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肌酐清除率的计算

Authors
Lesley A Inker, MD, MS
Ronald D Perrone, MD
Section Editor
Richard H Sterns, MD
Deputy Editor
John P Forman, MD, MSc

概述

肌酐清除率(creatinine clearance, CCr)广泛用于估计肾小球滤过率(glomerular filtration rate, GFR) [1,2]。肌酐来自骨骼肌中的肌酸代谢和饮食中的肉类，以相对恒定的速率释放进入血液循环并具有稳定的血浆浓度。与菊淀粉相似，肌酐可经肾小球自由滤过，既不由肾脏重吸收，也不由肾脏代谢。然而，对于GFR正常患者，近端小管通过有机阳离子分泌途径进行的肾小管分泌占患者尿肌酐的约10%-20%，该比例随GFR下降而逐渐升高[3]。净效应是随着疾病严重程度增加，GFR越来越被高估。 (参见下文‘肌酐分泌增加’)

如果忽略分泌的影响，则所有滤过肌酐[等于GFR与血清肌酐浓度(serum creatinine concentration, SCr)的乘积]都将被排泄[等于尿肌酐浓度(urine creatinine concentration, UCr)与尿流率或尿体积(volume, V)的乘积]。因此：

       GFR x SCr  =  UCr x V

       GFR = [UCr x V]/SCr

该公式被称为肌酐清除率计算公式，该结果倾向于超过真实GFR 10%-20%或更多，具体的超出比例取决于尿肌酐中来自肾小管分泌部分的比例[4]。以往，该误差因血清肌酐测定中产生相等程度的误差，而得以平衡。血清肌酐测定误差是由于存在于血清中的非肌酐色原体(如丙酮、抗坏血酸和丙酮酸盐或酯)所致，该误差占由旧式比色技术所测得肌酐浓度的10%-20%。然而，肌酐标准物质的血清肌酐测定国家标准化已在很大程度上消除了该误差。如果实验室采用标准化方法，则肌酐清除率测定值始终高出GFR正常患者的GFR 10%-20%，并会随GFR下降而逐渐升高。 (参见下文‘肌酐分泌增加’)

           

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Literature review current through: 2017-06 . | This topic last updated: 2017-06-21.
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