[Clinical comparison study of Chinese adult serum cystatin C based estimated glomerular filtration rate equations].

OBJECTIVE: To probe the clinical value of estimated glomerular filtration rate (GFR) formulas for adults Chinese based on the serum cystatin C(SCys C, SCysCAC). METHODS: GFRs for 96 cases of patient in hospital suffering from the kidney diseases without dialysis from January to December in 2011 were measured using clearance rate of (99m) Tc-diethylene triamine pentaacetic acid ((99m) Tc- DTPA, Tc-GFR) by prospective control study method. Based on the renal function, 96 patients were sorted into renal function insufficient group (RFI, n=54) and renal function normal group (RFN, n=42). The SCys C, serum creatinine (SCr) and blood urea nitrogen (BUN) were measured at the same day for calculating GFRs simultaneously by nine formulas such as SCysCAC, Arnal-Dade, Grubb, Filler, Grubb, Hojs, Larsson, Macisaac, Rule etc. The comparison were performed for the estimated GFRs (eGFRs) of renal insufficiency patients and those with normal renal function and the correlation analysis were done between the calculations and Tc-GFR respectively. RESULTS: eGFRs calculated by SCysCAC, Arnal-Dade, Larsson and Rule formulae always were close to those of Tc-GFR and that were 37.96±32.65 ml×min(-1)×1.73 m(-2), 33.69±25.24 ml×min(-1)×1.73 m(-2), 34.16±33.65 ml×min(-1)×1.73 m(-2), 33.02±30.88 ml×min(-1)×1.73 m(-2) vs. 36.21±31.16 ml×min(-1)×1.73 m(-2) in RFI group, 112.99±39.26 ml×min(-1)×1.73 m(-2), 101.86±72.29 ml×min(-1)×1.73 m(-2), 102.69±71.78 ml×min(-1)×1.73 m(-2), 99.12±69.54 ml×min(-1)×1.73 m(-2) vs. 110.54±48.98 ml×min(-1)×1.73 m(-2) in RFN group (all P>0.05). The absolute value difference between eGFR by SCysCAC, Larsson and Arnal-Dade formulae and Tc-GFR in RFN or RFI group showed no significant change and the absolute value of the value difference between SCysCAC-eGFR and Tc-GFR was the least among the three absolute values and showed that eGFRs from the three formulas could all reflect the GFR accurately and the SCysCAC formula was the best. The correlation analysis showed the eGFRs from every formula could all to some extent reflect the glomerular function or GFR accurately. CONCLUSION: The SCysCAC formula was a quickly and accurate method for estimating GFR and may apply clinically.

[Clinical study of the new intelligent determination and analysis system for glomerular filtration rate].

OBJECTIVE: To discuss the clinical application value of determining glomerular filtration rate(GFR) with the new intelligent determination and analysis system for GFR (B&G System). METHODS: GFR of 216 hospitalized patients suffering from the different diseases was determined accurately by clearance rate of (99m)Tc-diethylene triamine pentaacetic acid ((99m)Tc-DTPA) (Tc-GFR), and the serum creatinine (SCr) and blood urea nitrogen (BUN) were also determined. At the same time GFR was determined by B&G system and Robert formula (B&G-GFR, Robert-GFR), and creatinine clearance rate (CCr) and GFR were calculated by Cockcroft/Gault formula(CG-CCr-GFR). All the results were compared, and correlation analysis was done for the three groups of data. RESULTS: Among 216 patients, B&G-GFR and Tc-GFR in 106 patients with renal insufficiency and 110 patients with normal renal function showed no significant difference (ml · min(-1)· 1.73 m(-2): 29.13 ± 18.96 vs. 32.28 ± 25.03, 121.13 ± 49.79 vs. 118.48 ± 43.25, both P >0.05), while Robert-GFR (ml · min(-1) · 1.73 m(-2): 21.45 ± 15.67, 93.54 ± 30.01) and CG-CCr-GFR (ml · min(-1) · 1.73 m(-2): 11.87 ± 8.69, 86.27 ± 21.44)were significantly lower than Tc-GFR (P<0.05 or P <0.01 ). The values of B&G-GFR, Robert-GFR, CG-CCr-GFR and Tc-GFR in renal insufficiency group (ml · min(-1) · 1.73 m(-2) :6.15 ± 14.07, 13.83 ± 11.36, 23.41 ± 24.34) were respectively significantly lower than that of normal renal function group (ml · min(-1) · 1.73 m(-2):7.65 ± 6.54, 24.94 ± 13.24, 32.21 ± 21.81, all P <0.05). B&G-GFR, Robert-GFR, and CG-CCr-GFR of both groups were positively correlated with Tc-GFR (P<0.05 or P <0.01), but negatively correlated with SCr (P<0.05 or P <0.01). CONCLUSION: B&G-GFR, Robert-GFR and CG-CCr-GFR , to a certain extent, do accurately reflect GFR. However, B&G-GFR is more accurate than others, and it can take the place of Tc-GFR clinically. B&G system has the advantage of accuracy, simplicity, speed, safety and low-price compared with other methods for the determination of GFR, and it warrants popularization.

[Preparation and clinical application of an intelligent determination and analysis system for glomerular filtration rate].

OBJECTIVE: To prepare an intelligent determination and analysis system for renal glomerular filtration rate(GFRBMAS), and to explore its value in clinical setting. METHODS: GFRBMAS was prepared by programming with VB 6.0 software. GFR of 79 inpatients suffering from the different diseases was determined accurately by using clearance rate of (99)Tc(m)-diethylene triamine pentaacetic acid (DTPA) (Tc-GFR). The serum creatinine (SCr), blood urea nitrogen (BUN), serum uric acid (Uric), serum calcium (Ca) and serum phosphorus (P) were determined with both GFRBMAS and 7170S automatic biochemistry determination apparatus (ititachi), and the result of GFR was compared with that determined by using GFRBMAS and 7170S automatic biochemical determination apparatus. At the same time GFR was determined by using Robert formula (GFRBMAS-GFR, Robert-GFR), and creatinine clearance rate was calculated with Cockcroft/Gault formula (CG-CCr). All the results were compared and analyzed. RESULTS: No significant difference of SCr, BUN, Uric, Ca and P values determined by two methods. Robert-GFR and CG-CCr values were significantly lower than Tc-GFR value in the normal renal function group and the renal insufficiency group (P<0.01) and that of GFRBMAS-GFR was close to that of Tc-GFR and relative analysis showed that the values of GFRBMAS-GFR, Robert-GFR, CG-CCr showed significantly positive correlation with that of Tc-GFR, but negative correlation with values of SCr and BUN (P<0.05 or P<0.01). CONCLUSION: GFRBMAS-GFR, Robert-GFR and CG-CCr could all reflect GFR with accuracy to certain extent and GFRBMAS-GFR can take the place of Tc-GFR in clinical setting.

[Correlative study between angiotensin-converting enzyme gene polymorphism and hepatorenal syndrome].

OBJECTIVE: To investigate the relationship between insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) gene and uncompensated cirrhosis of liver with hepatorenal syndrome (HRS). METHODS: ACE I/D polymorphism was detected by polymerase chain reaction amplification of DNA fragment in 56 patients of uncompensated liver cirrhosis with HRS, and 60 healthy individuals served as the controls. At the same time, alanine aminotransferase, aspartate transaminase, serum creatinine (SCr), blood urea nitrogen (BUN) and glomerular filtration rate (GFR) etc. were measured in all the subjects, and the difference between these variables among different genotypes was noted. RESULTS: There was no significant difference in genotypes and allele frequency between the HRS group and controls(all P>0.05). The I allele frequency was higher than the D allele in all the subjects (all P<0.01). But in the control group, there was no significant difference in the genotype frequency among three genomic groups, while the II genotype frequency was higher than the one of ID and DD (all P<0.05). SCr and BUN of the II genotype were higher in the HRS group than that of ID and DD(both P<0.05) and GFR of the II genotype was lower than the one of ID and DD in the HRS group(P<0.05). CONCLUSION: There is relationship between ACE gene polymorphism and the incidence of uncompensated liver cirrhosis with HRS. II genotype may be the genetic factor of vulnerability to HRS patients with uncompensated cirrhosis of liver. The degree of kidney failure in II genotype population is more serious than in ID and DD individuals with uncompensated liver cirrhosis complicated by HRS.

[Study of the clinical factors associated with glomerular filtration rate].

OBJECTIVE: To investigate the relationship between glomerular filtration rate(GFR) and possible involved clinical factors and to offer an basis for building measurement GFR by the calculation method. METHODS: GFR from 46 cases of normal renal function group and 52 cases of renal insufficient group were determined by using clearance of 99mTc-DTPA, serum creatinine(SCr), urea nitrogen, uric, potassium, sodium, calcium and hemoglobin were determined. Simultaneously, heart rate, urine specific gravity, 24 hours urine protein quantum, average artery pressure, weight index and body surface area were determined. Age, isotope dose for determining GFR were recorded. The simple correlation analysis between GFR in every group and the difference primitive diseases and clinical factors mentioned above were performed and the multiple correlation analysis between every clinical factors mentioned above that had significantly correlation between GFR and GFR were performed as well. RESULTS: GFR in normal renal function group, insufficient group and the difference primitive diseases had significantly negative correlation with SCr, while the correlations between GFR and other clinical factors were different. CONCLUSION: SCr is the ideal index for GFR for renal insufficient patients due to different primitive diseases and patients with normal renal function.