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Proteinuria, 99mTc-DTPA Scintigraphy, Creatinine-, Cystatin- and Combined-Based Equations in the Assessment of Chronic Kidney Disease

DOI: 10.1155/2014/430247

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Abstract:

Background. Precise estimation of the glomerular filtration rate (GFR) and the identification of markers of progression are important. We compared creatinine, cystatin, and combined CKD-EPI equations with scintigraphy to measure GFR and proteinuria as markers of progression. Methods. Cross-sectional, observational study including 300 subjects. CKD was classified by scintigraphy. Determinations. Creatinine, 24-hour creatinine clearance, cystatin, Hoek formula, and creatinine, cystatin, and combined CKD-EPI equations. Results. In the global assessment, creatinine CKD-EPI and combined CKD-EPI equations yielded the highest correlations with : ρ = 0.839, and ρ = 0.831, . Intergroup analysis versus : control G, creatinine clearance ρ = 0.414, P = 0.013; G3, combined CKD-EPI ρ = 0.5317, ; G4, Hoek ρ = 0.618, , combined CKD-EPI ρ = 0.4638, ; and G5, creatinine clearance ρ = 0.5414, , combined CKD-EPI ρ = 0.5288, . In the global assessment, proteinuria displayed the highest significant correlations with cystatin (ρ = 0.5433, ) and cystatin-based equations (Hoek: , ). When GFR < 60?mL/min: in stage 3, proteinuria-cystatin (ρ = 0.4341, ); proteinuria-Hoek (ρ = ?0.4105, ); in stage 4, proteinuria-cystatin (ρ = 0.4877, ); proteinuria-Hoek (ρ = ?0.4877, P = 0.0026). Conclusions. At every stage of GFR < 60?mL/min, cystatin-based equations displayed better correlations with . Proteinuria and cystatin-based equations showed strong associations and high degrees of correlation. 1. Introduction In clinical practice, it is critical to assess kidney function in a precise and accurate manner. Measurement of the glomerular filtration rate (GFR) is considered the best method that reflects kidney function, both in health and in disease [1]. The Kidney Disease Outcomes Quality Initiative (K/DOQI) guidelines, widely employed in clinical practice, stratify CKD into 5 stages according to the GFR estimated through the depuration of creatinine [2]. During the last decades, serum creatinine has been the most frequently employed marker to estimate GFR. The K/DOQI guidelines emphasize the necessity to assess GFR employing equations based on serum creatinine and not to rely on serum creatinine concentration alone [2]. The most commonly used creatinine-based formulae include Crockoft-Gault, adjusted to age, weight, and gender, and the Modification of Diet in Renal Disease (MDRD) and its variants, focused on estimating GFR [3]. Finally, Chronic Kidney Disease Epidemiology (CKD-EPI) equation, published in 2009 appears to be more exact than the previous ones in estimating GFR [1]. All these

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