肾小球滤过率讲解.ppt

Courtesy of David Seccombe, UBC CEQUAL …estimating… Glomerular Filtration Rate The test Limitations Analytical Issues Performance standards Importance of Serial Monitoring Real Change in Value The Test? eGFR-MDRDas: 186x(sCREA/88.4)-1.154 x age-0.203 x 0.742 if female mL/min/1.73m2 (non SI units!) Upper reporting limit may be “ 60 mL/min/1.73m2”; automatically calculated and reported with serum creatinine Serum creatinine and eGFR should be included with risk testing for diseases such as diabetes, hypertension, CVD (hyperlipidemia), family history, genetic suseptibility. The Test? Testing frequency? … will probably vary from a few repeats per year to a few per decade. delta checks for serum creatinine and eGFR if possible Creatinine Clearance measurements are expected to decline (units to remain SI) eGFR-MDRDas: Limitations NOT for DRUG DOSING! These recommendations are not to be applied to drug dosing calculations. ASSUMES “STEADY STATE” . If kidney function is changing rapidly, monitor serum creatinine (100% increase/ day = no GFR). eGFR-MDRDas: Limitations Creatinine and eGFR vary with muscle mass. If muscle mass is above average due to race or training, multiply result by “1.21”. MDRDas is normalized for average height/weight. Consult nephrologist if patient has special physical or other circumstances. eGFR-MDRDas: Limitations Creatinine assay subject to interferences -acetoacetate, ascorbic acid, fructose, pyruvate, cephaolosporins, creatine, proline (avoid hypealimentation fluid contamination), chronic lidocaine administration; bilirubin. In vivo inhibition of creatinine secretion occurs with cimetidine or trimethoprim. Calibration affects Medical Decisions Laboratory results trigger 75% of medical decisions Calibration error systematically skews all test results for a particular test Calibration errors in calcium cost the US Health Care system $60 - $199 million annually Bristish Columbia – Standardization Program 22 human se