在成年人脊柱二叉脊椎患者中,囊素C和肌素估计的GFR的变化
Stephen Kisty1, Sarah A Korth2, Blaise W Abramovitz3
1University of Pittsburgh School of Medicine, Pittsburgh, PA.
Urology
|December 21, 2025
概括
血清囊素C在脊髓折患者中提供了稳定的功能测量,与根据病变水平而有所不同的基于肌素的估计不同. 这一发现对于对这一群体进行准确评估至关重要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 泌尿器科 泌尿器科 泌尿器科 泌尿器科
- 临床生物化学 临床生物化学
背景情况:
- 估计脊髓折患者的功能是具有挑战性的,因为可变的肌肉质量影响了基于肌素的计算.
- 基于血清肌素的估计膜过率 (eGFR) 可能会高估脊髓裂患者的功能,特别是那些脊髓损伤水平较高的人.
- 血清囊C是一种潜在的替代生物标志物用于评估功能,因为它不受肌肉质量的影响.
研究的目的:
- 评估血清囊素C作为可靠的替代血清肌素测量功能在成年人脊髓折裂和下尿路功能障碍.
- 为了比较不同脊髓损伤水平和Spina Bifida亚表型的各种基于肌素和基于囊素C的eGFR方程的稳定性和准确性.
主要方法:
- 追溯分析155名脊柱裂患者成年患者的数据.
- 估计的淋巴膜过率 (eGFR) 值的比较,这些值来自五种不同的方程:三种基于酸的 (CysC-eGFR-2012,Zappitelli-CysC-eGFR,CrCysC-eGFR-2021) 和两种基于肌素的 (Cr-eGFR-2009,Cr-eGFR-2021).
- 对五种脊髓损伤水平和两种脊髓折裂子类型 (骨髓瘤与非骨髓瘤) 的eGFR稳定性和相关性的分析.
主要成果:
- 基于肌素的EGFR在较高的病变水平时显著增加,与囊素C估计相比,胸部水平骨髓髓瘤细胞中脏功能的中位数为12mL/min/1.73m2高估.
- 这三种基于cystatin C的eGFR配方都在病变水平 (p > 0.39) 中表现出稳定性,并且彼此之间有很高的相关性 (ρ = 0.84-0.94).
- 肌素和囊素C估计值之间的差异显示偏差高达±7.8mL/min/1.73m2和超过±40mL/min/1.73m2.2的广泛协议极限.
结论:
- 基于肌素的eGFR方程式在脊髓裂患者中与瘤水平较高的患者和骨髓瘤患者中相对于囊素C来说,始终高估了功能.
- 基于赛斯塔丁C的eGFR估计提供了稳定的功能评估,无论该人群的脊髓损伤水平如何.
- 虽然基于氨酸C的估计值是稳定的,但建议对临床实践中不同基于氨酸C的eGFR值的直接互换性保持谨慎.
相关概念视频
01:28Drug Dosing in Renal Diseases: Estimation of Glomerular Filtration Rate Based on Serum Creatinine Concentration
171
Glomerular filtration rate (GFR) can be estimated from serum creatinine using the modification of diet in renal disease (MDRD) formula or the chronic kidney disease–epidemiology collaboration (CKD–EPI) equation. Both methods are widely used in clinical practice to assess kidney function and guide treatment decisions.The MDRD equation does not require weight or height measurements and is normalized to the body surface area of 1.73 m², considered the average adult surface area.
171
01:25Drug Dosing in Renal Diseases: Measurement of Serum Creatinine Concentration and Clearance
170
In healthy individuals, serum creatinine levels remain stable due to a balance between its constant production—primarily from muscle metabolism—and renal excretion. Creatinine is freely filtered by the glomeruli, making it a valuable marker for estimating renal function. When the glomerular filtration rate (GFR) decreases, the kidneys can only eliminate less creatinine, causing serum levels to rise.Serum creatinine concentration is widely used to estimate creatinine clearance...
170
01:17Factors Affecting Renal Clearance: Renal Impairment
402
Renal dysfunction significantly impairs the renal clearance of drugs, leading to potential complications in drug therapy. Renal failure, which can be caused by various factors, poses a significant challenge in the elimination of drugs from the body.
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
402
01:18Pharmacokinetics in Geriatric Patients: Effect of Age on Drug Excretion
217
In geriatric patients, renal physiology undergoes significant changes, including diminished renal blood flow and a lower glomerular filtration rate (GFR), leading to alterations in medication clearance. Drugs such as aminoglycoside antibiotics, lithium, and digoxin, which rely on glomerular filtration for removal from the body, particularly impact pharmacokinetics. These drugs tend to have slower clearance rates in older adults, necessitating careful dosage considerations.Evaluation of renal...
217
01:24Serum Studies: Renal Function Tests
341
Renal function tests are crucial for assessing kidney health, monitoring disease progression, and evaluating the kidneys' efficiency in waste elimination, fluid balance, and electrolyte regulation. These tests offer critical insights into kidney function, even though routine measurements may appear normal until there is a significant decline in the glomerular filtration rate or GFR. Typically, signs of kidney impairment only become evident when the GFR falls to about 50% of its normal level.
341
01:23Renal Clearance
2.3K
The glomerular filtration rate (GFR) is a critical marker of kidney function, reflecting the efficiency of filtration by the glomeruli. Renal clearance of specific substances, such as inulin or creatinine, is commonly used to measure GFR.
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
Renal clearance refers to the volume of plasma cleared of a specific substance, such as creatinine, per unit of time. To measure clearance, urine samples are collected over a 24-hour period during each bladder voiding, followed by a single blood sample at the...
2.3K