Nkag siab txog Kev Ntsuam Xyuas Kev Ua Haujlwm Hauv Lub raum: Lub Hauv Paus Thiab Ua Ntej
Mar 16, 2022
Yog xav paub ntxiv:Ali.ma@wecistanche.com
Houry V. Puzantian, et al
AbstractPurpose:
Ntaulub raum ua haujlwmCov kev ntsuas ntsuas muaj, tab sis lawv qhov tsim nyog raug nug tas li. Qhov kev tshuaj xyuas no muab cov kws kho mob nkag siab txog qhov toblub raum ua haujlwmCov kev ntsuas kev ntsuas, lawv cov txiaj ntsig kho mob, thiab kev sib piv.
Cov ntaub ntawv qhov chaw:PUBMED tshawb nrhiav tau ua los ntawm cov ncauj lus tseem ceeb.
Cov lus xaus:Glomerular filtration rate (GFR) yog qhov qhia tau zoo tshaj plaws ntawmlub raum ua haujlwm. Exogenous compounds xws li inulin pab ntsuas GFR, tab sis cov tshuaj endogenous (xws li creatinine) yooj yim dua, txawm hais tias muaj qhov sib txawv ntau dua. Cystatin C tau tawm tswv yim ua tus cim ua haujlwm; nws qhov tseem ceeb ntawm kev kho mob tab tom kawm. Proteinuria ntxiv tus nqi rau GFR kwv yees. Muaj ntau qhov sib npaug ntawm kev kwv yees GFR zoo li creatinine-based Cockcroft-Gault thiab kev hloov pauv ntawm kev noj zaub mov hauv lub raum kab mob. Qhov kev sib npaug ntawm cov kab mob hauv lub raum tshiab (CKD EPI) ua rau pom tseeb dua ntawm kev faib cov neeg mob hauv cov theem ua ntej ntawm tus kab mob. Tsis ntev los no, Kev Tshawb Fawb Txog Lub Raum Tsis Txaus Siab (CRIC) kev tshawb fawb tau tsim ib qho kev sib npaug sib txuas cov ntshav creatinine thiab cystatin C inlongitudinal qauv ntawmlub raum ua haujlwm.
Qhov cuam tshuam rau kev ua haujlwm:Txoj kev kwv yees GFR tam sim no muaj kev txwv, thiab muaj txiaj ntsig zoo rau cov neeg uas lawv tau sim hauv. qhov no yuav pab ua kom muaj kev tiv thaiv thiab kev cuam tshuam cov tswv yim tsim nyog.
Ntsiab lus:Lub raum ua haujlwmkuaj; kab mob raum; glomerular pom tus nqi; creatinine ua
cistanche raulub raum ua haujlwm
Lub raum ua haujlwmKev soj ntsuam yog ib qho tseem ceeb ntawm kev kuaj mob thiab pib tiv thaiv thiab kho mob raum kab mob (CKD). Nws kwv yees tias kwv yees li 26 lab tus tib neeg hauv Tebchaws Meskas muaj CKD (Coresh li al., 2007). Sib nrug los ntawm kev nce qib hauv kev kho raum hloov, cov neeg mob no muaj kev pheej hmoo siab rau cov xwm txheej hauv plawv thiab kev tuag (Collinset al., 2003) yuav tsum tau soj ntsuam xyuas kev kho mob. Kev txiav txim siab ntawmlub raum ua haujlwmkuj tseem pab rau kev txiav txim siab kho mob ntsig txog kev tswj dej thiab kev siv tshuaj; nws yog qhov tseem ceeb hauv kev tiv thaiv kev tsis zoo uas tshwm sim los ntawm kev kuaj mob thiab kho cov txheej txheem xws li cov uas yuav tsum tau siv cov tshuaj intravenous contrast medium. Li no, tsim nyog kev ntsuam xyuas ntawmlub raum ua haujlwmplays lub luag haujlwm tseem ceeb hauv kev saib xyuas neeg mob. Nyob rau hauv xyoo tas los, txoj kev loj hlob ntawm ntau txoj hauv kev mus raulub raum ua haujlwmKev soj ntsuam tau tsa kev txhawj xeeb txog lawv cov kev txwv thiab kev siv tshuaj kho mob. Lub hom phiaj ntawm qhov kev tshuaj xyuas no yog los muab cov kws kho mob nrog kev nkag siab tob txoglub raum ua haujlwmCov txheej txheem kev soj ntsuam, lawv cov khoom siv kho mob tsim nyog, thiab lawv piv li cas.
Txoj kev ntsuas lub raum ua haujlwm
Glomerular filtration rate (GFR) tau lees paub tias yog qhov qhia tau zoo tshaj plaws ntawmlub raum ua haujlwm. Txo GFR tuaj yeem qhia txog kab mob hauv lub raum lossis cov teeb meem thib ob xws li txo qis raum perfusion lossis tshuaj toxicity (Stevens & Levey, 2005). Nws yog, qhov tseeb, GFR tsis tu ncua uas muab qhov ntsuas zoo ntawm kev poob qislub raum ua haujlwm(National Kidney Foundation [NKF], 2002), thiab nws yuav yog ib qho tseem ceeb uas yuav tsum nco ntsoov seb GFR puas hloov pauv lossis puas ruaj khov. Tam sim no, ib txoj hauv kev txhais CKDs tseem yog qib GFR (Table 1; NKF, 2002). Qhov hnyav ntawm CKD kuj tau txiav txim los ntawm theem ntawm GFR (Table 2).
GFR txhais tau tias yog tus nqi ntawm cov ntshav plasma lim los ntawm glomeruli ib chav tsev ntawm lub sijhawm thiab sawv cev rau cov txiaj ntsig pom ntawm tag nrho cov nephrons ua haujlwm. Ib txwm GFR txawv raws hnub nyoog, poj niam txiv neej, haiv neeg, thiab lub cev loj (Stevens & Levey, 2005). GFR yog kwv yees li 120-130 mL / min / 1.73 m2; Nws poob qis nrog lub hnub nyoog, qis qis dua, yog siab dua hauv cov neeg Asmeskas Asmeskas, thiab sib txawv nrog cov kab mob ntawm cov leeg pob txha thiab txiav. GFR tuaj yeem ntsuas los yog kwv yees los ntawm kev sib npaug.
GFR tsis tuaj yeem ntsuas ncaj qha. Nws yog ntsuas los ntawm cov zis tshem tawm ntawm cov cim pom. Anideal marker yuav yog cov tshuaj lim dej dawb, tsis yog metabolized, secreted, los yog reabsorbed los ntawm lub raum (Traynor, Mactier, Geddes, & Fox, 2006). Exogenous thiab endogenous markers tau siv.
Exogenous cov cim
Inulin yog tus qauv ntsuas kub ntsuas tab sis kim thiab cumbersome los ntsuas (Stevens & Levey, 2005). Txhawm rau kom ua tiav cov qib plasma nyob ruaj khov, yuav tsum muaj inulin bolus thiab infusion; Qee cov ntshav thiab cov zis yuav tsum tau kwv yees kom tshem tawm inulin.
Cov kws tshawb nrhiav kuj tau siv cov tshuaj radioisotopic: iodine-125-iothalamate, chromium-51-ethylenediaminetetraacetic acid, thiab technetium-99m-diethylenetriamine pentaacetic acid. Cov no yuav tsum tau ceev faj txog kev tuav pov hwm, kim, overestimate GFR, nthuav tawm lub caij nyoog tshem tawm hauv cov kab mob hauv lub raum siab, thiab tsis tsim nyog siv thaum cev xeeb tub (Rahn, Heidenreich, & Bruckner, 1999; Traynor et al., 2006) lossis cov neeg mob hauv lub zais zis.
Niaj hnub no, cov khoom siv hluav taws xob sib txawv (nonradioactive) zoo liiohexol, iothalamate, thiab diatrizoate meglumine muaj thiab suav tias muaj kev nyab xeeb dua li cov khoom siv hluav taws xob. Iohexol tau tawm tswv yim ua tus cim nrog kev tshem tawm piv rau cov inulin. Nws tuaj yeem ntsuas ntshav plasma, ntshav, thiab zis siv cov kua chromatography ua haujlwm siab. Thaum cov txheej txheem no muaj peev xwm, kev tswj hwm bolus ntawm cov tshuaj thiab cov txheej txheem plasma xav tau ua rau lawv tsis xav tau.
cistanche raulub raum ua haujlwm
Endogenous cov cim
Cov teeb meem ntsib nrog kev ntsuas ntawm exogenous markers tau coj mus rau qhov kev soj ntsuam tsis tu ncua ntawm cov txheej txheem pom ntawm cov tshuaj endogenous.
Urea.Urea, ib qho khoom kawg ntawm cov protein catabolism, yog tsim nyob rau hauv daim siab feem ntau los ntawm kev noj cov protein kom tsawg. Kev tsim khoom nce ntxiv nrog kev noj zaub mov muaj protein ntau, tshuaj xws li corticosteroids thiab tetracyclines, lossis cov xwm txheej zoo li raug mob, plab hnyuv, kab mob, plawv tsis ua haujlwm, thiab mob raum tsis ua haujlwm (Stevens & Levey, 2005; Traynor li al., 2006). Txawm hais tias urea tau lim dej dawb ntawm lub glomerulus, 40 feem pua -50 feem pua yog reabsorbed atproximal thiab distal tubules, underestimating GFR. Volume depletion thiab antidiuresis nce urea reabsorption, nrog kev txo qis hauv urea clearance dua li hauv GFR. Extracellular ntim expansion thiab diuresis nce urea clearance yog ntau tshaj GFR. Cov xwm txheej no ua rau muaj kev sib txawv ntawm tus kheej thiab tus kheej qhov sib txawv ntawm inurea tiam thiab tso tawm, ua rau urea ib qho cim tsis ntseeg ntawmlub raum ua haujlwm.
Creatinine tshem tawm.
CrCl yog raws li nyob rau hauv urinarycreatinine, tso zis ntim nyob rau hauv ib lub sij hawm 24-teev sij hawm, thiab serum creatinine (SCr) ntau ntau, qhia creatinine excretion ib hnub twg: CrCl (ml/min)=[ zis creatinine (mg/mL)] × 24- teev ntim (mL)]/[creatinine hauv ntshav (mg/mL) × 24 × 60 min]. Ntxiv nrog rau qhov glomerular pom ntawm creatinine, lub raum tubules secrete creatinine; Yog li kev ntsuas ntawm CrCl tuaj yeem kwv yees GFR ntau dhau. Piv txwv li, cov neeg uas muaj lub cev loj qhov Performance index (BMI) exhibita BMI koom nrog nce hauv tubular tso tawm ntawm creatinine, nrog CrCl overestimating tseeb GFR (Sinkeler etal., 2011). Hauv cov kab mob hauv lub raum ua ntej, qhov overestimation yog ib qho kev ua yuam kev hloov pauv tau zoo ib yam, thiab CrCl tseem muaj txiaj ntsig zoo hauv kev saib xyuas.lub raum ua haujlwmhloov hauv tib tus neeg mob. Txawm li cas los xij, raws li GFR txo qis nrog cov kab mob siab heev, qhov nce ntawm qhov sib txawv tau pom nyob rau hauv qhov kev faib ua feem ntawm creatinine secretion tofiltration (Stevens & Levey, 2005; Traynor et al., 2006). Yog li ntawd, CrCl yog qhov qhia tsis tseeb ntawmlub raum ua haujlwmnyob rau hauv qis GFR theem, underestimating qhov hnyav ntawm lub raum kab mob. Nws tau pom tias CrCl raug ntsuas nrog cimetidine, uas inhibits tubular secretion ntawm creatinine; ua rau kev kwv yees GFR zoo dua (Walser, 1998).Txhua hnub hloov pauv hauv creatinine excretion yuav tsum tau txiav txim siab. Tsis tas li ntawd, 24-h cov zis khaws cia yog cumbersome, thiab ua yuam kev-nrhiav vim hais tias ntawm cov qauv poob thiab overcollections los ntawm kev ua tsis tau tejyam rau thawj voided qauv. Txawm li cas los xij, CrCl tseem raug pom zoo rau cov xwm txheej cuam tshuam rau creatinine concentration qhov twg nws cov khoom noj txhua hnub yog qhov nyuaj rau kwv yees: piv txwv li, noj zaub mov tsis zoo, noj tsis txaus, rog rog, mob pob txha, paraplegia, quadriplegia, lossis amputation, thiab cev xeeb tub (Fawaz & Badr, 2006) . Vim tias CrCl nyiam tshaj qhov tseeb GFR, thiab urea clearance underestimatesGFR, ib txhia tau pom zoo qhov nruab nrab qhov ntsuas ntawm ob qho tib si ntsuas tib lub sijhawm kom tau txais kev kwv yees ze dua ntawmlub raum ua haujlwmrau cov neeg mob xav tias yuav nyob rau theem 4 lossis 5 CKD (Almond, Siddiqui, Robertson, Norrie, & Isles, 2008).
Cistanche tuaj yeem txhim kholub raum ua haujlwm
Cov tshuaj creatinine.
SCr tau ua tib zoo tshawb nrhiav glomerular filtration marker. Creatinine yog tsim los ntawm cov leeg pob txha tawg thiab muaj nyob rau hauv cov nqaij siav. Ntau yam cuam tshuam rau SCr.Advancing hnub nyoog, poj niam los txiv neej, thiab haiv neeg dawb yog txuam nrog qis SCr vim cov leeg nqaij qis dua cov hnub nyoog yau, txiv neej poj niam, thiab haiv neeg dub (Jones et al.,1998). Kev hloov pauv hauv lub cev xws li kev txiav tawm, thiab kev hloov pauv hauv kev noj zaub mov xws li kev noj zaub mov tsis zoo lossis cov tshuaj creatinine ua rau muaj kev hloov pauv hauv SCr. Creatinineis tau lim tawm ntawm lub glomerulus thiab tsis rov nqus, tab sis 10 feem pua -15 feem pua ntawm cov tubules thiab kev tshem tawm extrarenal tshwm sim los ntawm txoj hnyuv (Fawaz & Badr, 2006; Stevens & Levey, 2005; Traynor et al., 200).
Kab mob raum parenchymal tuaj yeem pib ua rau hypertrophic thiab hyperinflation compensatory mechanisms hauv kev ua haujlwm nephrons tiv thaiv SCr nce, yog li npoglub raum ua haujlwmdeterioration (Shemesh, Golbetz, Kriss, & Myers, 1985). Ib qho kev txo qis hauv GFR los ntawm 120 mus rau 80 mL / min / 1.73 m2 yog nrog tsuas yog nce me me ntawm SCr los ntawm 0.8 mus rau 1.2 mg / dL (Daim duab 1; Inker & Perrone, 2012). Yog li ntawd, SCr yog ib tug insensitivemarker ntawmlub raum ua haujlwmnyob rau hauv cov kab mob raum thaum ntxov.
Raws li cov kab mob hauv lub raum loj hlob tuaj, creatinine yog hyper secreted los ntawm kev ua haujlwm nephron tubules ua rau muaj qhov tsis txaus ntseeg GFR. Ua ntej creatinine standardization (Myers li al., 2006), muaj qhov tsis raug hauv creatininemeasurement thiab variations nyob rau hauv kev soj ntsuam calibration ntawm thiab nyob rau hauv lub chaw soj nstuam (Coresh li al., 2002; Murthy, Stevens, Stark, & Levey, 2005) ua rau inappropriate.lub raum ua haujlwmkev soj ntsuam. Rau tag nrho cov saum toj no yog vim li cas, lwm yamlub raum ua haujlwmcov cim tau raug nrhiav.
Cystatin C.
Serum cystatin C, ib qho tseem ceeb tshiab, muaj peev xwm zoo dua rau SCr nyob rau hauv qee yam mob. Cystatin C yog cov protein uas muaj nyob rau hauv cysteineprotease inhibitor superfamily, yog tsim los ntawm nucleatedcells, lim ntawm glomerulus, reabsorbed, thiab metabolized ntawm tubules (Madero, Sarnak, & Stevens, 2006). Nws sreabsorption, metabolism, thiab extrarenal excretion cuam tshuam qhov kev ntsuas ntawm nws cov zis tso zis.
Serum cystatin C nthuav tawm ntau qhov sib txawv ntawm tus kheej ntau dua li SCr (Madero li al., 2006). Cov laj thawj cuam tshuam nrog cystatin C yog qhov siab, qhov hnyav, haus luam yeeb, ntshav qab zib, suav ntshav dawb, cov thyroid ua haujlwm, corticosteroids, thiab mob xws li nce siab C-reactive protein ntau ntau (Knight et al., 2004; Stevenset al., 2009) . Tsis zoo li SCr, cystatin C tsis cuam tshuam los ntawm cov leeg nqaij thiab cov khoom noj khoom haus; nws yog ib yam khoom lag luam thiab tsim tawm tsis tu ncua (Abrahamson li al., 1990). Txawm hais tias cystatin C tau xav tias tsis muaj hnub nyoog thiab poj niam txiv neej (Laterza, Nqe, & Scott, 2002) tsis ntev los no qhia tau hais tias muaj hnub nyoog laus thiab txiv neej poj niam txiv neej yuav cuam tshuam nrog ntau dua cystatin C qib (Knight et al., 2004).
Cystatin C yog ib qho rhiab heev dua li creatininein kuaj pom qhov txo qis thaum ntxovlub raum ua haujlwm(Collet al., 2000); Txawm li cas los xij, nyob rau theem qis ntawm GFR (tsawg dua lossis sib npaug li 70mL / min / 1.73 m2), SCr-raws li kev ntsuas yuav ua tau zoo dua. Nyob rau hauv lub xub ntiag ntawm kev cog lus pov thawj ntawm cystatinC, kev tshuaj xyuas ntawm ntau yam kev tshawb fawb ntawm GFR kwv yees qhia cov ntshav cystatin C kom sib npaug lossis zoo dua rau SCr (Dharnidharka, Kwon, & Stevens, 2002); cov ntaub ntawv pov thawj tseem tseem tos (Prigent, 2008) .
Kev kwv yees sib npaug rau kev kwv yees ntawm lub raum ua haujlwm
GFR-kev kwv yees sib npaug muab cov kev kwv yees GFR zoo los ntawm kev suav nrog cov pej xeem thiab lub cev hloov pauv uas cuam tshuam rau cov tshuaj endogenous zoo li Cr. Cov kev thuam hais txog kev ua tib zoo txhais cov txiaj ntsig thiab cov txheej txheem kev faib tawm los ntawm cov cuab yeej ntsuas no (Glassock & Winearls, 2008). Qhov kev ua tau zoo ntawm kev sib npaug yog ntsuas los ntawm kev ntsuas kev tsis ncaj ncees, qhov tseeb, thiab qhov tseeb (Stevens, Zhang, & Schmid, 2008). Bias yog qhov txawv nruab nrab ntawm ntsuas GFR (mGFR) thiab kwv yees GFR (eGFR). Precision yog hais txog kev hloov pauv lossis nthuav tawm ib ncig ntawm qhov sib txawv ntawd. Qhov tseeb ua pov thawj rau ob qho tib si kev tsis ncaj ncees thiab qhov tseeb. Kev kwv yees nrog qhov raug siab muaj qhov tsis ncaj ncees thiab siab precision (Daim duab 2). Qhov tseeb yog feem ntau txiav txim los ntawm tus nqi ntawm P30 (qhov tseeb hauv 30 feem pua), uas yog feem pua ntawm eGFRs hauv 30 feem pua ntawm mGFR.
Daim duab 2 Bias, precision, thiab raug
Cockcroft-Gault equation
Qhov sib npaug ntawm Cockcroft-Gault (Table 3) yog raws li kev tshawb fawb tau ua rau 249 tus txiv neej pw hauv tsev kho mob (kho rau poj niam), hnub nyoog 18-92 xyoo (Cockcroft & Gault, 1976). Nws suav nrog qhov hnyav ntawm lub cev, uas yuav tsum theoretically coj qhov sib txawv ntawm cov leeg nqaij mus rau hauv tus account.Lub hom phiaj yog kwv yees CrCl yam tsis muaj 24-h urinecollection.
Qhov sib npaug yog raws li SCr; xam CrCl qhov tseem ceeb ntawm mGFR vim qhov kev ntsuas SCr yuam kev.Recalibration rau thawj qhov kev ntsuam xyuas tsis tuaj yeem ua tau vim tias cov qauv kev sim siv los muab cov qauv raug tso tseg (Stevens & Levey, 2005). Theequation tuaj yeem overestimate CrCl nyob rau hauv cov rog rog thiab cov kua dej ntau dhau lub xeev, qhov "qhov tseeb" qhov hnyav yuav tsis pom meej tias cov leeg nqaij (Traynor li al., 2006). Txawm li cas los xij, txawm tias nws cov kev txwv, qhov sib npaug muaj txiaj ntsig zoo rau kev taug qab kev hloov pauv hauvlub raum ua haujlwmthiab rau kev noj tshuaj (FDA labeling requirements).
Kev hloov pauv ntawm kev noj zaub mov hauv lub raum kab mob (MDRD) kev kawm
Qhov sib npaug MDRD (Table 3), pom zoo los ntawm NKF (2002), yog siv dav hauv kev kho mob. Nws tshwm sim los ntawm qhov kev tshawb fawb MDRD tshawb xyuas 1628 cov kev kawm uas muaj cov kab mob raum tsis zoo (Levey li al., 1999). Thawj qhov sib npaug suav nrog hnub nyoog, poj niam txiv neej, haiv neeg, SCr, ntshav ureanitrogen, thiab albumin concentrations. Cov neeg tshawb xyuas tau tshaj tawm tias eGFR los ntawm MDRD qhov sib npaug tsis sib txawv ntawm qhov sib txuam mGFR, thiab yog qhov tsis txaus ntseeg. Tsis tas li ntawd, 91 feem pua ntawm eGFRs kwv yees los ntawm qhov sib npaug yog nyob rau hauv 30 feem pua ntawm cov txiaj ntsig mGFR concurrent (Levey, Greene, Kusek, & Beck, 2000), yog li nws yog qhov tseeb tiag.
Lub calibration mus rau ib tug standardized SCr raws li goldstandard methodology tau pom zoo heev rau kev siv ntawm GFR-kwv yees sib npaug (Coreshet al., 2002; Myers li al., 2006). Kev koom ua ke ntawm tus qauv SCr hauv MDRD qhov sib npaug muab eGFRs tseeb dua li qhov kev ntsuas SCr uas tsis tau ntsuas (Levey li al., 2006, 2007).
Thaum lub Cockcroft-Gault tso siab rau qhov hnyav, MDRDequation tau hloov kho rau lub cev thaj tsam ntawm kev suav cov kev hloov pauv hauv cov leeg nqaij nrog qee yam kab mob lossis kev txiav. MDRD qhov sib npaug ua tau zoo tshaj qhov Cockcroft-Gault mis mis rau cov laus, cov neeg mob rog (Fares li al., 2004), thiab cov neeg mob ntshav qab zib (Poggio, Wang, Greene, Van Lente, & Hall, 2005). Qhov sib npaug MDRD, zoo li Cockcroft-Gault, tsis tshua muaj tseeb hauv cov kab mob raum thaum ntxov; nws yog biased rau underestimatinglub raum ua haujlwm(Poggio, Wang, et al., 2005). Nws siv hauv tsev kho mob cov neeg mob xav tau kev pov thawj ntxiv (Poggio, Nef, et al., 2005). MDRD tsis tau raug kuaj hauv menyuam yaus, cev xeeb tub, lossis qhov loj ntawm lub cev.
Cystatin C-raws li kev sib npaug
Nyob rau hauv xyoo tas los no, cystatin C-raws li GFR-kwv yees sib npaug (Table 3) tau tsim (Madero li al., 2006; Stevens li al., 2008). Txawm hais tias tsis muaj qhov tsis sib xws hauv eGFR rau cov qib cystatin C zoo sib xws los ntawm kev sib npaug sib txawv, qee cov kev tshawb fawb qhia txog GFR kev kwv yees nrog cystatin C-raws li kev sib npaug (Tanaka, Suemaru, & Araki, 2007). Qhov kawg xav txoglub raum ua haujlwmQhov tseeb tshaj li qhov sib npaug ntawm creatinine-based inpopulations uas ua rau qis qis ntawm creatinine zoo li cov neeg laus, cov menyuam yaus, cov neeg tau txais kev hloov raum, thiab cov neeg mob cirrhosis. Txawm hais tias qhov kev sim siab no, kev sib piv cov kev tshawb fawb ntawm cystatin C thiab creatinine-raws li kev sib npaug tseem tsis tiav (Stevens, Padala, & Levey, 2010). Siv ob qho tib si cystatin C thiab SCr, txawm li cas los xij, tau pom tias muab kev kwv yees zoo dua ntawm GFR dua li qhov sib npaug siv cov cim sib cais; Qhov feem pua ntawm eGFRs poob hauv 30 feem pua ntawm mGFRs tau nce los ntawm 80.4 feem pua increatinine-raws li kev sib npaug mus rau 89 feem pua ntawm creatinine cystatin C ua ke sib npaug (Stevens li al., 2008; Tidman, Sjostrom, & Jones, 2008).
Cov lus pom zoo hais txog kev siv tshuaj kho mob ntawm cystatinC-raws li kev sib npaug tseem tseem tos (Prigent, 2008). Nws raug pom zoo tias qhov kev ntsuas ntawm cystatin-C kev soj ntsuam ua tau zoo, thiab cystatin-C-raws li kev sib npaug yuav tsum tau ua ntxiv rau hauv cov neeg sib txawv.
CKD epidemiology kev sib koom tes (CKD-EPI) equation
Qhov sib npaug CKD-EPI (Table 3) tsis ntev los no tau tsim los ntawm cov ntaub ntawv khaws cia suav nrog cov neeg muaj thiab tsis muaj mob raum. Lub hom phiaj tseem ceeb yog ua kom tau qhov tseeb ntau dua ntawm GFRs siab dua li piv rau MDRD kab zauv (Levey, Stevens, et al., 2009). Cov pejxeem suav nrog feem ntau cov neeg dawb thiab African Ameri cov kaus poom. Cov neeg Esxias tsis tau hloov kho rau hauv qhov sib npaug, qhov kev hloov kho coefficient (0.813) raug xam rau kev siv CKD-EPI hauv Japanese pawg (Horio, Imai, Yasuda, Watanabe, & Matsuo, 2010).
Qhov kev sib npaug CKD-EPI tshiab ua tau zoo tshaj qhov kev pom zoo MDRD. Hauv qhov kev tshawb fawb thawj, qhov kev tsis ncaj ncees qis dua, qhov tseeb dua, thiab qhov tseeb tau txais nrog CKD EPI qhov sib npaug dua li nrog MDRD (p < .001)="" (levey,="" stevens,="" et="" al.,="" 2009),="" feem="" ntau="" hauv="" cov="" neeg="" mob="" egfr="" ntau="" dua="" lossis="" sib="" npaug.="" mus="" txog="" 60="" ml="" min="" 1.73="" m2.="" nrog="" ckd-epi,="" qhov="" feem="" pua="" ntawm="" cov="" egfr="" ntau="" dua="" (p="">< .001)="" yog="" nyob="" rau="" hauv="" 30="" feem="" pua="" ntawm="" mgfr="" ntau="" dua="" li="" ntawm="" mdrd;="" txawm="" li="" cas="" los="" xij,="" cov="" kws="" sau="" ntawv="" tseem="" pom="" qhov="" tseeb="" yog="" qhov="" zoo="" tshaj="" plaws.="" tsis="" tas="" li="" ntawd,="" siv="" ckd-epi="" ntau="" tus="" neeg="" mob="" yuav="" raug="" cais="" raws="" li="" theem="" 2="" uas="" yuav="" txwv="" tsis="" pub="" raug="" cais="" raws="" li="" qib="" siab="" dua="" 3="" tus="" neeg="" mob="" hauv="" qhov="" tsis="" tseeb-zoo,="" los="" ntawm="" kev="" siv="" mdrd.="" qhov="" no="" qhia="" tau="" tias="" ckd-epi="" muaj="" qhov="" qis="" dua="" piv="" rau="" mdrd="" kab="" zauv.="" ckd-epi="" qhov="" sib="" npaug="" pom="" tias="" muaj="" ckd="" ntau="" ntawm="" 11.5="" feem="" pua;="" qis="" dua="" qhov="" ntawd="" (13.1="" feem="" pua)="" tau="" txais="" los="" ntawm="" mdrd="" kab="" zauv="" (levey,="" stevens,="" et="" al.,="" 2011).="" kev="" txo="" qis="" qis="" dua="" kuj="" tau="" txais="" nrog="" qhov="" sib="" npaug="" ckd-epi="" hauv="" lwm="" qhov="" kev="" kawm="" hauv="" tebchaws="" meskas,="" australia,="" thiab="" nyij="" pooj="" (horioet="" al.,="" 2010;="" matsushita,="" selvin,="" bash,="" astor,="" &="" coresh,="" 2010;="" white,="" polkinghorne,="" atkins,="" &="" chadban.="" qhov="" tsis="" sib="" xws="" no="" tuaj="" yeem="" yog="" vim="" muaj="" kev="" cuam="" tshuam="" ntawm="" lwm="" yam="" xws="" li="" qhov="" sib="" txawv="" hauv="" creatinine="" kev="" soj="" ntsuam,="" cov="" yam="" ntxwv="" ntawm="" cov="" leeg="" nqaij,="" thiab="" kev="" noj="" haus="" (levey,="" stevens,="" et="" al.,="">
Tsis ntev los no, CKD-EPI cov neeg tshawb xyuas tau tshaj tawm txog kev tsim kho tshiab ua ke creatinine-cystatin C sib npaug uas yog qhov tseeb dua hauv CKD kev faib tawm ntau dua li qhov sib npaug siv tus cim ib leeg (Inker et al., 2012).
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Chronic Renal Insufficiency Cohort (CRIC) kev tshawb fawb
Hauv kev sib zog los txhim kho qhov kev kwv yees ntawm GFR, CRICstudy (Feldman li al., 2003) qhia txog GFR tshiab kwv yees qhov sib npaug kom suav nrog SCr thiab cystatin C, ntxiv rau hnub nyoog, poj niam txiv neej, thiab haiv neeg (Anderson li al., 2012) .Siv qhov sib npaug no, 89 feem pua ntawm eGFRs poob hauv 30 feem pua ntawmmGFRs. Qhov kev sib npaug no tau tsim los rau hauvlub raum ua haujlwmKev soj ntsuam hauv CRIC thiab yuav raug siv los saib xyuas qhov kev nce qib ntawm CKD hauv pawg kawm ntawd. External validation yuav tsum tau txiav txim siab nws clinicalutility thiab generalizability rau ntau haiv neeg.
Xav txog txhua qhov sib npaug raulub raum ua haujlwmKev kwv yees, cov kev tshawb fawb yav tom ntej yuav tsum nrhiav cov cim tshiab los txhim kho qhov tseeb ntawm GFR kev kwv yees thiab tshawb nrhiav txoj hauv kev los ntsuas qhov hloov pauv hauv GFR lub sijhawm.
Proteinuria ua ib qho qhia txog kab mob raum
Lub raum noj qab nyob zoo tso tawm me me ntawm cov protein. Kev nce qib ntawm cov zis tso zis tsis tu ncua qhia txog kev puas tsuaj rau lub raum raws li NKF Lub Raum Kab Mob Uas Tau Zoo Tshaj Plaws (NKF KDOQI) cov lus qhia (NKF, 2002). NKF CKD staging system saib cov proteinuria thiab eGFR raws li cov cim cais ntawm cov kab mob raum. Ib qho kev sib piv tsis ntev los no, xav txog cov proteinuria ua ke nrog eGFR, muaj feem ntau dua li NKF staging system kom raug cais cov tib neeg rau cov kab mob hauv lub raum: ob npaug ntawm creatinine los ntawm qhov kawg ntawm kev rov qab los, pib lim ntshav, lossis hloov raum (Tonelli li al., 2011).
The urinary albumin concentration is, in turn, an independent predictor of all-cause mortality in the general population (Hillege et al., 2002; Matsushita, van der Velde et al., 2010). Furthermore, increased albuminuria is associated with both cardiovascular disease and mortality in patients with a history of hypertension, diabetes, or cardiovascular disease (van der Velde et al., 2011); microalbuminuria seems to reflect diffuse endothelial injury (Glassock, 2010). Albuminuria is a significant prognostic marker and is advocated by the current expert consensus for integration in the eGFR-based kidney disease staging process (Levey & Coresh, 2012). Albumin to creatinine ratio (ACR) > 17 mg/g for men and >25 mg/g poj niam yog suav tias yog siab lossis siab heev (Levey, Cattran, et al., 2009), commensurate nrog CKD. Kev ua haujlwm tsis tu ncua suav nrog kev hloov kho thoob ntiaj teb cov lus qhia kev coj ua los ntawm Kab Mob Raum: Txhim Kho Cov txiaj ntsig thoob ntiaj teb (KDIGO) pawg ua haujlwm.
Xaus
Qhov tsim nyog ntawmlub raum ua haujlwmkev soj ntsuam cov tswv yim muaj kev txhawj xeeb. GFR yog txiav txim los ntawm kev ntsuas lub excretion ntawm exogenously tswj los yog endogenous tebchaw, los yog los ntawm kev kwv yees sib npaug. Muaj qhov nyuaj hauv kev ntsuas GFR los ntawm cov tshuaj exogenous; cov cim endogenous tau yog qhov tseem ceeb hauvlub raum ua haujlwmkev soj ntsuam. Cohort cov kev tshawb fawb zoo li CRIC tau qhia tias eGFR ua tau zoo li mGFR rau cov chaw kho mob uas muaj feem cuam tshuam rau lub raum tsis ua haujlwm: anemia, acidosis, thiab nce hauv potassium lossis phosphate (Hsuet al., 2011). Urea yog ib qho cim uas cuam tshuam zoo tshaj plaws nrog rau theem kab mob hauv lub raum, tab sis nws tsis suav tias yog tus cim tseem ceeb vim tias muaj kev sib raug zoo ntawm tus kheej thiab tus kheej sib txawv. CrCl tuaj yeem siv rau hauv cov neeg mob uas muaj kab mob hauv lub raum thaum ntxov, txawm li cas los xij, lub sijhawm 24-h cov zis tso zis ua rau nws ua yuam kev thiab cuam tshuam rau cov neeg mob, thiab nws tsis yog qhov qhia tau zoo ntawm GFR hauv cov kab mob siab. SCr, ib zaug pom cov cim pom zoo, yog qhov taw qhia tsis zoo ntawmlub raum ua haujlwmNtawm nws tus kheej. Muaj ntau yam cuam tshuam rau nws tiam, creatinine nthuav tawm cov tubular secretion, incoherence nrog GFR nyob rau hauv cov kab mob hauv lub raum thaum ntxov, thiab muaj peev xwm rau kev kuaj ntsuas qhov yuam kev. Txawm li cas los xij, SCr yog ib qho tseem ceeb ntawm GFR kwv yees qhov sib npaug. Cystatin C, ib qho tshiablub raum ua haujlwmmarker, zoo li sib npaug rau SCr hauv kev kwv yees GFR; nws superiority rau SCr yog tseem debatable. Proteinuria tau tawm tswv yim los ua tus cim tseem ceeb hauv kev ua ke nrog eGFR, muaj peev xwm ua rau cov kws kho mob zoo dua los ntsuas kev mob raum.
Ntau qhov sib npaug tau tsim los rau kev kwv yees GFR siv cov pej xeem thiab kev kho mob sib txawv. TheMDRD kab zauv, tam sim no tau pom zoo los ntawm NKF, tau pom tias ua tau zoo tshaj tus qauv Cockcroft-Gault. MDRD yog ib qho kev sib npaug sib npaug uas tso siab rau tus qauv SCr ntxiv rau cov kev sib txawv ntawm cov pej xeem. Cystatin C tau muab tso rau hauv GFR-kev kwv yees vim tias nws muaj peev xwm ua tau zoolub raum ua haujlwmkev soj ntsuam; Txawm li cas los xij, kev sib piv cov txiaj ntsig nrog SCr-raws li qhov sib npaug tseem tsis suav nrog. Tsis ntev los no, CKD-EPI kab zauv tau raug pom zoo los hloov MDRD hauv kev ua haujlwm kho mob niaj hnub (Levey, Stevens, et al., 2011; Stevens et al., 2010). Nws qhov raug siab dua hauv CKD kev faib tawm ntawm tus kab mob thaum ntxov pab cuam tshuam cov kev pab cuam rau cov neeg mob thiab pab txhawb cov txheej txheem kho mob rau cov neeg mob tsawg. Tsis tas li ntawd, txoj kev tshawb fawb CRIC, raws li cov neeg koom nrog, tau tsim ib qho kev kwv yees GFR tshiab kom suav nrog SCr thiab cystatin C (Anderson li al., 2012). Nws cov khoom siv kho mob tseem tsis tau tshawb nrhiav.
Thaum kawg, qhov kev ua tau zoo ntawm GFR kwv yees txoj kev tseem ceeb heev. Muaj qhov sib npaug nthuav tawm cov kev txwv; lawv siv yuav yog qhov tsim nyog tshaj plaws rau cov pej xeem uas lawv tau sim. Cov kws kho mob yuav tsum txiav txim siab tsis yog-GFR kev kwv yees, hom kab mob raum, proteinuria, thiab kev soj ntsuam cov urinary sediments. Xav tau kev qhia ntxiv ntxiv txog yuav ua li cas cov kws kho mob yuav tsum siv GFRestimates tau los ntawm ntau txoj hauv kev hauv ntau qhov chaw kho mob. Tsis tas li ntawd, cov kws kho mob yuav tsum tau ceev faj txog kev txheeb xyuas qhov sib npaug yav tom ntej uas tuaj yeem pab kuaj mob CKD nrog qhov tseeb dua, pom cov theem sib txawv, thiab cuam tshuam raws li.
Cistanche tuaj yeem txhim kholub raum ua haujlwm
Kev lees paub
Cov kws sau ntawv ua tsaug rau Dr. Barbara Riegel, Dr. PamelaCacchione, thiab Ms. Justine Sefcik rau lawv qhov kev tshuaj xyuas thiab kev tawm tswv yim ntawm cov ntawv sau
Kev nkag siablub raum ua haujlwmkev soj ntsuam
From: 'Kev nkag siablub raum ua haujlwmKev ntsuam xyuas: Cov hauv paus thiab kev nce qib 'los ntawmHoury V. Puzantian, et al
---Journal of the American Association of Nurse Practitioners 25 (2013) 334–341 C 2013 The Author(s) C 2013 American Association of Nurse Practitioners