אילמ"ר - האיגוד הישראלי למדעי המעבדה הרפואית

אילמ"ר - האיגוד הישראלי למדעי המעבדה הרפואית

תקצירי הכינוס השנתי ה-47 | 2013

ישיבה שישית: תפקודי כליה ומדדי איכות בנפרולוגיה

בדיקות ישנות וחדשות בשירות הנפרולוגי: Creatinine, eGFR, Cystatine C ועוד

ד"ר מריאל קפלן,
אגף מעבדות, הקריה הרפואית לבריאות האדם, רמב"ם, חיפה

Old and New Biomarkers for Kidney Diseases: Creatinine, eGFR, Cystatin C & more….


Dr Marielle Kaplan, PhD,
Laboratory of Clinical Biochemistry, Rambam health Care Campus, Haifa, Israel


Kidney diseases, both acute and chronic, remain associated with high morbidity and mortality, despite progress in medical care. Chronic kidney diseases (CKD) are a major health problem worldwide with dramatically rising incidence and prevalence often in association with cardiovascular diseases. Moreover, kidney diseases management is mainly protective and acute kidney diseases (AKD) when not properly diagnosed and treated can lead to kidney failure and a need for dialysis. Therefore, the identification of effective markers of changing kidney function is a priority in clinical nephrology.

Glomerular filtration rate (GFR) is used universally to measure kidney function and serum creatinine has been most commonly used to detect reductions in GFR using eGFR (estimated GFR). Despite improvements in methodology, serum creatinine test is mainly based on the classic, 100-years old Jaffe reaction and it is the most common test for kidney function assessment. There are major limitations to the use of serum creatinine to estimate kidney function and it is insensitive as an early marker of CKD or AKD. Creatinine levels are affected by age, race and gender as well as by any pathologies affecting muscle functioning. Currently, there are about 46 different equations for estimating GFR using creatinine, the most common being the MDRD. However, these equations have not been validated across all clinical presentations. For example, the MDRD equation derived with chronic kidney disease (CKD) patients underestimated GFR in healthy persons. Finally standardization of creatinine remains an issue and it is now required to use IDMS (isotope dilution mass spectrometry method)-traceable creatinine methods in order to calculate eGFR. Therefore reliable early-detecting biomarkers for kidney diseases are still needed.

Cystatin C (CysC) has been recognized as a promising marker of GFR. Studies demonstrated that CysC could be used as a marker to replace or to supplement serum creatinine-based estimates of GFR. Since Cys C is not affected by muscle mass, it is not influenced by age or gender and can be used in children over 1 year old. Moreover, Cystatin C-based equations may offer an advantage over the MDRD equation in kidney transplant recipients. Additional renal biomarkers have been recently added to the list of kidneys functions biomarkers including neutrophil gelatinase-associated lipocalin, kidney injury molecule-1, and liver-type fatty acid-binding protein. Overall, more studies are needed to assess the proper use of these new tests within modern clinical nephrology.

 


חזרה לתקצירי הכנס
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