The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity...The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.展开更多
During the tests of glomerular filtration function,serum creatinine,urea and endogenous creatinine clearance rate are the most commonly used indicators,which possess many disadvantages.Currently,a large number of stud...During the tests of glomerular filtration function,serum creatinine,urea and endogenous creatinine clearance rate are the most commonly used indicators,which possess many disadvantages.Currently,a large number of studies have been conducted on investigating new indicators reflecting changes in glomerular filtration rate.As a low-molecular weight protein,cystatin C is a member of cysteine protease inhibitor superfamily,which can be produced by all the nucleated cells in vivo with a stable generation rate.In the circulation process in vivo,cystatin C can only be removed via glomerular filtration,which is an ideal endogenous marker reflecting changes in glomerular filtration rate.Serum cystatin C concentration is superior to serum creatinine concentration in renal function tests.展开更多
目的探讨血尿素氮(BUN)、血肌酐(Scr)与血清胱抑素C(Cys-C)联合检测对肾功能损害程度的诊断价值。方法选取某院确诊有肾功能损害的患者720例作为观察组,根据肾损害程度将其分为:肾功能不全代偿组273例、肾功能不全失代偿组235例、肾功...目的探讨血尿素氮(BUN)、血肌酐(Scr)与血清胱抑素C(Cys-C)联合检测对肾功能损害程度的诊断价值。方法选取某院确诊有肾功能损害的患者720例作为观察组,根据肾损害程度将其分为:肾功能不全代偿组273例、肾功能不全失代偿组235例、肾功能衰竭组212例;选取同期健康体检者210例作为肾功能正常对照组。检测所有研究对象的BUN、Scr、Cys-C和内生肌酐清除率(Ccr)。观察不同肾功能损害程度的BUN、Scr、Cys-C及Ccr,分析BUN、Scr、Cys-C与肾小球滤过率(GFR)之间的相关性,采用受试者工作特征(R O C)曲线分析BUN、Scr、Cys-C各指标单用或联用对肾功能损害程度的诊断价值。结果观察组各指标与对照组相比,差异均具有统计学意义(P<0.05)。血清BUN、Scr、Cys-C与GFR水平均呈负相关,差异均具有高度统计学意义(r=-0.395,P<0.01;r=-0.492,P<0.01;r=-0.635,P<0.01)。R O C曲线显示:三组各指标单用的AUC呈规律性变化,即肾功能衰竭组>肾功能不全失代偿组>肾功能不全代偿组;各指标联用评估肾功能损害的AUC均高于其单用。结论 BUN、Scr、Cys-C各指标联用对肾功能损害程度的临床诊断价值较各项指标单用更满意,具有重要的临床应用价值。展开更多
基金the Research Service of the Raymond G. Murphy VA Medical Center for its support of this work
文摘The development of formulas estimating glomerular filtration rate(eG FR) from serum creatinine and cystatin C and accounting for certain variables affecting the production rate of these biomarkers, including ethnicity, gender and age, has led to the current scheme of diagnosing and staging chronic kidney disease(CKD),which is based on e GFR values and albuminuria.This scheme has been applied extensively in various populations and has led to the current estimates of prevalence of CKD. In addition, this scheme is applied in clinical studies evaluating the risks of CKD and the efficacy of various interventions directed towards improving its course. Disagreements between creatinine-based and cystatin-based e GFR values and between e GFR values and measured GFR have been reported in various cohorts. These disagreements are the consequence of variations in the rate of production and in factors, other than GFR, affecting the rate of removal of creatinine and cystatin C. The disagreements create limitations for all e GFR formulas developed so far. The main limitations are low sensitivity in detecting early CKD in several subjects, e.g., those with hyperfiltration, and poor prediction of the course of CKD. Research efforts in CKD are currently directed towards identification of biomarkers that are better indices of GFR than the current biomarkers and,particularly, biomarkers of early renal tissue injury.
文摘During the tests of glomerular filtration function,serum creatinine,urea and endogenous creatinine clearance rate are the most commonly used indicators,which possess many disadvantages.Currently,a large number of studies have been conducted on investigating new indicators reflecting changes in glomerular filtration rate.As a low-molecular weight protein,cystatin C is a member of cysteine protease inhibitor superfamily,which can be produced by all the nucleated cells in vivo with a stable generation rate.In the circulation process in vivo,cystatin C can only be removed via glomerular filtration,which is an ideal endogenous marker reflecting changes in glomerular filtration rate.Serum cystatin C concentration is superior to serum creatinine concentration in renal function tests.
文摘目的探讨血尿素氮(BUN)、血肌酐(Scr)与血清胱抑素C(Cys-C)联合检测对肾功能损害程度的诊断价值。方法选取某院确诊有肾功能损害的患者720例作为观察组,根据肾损害程度将其分为:肾功能不全代偿组273例、肾功能不全失代偿组235例、肾功能衰竭组212例;选取同期健康体检者210例作为肾功能正常对照组。检测所有研究对象的BUN、Scr、Cys-C和内生肌酐清除率(Ccr)。观察不同肾功能损害程度的BUN、Scr、Cys-C及Ccr,分析BUN、Scr、Cys-C与肾小球滤过率(GFR)之间的相关性,采用受试者工作特征(R O C)曲线分析BUN、Scr、Cys-C各指标单用或联用对肾功能损害程度的诊断价值。结果观察组各指标与对照组相比,差异均具有统计学意义(P<0.05)。血清BUN、Scr、Cys-C与GFR水平均呈负相关,差异均具有高度统计学意义(r=-0.395,P<0.01;r=-0.492,P<0.01;r=-0.635,P<0.01)。R O C曲线显示:三组各指标单用的AUC呈规律性变化,即肾功能衰竭组>肾功能不全失代偿组>肾功能不全代偿组;各指标联用评估肾功能损害的AUC均高于其单用。结论 BUN、Scr、Cys-C各指标联用对肾功能损害程度的临床诊断价值较各项指标单用更满意,具有重要的临床应用价值。
