The methods for measuring glomerular filtration rate and their clinical application

doi:10.3969/j.issn.1673-8640.2015.07.003

Abstract

Abstract:

As the best scaleplate for evaluation on kidney function, the glomerular filtration rate (GFR) plays an important role in daily practice and has a great influence on the optimization of diagnosis and treatment. GFR can be estimated through different formulas based on routine text results or measured directly. Bias may arise in certain situations as well as special populations when using estimated glomerular filtration rate (eGFR),while measured glomerular filtration rate (mGFR) is more reliable. Regarding the different properties of common filtration markers such as inulin,creatinine,iohexol, ^99mtechnetium-diethylene triamine pentaacetic acid (^99mTc-DTPA),⁵¹chromium-ethylene diamine tetraacetic acid and iothalamate, we could measure mGFR by means of blood and urine clearance rates or kidney dynamic imaging, and the results shows different accuracies. Endogenous creatinine clearance rate is widely used in common practice for convenience,while plenty of studies have revealed its remarkable bias of overestimating GFR. Regarding the outstanding performances in accuracy, either urine iohexol or ^99mTc-DTPA clearance rate is better for popularization. As the validation for eGFR, mGFR deserves further work on its application and evaluation.

Key words: Glomerular filtration rate, Endogenous creatinine clearance rate, Iohexol, Radionuclide, Kidney function

CLC Number:

R446.1

YU Qian, WANG Beili, GUO Wei, PAN Baishen. The methods for measuring glomerular filtration rate and their clinical application[J]. Laboratory Medicine, 2015, 30(7): 674-679.

Figures/Tables 1

References 27

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标志物	优点	缺点
菊粉	理想标志物,无毒无害,无肾小管排泌和重吸收	血尿样品需特殊去蛋白处理,检测方法繁琐
肌酐	内源性标志物,无需额外摄入,检测方法满足标准化和一致性	个体生成速率差异较大,存在肾小管排泌和重吸收
碘海醇	廉价易得,无放射性,无肾小管分泌	在肾小管有少量重吸收,不良反应报道,碘过敏受检者慎用
^99mTc-DTPA	常用易得,半衰期短,辐射曝露较小,无肾小球排泌及重吸收	放射性药物需特殊制备及管理,^99mTc与DTPA的解离率影响检测结果
⁵¹Cr-EDTA	国内较少应用	存在肾小管重吸收及血浆蛋白结合
¹²⁵I-碘肽酸盐	无血浆蛋白结合	放射性药物,存在少量肾小管分泌及重吸收,碘过敏受检者慎用
Gd-DOTA	磁共振常规造影剂,较为易得	具有潜在肾脏毒性

标志物	优点	缺点
菊粉	理想标志物,无毒无害,无肾小管排泌和重吸收	血尿样品需特殊去蛋白处理,检测方法繁琐
肌酐	内源性标志物,无需额外摄入,检测方法满足标准化和一致性	个体生成速率差异较大,存在肾小管排泌和重吸收
碘海醇	廉价易得,无放射性,无肾小管分泌	在肾小管有少量重吸收,不良反应报道,碘过敏受检者慎用
^99mTc-DTPA	常用易得,半衰期短,辐射曝露较小,无肾小球排泌及重吸收	放射性药物需特殊制备及管理,^99mTc与DTPA的解离率影响检测结果
⁵¹Cr-EDTA	国内较少应用	存在肾小管重吸收及血浆蛋白结合
¹²⁵I-碘肽酸盐	无血浆蛋白结合	放射性药物,存在少量肾小管分泌及重吸收,碘过敏受检者慎用
Gd-DOTA	磁共振常规造影剂,较为易得	具有潜在肾脏毒性