko koncentracijo cistatina C (r=-0,902), recipročno vrednostjo cistatina C (r=0,901) in očistkom kreatinina, izračunanega tako po enačbi C&G (r=0,808) kot po enačbi raziskave MDRD (r=0,901). Ugotovili smo (ROC krivulje) višjo diagnostično zanesljivost meritev serumskega cistatina C v primerjavi z diagnostično zanesljivostjo meritev serumskega kreatinina (P=0,006) in očistka kreatinina, izračunanega po enačbi C&G (P=0,004) pri mejni vrednosti GF 60 ml/min/1,73m[na]2. Diagnostična zanesljivost serumskega cistatina C je bila v primerjavi z diagnostično zanesljivostjo enačbe raziskave MDRD statistično neznačilna. Zaključki Serumski cistatin C je v primerjavi s serumskim kreatininom in izračunom očistka kreatinina z enačbo C&G boljša metoda za oceno GF. Izračun očistka kreatinina z enačbo raziskave MDRD se je izkazal kot diagnostično enako zanesljiv kot metoda določanja cistatina C.

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Language:	Slovenian
Year of publishing:	2006
Typology:	1.01 - Original Scientific Article
Organization:	UM - University of Maribor
UDC:	616.6
COBISS:	2393663
ISSN:	1318-0347
Parent publication:	Zdravniški vestnik
Views:	2501
Downloads:	57
Average score:	0 (0 votes)
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Secondary language:	English
Secondary title:	Estimation of the glomerular filtration rate - comparison between serum creatinine, cystatin C and calculated creatinine clearance
Secondary abstract:	Background With increasing emphasis on the earlier detection and management of chronic kidney disease (CKD), estimation of the glomerular filtration rate (GFR) has assumed greater importance. GFR is often estimated from serum creatinine, recently also from serum cystatin C and by Cockcroft-Gault (C&G) and Modification of diet in renal disease (MDRD) formulas. In our study different markers of GFR were compared with gold standard [above]51CrEDTA clearance. Patients and methods We included 468 patients with CKD stages 2-5 (216 women and 252 men, average age 60.4 +/- 14.3 years), who performed [above]51CrEDTA clearance. In each patient, serum creatinine and cystatin C were determined, creatinine clearance was calculated using C&G and MDRD formulas. Results We found significant correlation between [above]51CrEDTA clearance with serum creatinine (r=-0,889), reciprocal of serum creatinine (r=0.866), serum cystatin C (r=-0.902), reiprocal of serum cystatin C (r=0.901) and with calculated creatinine clearance from C&G (r=0.808) and MDRD formulas (r=0.901). The ROC curve analysis (cut-off for GFR 60 ml/min/1.73 m[sup]2) showed that serum cystatin C had higher diagnostic accuracy than serum creatinine (P=0.006) and calculated creatinine clearance from C&G formula (P=0.004). No difference and diagnostic accuract was found between serum cystatin C and creatinine clearance calculated from MDRD formula. Conclusions serum cystatin C is a better marker of GFR and has a higher diagnostic accuracy than serum creatinine and calculated creatinine clearance from C&G formula. No difference in diagnostic accuracy was found between serum cystatin C and creatinine clearance calculated from the MDRD formula.
Secondary keywords:	Kidney Failure, Chronic;Ledvica, odpoved kronična;Creatinine;Kreatinin;Cystatins;Cistatini;Glomerular Filtration Rate;Glomerulna filtracija, hitrost;
URN:	URN:NBN:SI
Type (COBISS):	Not categorized
Pages:	str. 455-462
Volume:	ǂLetn. ǂ75
Issue:	ǂšt. ǂ8
Chronology:	2006
ID:	9096528