PDF(Pubmed)
Abstract：
Glomerular filtration rate (GFR) is thought to be the best overall indicator of kidney health. On an individual patient basis, a working knowledge of GFR is important to understand the future risk for chronic kidney disease (CKD) progression, enhanced risk for cardiovascular disease and death, and for optimal medical management including the dosing of certain drugs. Although GFR can be directly measured using exogenous compounds that are eliminated by the kidney, these methods are not scalable for repeated and routine use in clinical care. Thus, in most circumstances GFR is estimated, termed estimated GFR (eGFR), using serum biomarkers that are eliminated by the kidney. Of these, serum creatinine, and to a lesser extent cystatin C, are most widely employed. However, the resulting number is simply a population average for an individual of that age and sex with a given serum creatinine and/or cystatin C, while the range of potential GFR values is actually quite large. Thus, it is important to consider characteristics of a given patient that might make this estimate better or worse in a particular case. In some circumstances, cystatin C or creatinine might be the better choice. Ultimately it is difficult, if not impossible, to have an eGFR equation that performs equally well in all populations. Thus, in certain cases it might be appropriate to directly measure GFR for high consequence medical decision-making, such as approval for kidney donation or prior to certain chemotherapeutic regimens. In all cases, the eGFR thresholds of CKD stage should not be viewed as absolute numbers. Thus, clinical care should not be determined solely by CKD stage as determined by eGFR alone, but rather by the combination of an individual patient\'s likely kidney function together with their current clinical situation.
摘要：
肾小球滤过率（GFR）被认为是肾脏健康的最佳总体指标。在个体患者的基础上，了解GFR的工作知识对于了解慢性肾脏病（CKD）进展的未来风险很重要，增加心血管疾病和死亡的风险，以及最佳医疗管理，包括某些药物的剂量。尽管GFR可以使用被肾脏消除的外源性化合物直接测量，这些方法对于临床护理中的重复和常规使用是不可扩展的.因此，在大多数情况下，GFR是估计的，称为估计GFR(eGFR)，使用被肾脏消除的血清生物标志物。其中,血清肌酐,程度较小的胱抑素C，被广泛使用。然而,所得数字只是该年龄和性别的个体的人口平均值，具有给定的血清肌酐和/或胱抑素C，而潜在GFR值的范围实际上相当大。因此，重要的是要考虑特定患者的特征，这些特征可能会使这种估计在特定情况下更好或更差。在某些情况下,胱抑素C或肌酐可能是更好的选择。最终很难，如果不是不可能,具有在所有人群中表现同样出色的eGFR方程。因此，在某些情况下，对于高后果的医疗决策，直接测量GFR可能是合适的，例如批准捐赠肾脏或在某些化疗方案之前。在所有情况下,CKD阶段的eGFR阈值不应被视为绝对数.因此，临床护理不应仅由CKD分期决定，而由eGFR决定，而是通过个体患者可能的肾功能与他们目前的临床情况相结合。
