升高血清肌酐的药物
- Authors
- Lesley A Inker, MD, MS
Lesley A Inker, MD, MS
- Associate Professor of Medicine
- Tufts University School of Medicine
- Ronald D Perrone, MD
Ronald D Perrone, MD
- Section Editor — Cystic Disease
- Professor of Medicine
- Tufts University School of Medicine
- Section Editor
- Richard H Sterns, MD
Richard H Sterns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Fluid and Electrolytes
- Professor Emeritus
- University of Rochester School of Medicine and Dentistry
- Deputy Editor
- John P Forman, MD, MSc
John P Forman, MD, MSc
- Senior Deputy Editor — UpToDate
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Translators
- 林琼真, 副主任医师
林琼真, 副主任医师
- 河北医科大学第三医院肾内科
引言
血清肌酐浓度(serum creatinine concentration, SCr)升高通常反映了肾小球滤过率(glomerular filtration rate, GFR)下降，且同时伴随血尿素氮(blood urea nitrogen, BUN)升高。 (参见“肾功能的评估”)
但在很多情况下，SCr可独立于GFR急剧升高，因此这类情况下肾功能总体无真正改变。可能的3种原因包括：肌酐分泌减少，血清化验受干扰和肌酐生成增多。
肌酐分泌减少
正常人约15%的尿肌酐由近端肾小管分泌，而晚期肾病患者的该值可高达50%，使得通过肌酐清除率估计的GFR较真实值偏高[1]。 (参见“肌酐清除率的计算”)
肌酐在生理性pH范围内是有机阳离子，由有机阳离子分泌泵分泌，该泵可被其他有机阳离子抑制。可干扰肌酐分泌而导致SCr自限性、可逆性升高约0.4-0.5mg/dL(35-44μmol/L)且不改变真实GFR的常用药物包括：
●抗生素甲氧苄啶(最常与磺胺甲噁唑联用)[2]。
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To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:Literature review current through: 2017-06 . | This topic last updated: 2016-07-13.The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.References- Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985; 28:830.
- Berg KJ, Gjellestad A, Nordby G, et al. Renal effects of trimethoprim in ciclosporin- and azathioprine-treated kidney-allografted patients. Nephron 1989; 53:218.
- Duncker D, Oswald H, Gardiwal A, et al. Stable cystatin C serum levels confirm normal renal function in patients with dronedarone-associated increase in serum creatinine. J Cardiovasc Pharmacol Ther 2013; 18:109.
- Hilbrands LB, Artz MA, Wetzels JF, Koene RA. Cimetidine improves the reliability of creatinine as a marker of glomerular filtration. Kidney Int 1991; 40:1171.
- Rocci ML Jr, Vlasses PH, Ferguson RK. Creatinine serum concentrations and H2-receptor antagonists. Clin Nephrol 1984; 22:214.
- Kemperman FA, Silberbusch J, Slaats EH, et al. Follow-up of GFR estimated from plasma creatinine after cimetidine administration in patients with diabetes mellitus type 2. Clin Nephrol 2000; 54:255.
- Tangri N, Alam A, Edwardes MD, et al. Evaluating cimetidine for GFR estimation in liver transplant recipients. Nephrol Dial Transplant 2010; 25:1285.
- German P, Liu HC, Szwarcberg J, et al. Effect of cobicistat on glomerular filtration rate in subjects with normal and impaired renal function. J Acquir Immune Defic Syndr 2012; 61:32.
- Molitch ME, Rodman E, Hirsch CA, Dubinsky E. Spurious serum creatinine elevations in ketoacidosis. Ann Intern Med 1980; 93:280.
- Saah AJ, Koch TR, Drusano GL. Cefoxitin falsely elevates creatinine levels. JAMA 1982; 247:205.
- Mitchell EK. Flucytosine and false elevation of serum creatinine level. Ann Intern Med 1984; 101:278.
- Myers GL, Miller WG, Coresh J, et al. Recommendations for improving serum creatinine measurement: a report from the Laboratory Working Group of the National Kidney Disease Education Program. Clin Chem 2006; 52:5.
- Smith CH, Landt M, Steelman M, Ladenson JH. The Kodak Ektachem 400 Analyzer evaluated for automated enzymic determination of plasma creatinine. Clin Chem 1983; 29:1422.
- Noble MA, Harper B, Grant AG, Bernstein M. Rapid determination of 5-fluorocytosine levels in blood. J Clin Microbiol 1984; 20:996.
- Herrington D, Drusano GL, Smalls U, Standiford HC. False elevation in serum creatinine levels. JAMA 1984; 252:2962.
- Bell TW, Hou Z, Luo Y, et al. Detection of creatinine by a designed receptor. Science 1995; 269:671.
- Payne RB. Creatinine clearance: a redundant clinical investigation. Ann Clin Biochem 1986; 23 ( Pt 3):243.
- Hamilton RW, Gardner LB, Penn AS, Goldberg M. Acute tubular necrosis caused by exercise-induced myoglobinuria. Ann Intern Med 1972; 77:77.
- Oh MS. Does serum creatinine rise faster in rhabdomyolysis? Nephron 1993; 63:255.
- Gualano B, de Salles Painelli V, Roschel H, et al. Creatine supplementation does not impair kidney function in type 2 diabetic patients: a randomized, double-blind, placebo-controlled, clinical trial. Eur J Appl Physiol 2011; 111:749.
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