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Bestimmung der glomerulären Filtrationsrate bei Kindern und Jugendlichen: Alternative Methoden zur Inulin-Clearance und der Einfluss der laborchemischen Untersuchungsmethoden

By Joachim Schmitt

Abstract

Hintergrund: Welche Methode zur Bestimmung der glomerulären Filtrationsrate (GFR) bei Kindern im klinischen Alltag die beste Übereinstimmung mit der Inulin-Clearance liefert, ist in der Literatur nicht eindeutig geklärt. Patienten und Methoden: An 27 Patienten wurden parallel zur Inulin-Clearance 10 verschiedene GFR-Bestimmungsmethoden evaluiert. Eine Kurz-Zeit-Kreatinin-Clearance mit 3 x 90 minütiger Urinsammlung, eine klassische 24-Stunden-Kreatinin-Clearance, eine Formelberechnung nach Schwartz sowie die Bestimmung von Cystatin C. Die Kreatinin-Bestimmungen erfolgten aus jeder Probe durch drei verschieden Tests: naß-enzymatisch durch Creatinin plus, trocken-enzymatisch durch Ektachem und durch die klassische Jaffé-Methode. Außerdem wurde an sechs erwachsenen Kontrollprobanden das gesamte Studienprotokoll an zwei aufeinander folgenden Tagen durchgeführt. Ergebnisse: Alle 10 Methoden wichen in klinisch relevantem Maß von der Inulin-Clearance ab. Die Kurz-Zeit-Kreatinin-Clearance lieferte ähnliche Werte, wie die 24-Stunden-Kreatinin-Clearance. Die Bestimmung der GFR durch die Schwartz-Clearance, bestimmt mit dem klassischen Jaffé-Test, lieferte die beste Übereinstimmung mit der Inulin-Clearance und ist zudem am wenigsten belastend für Kinder. Auch bei den erwachsenen Kontrollprobanden zeigte sich durch diese Methode die geringste von Tag-zu-Tag-Abweichung. Die Kreatinin-abhängigen Methoden zeigen unabhängig von der Untersuchungsmethode mit Jaffé die beste Übereinstimmung mit der Inulin-Clearance. Schlussfolgerung: Keine der 10 untersuchten Methoden kann die GFR zuverlässig bestimmen. Die Schwartz-Clearance bestimmt durch Jaffé ist für den klinischen Alltag die Methode der besten Übereinstimmung mit der tatsächlichen GFR und ist zudem einfach durch zu führen und für den Patienten wenig belastend

Topics: Kind ; Klinische Chemie ; Nierenfunktionsdiagnostik ; Glomerular filtration rate ; Creatinin-Clearance ; Kreatinin ; Cystatin C ; Glomeruläre Filtrationsrate ; Inulin ; Children ; Creatinine ; Nierenfunktion ; Medical sciences, Medicine, Kind -- Klinische Chemie -- Nierenfunktionsdiagnostik -- Glomerular filtration rate -- Creatinin-Clearance -- Kreatinin -- Cystatin C -- Cystatin C -- Glomeruläre Filtrationsrate -- Inulin -- Children -- Inulin -- Creatinine -- Nierenfunktion -- Medizin, Gesundheit, ddc:610
Publisher: Philipps-Universität Marburg, Medizin
Year: 2005
OAI identifier: oai:Archiv.UB.Uni-Marburg.de:04-z2005-0625

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