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Том 26 №2 2024 год - Нефрология и диализ

Определение скорости клубочковой фильтрации у детей и подростков: теоретические и практические аспекты

Байко С.В. Кулакова Е.Н. Аксёнова М.Е. Шумихина М.В. Настаушева Т.Л.

DOI: 10.28996/2618-9801-2024-2-186-203

Аннотация: Скорость клубочковой фильтрации (СКФ) является основным показателем, характеризующим функцию почек. Целью работы явилась систематизация данных по методам измерения и расчета СКФ в детской популяции с разработкой алгоритма действий для единого подхода и более точного определения СКФ. В статье обсуждаются методы измерения с помощью экзогенных и эндогенных маркеров клубочковой фильтрации и уравнения расчета СКФ (рСКФ), преимущества и ограничения их использования. Подробно описываются эндогенные маркеры СКФ - сывороточный креатинин и цистатин С. Подчеркивается, что в современных формулах рСКФ используются значения этих маркеров, полученные только стандартизованными методами. Для стандартизации измерения концентрации креатинина применяется эталонный метод - тандемная масс-спектрометрия с изотопным разбавлением (isotope dilution mass spectrometry, IDMS) и калибраторы со стандартным эталонным материалом (SRM) креатинина с присвоением сертификационного кода NIST (для креатинина NIST SRM 967). Переход лабораторий на измерение концентрации креатинина со стандартизацией по IDMS послужил толчком к модернизации уже имевшихся формул и появлению новых уравнений для расчета СКФ. Подробно описываются международные рекомендации для первичной оценки почечной функции с использованием креатинина крови и рСКФ, а при определенных обстоятельствах, когда рСКФ по креатинину дает менее точный результат, предлагается включать дополнительные уточняющие тесты. Важной составляющей статьи является подробное описание расчетных формул СКФ в историческом аспекте и обоснование преимущественного использования в настоящее время уравнений CKiD U25 и EKFC. Отдельные разделы работы посвящены особенностям оценки СКФ у детей раннего возраста, подростков и молодых взрослых. Выделены частные вопросы определения СКФ, а именно: у детей с тяжелыми соматическими, онкогематологическими заболеваниями, хроническими инфекциями, а также у пациентов, находящихся в критическом состоянии. В заключении приводится четкий алгоритм выбора формулы для расчета СКФ и последовательность проведения уточняющих тестов в случае необходимости.

Для цитирования: Байко С.В., Кулакова Е.Н., Аксёнова М.Е., Шумихина М.В., Настаушева Т.Л. Определение скорости клубочковой фильтрации у детей и подростков: теоретические и практические аспекты. Нефрология и диализ. 2024. 26(2):186-203. doi: 10.28996/2618-9801-2024-2-186-203

Весь текст

Ключевые слова: скорость клубочковой фильтрации (СКФ), дети и подростки, маркеры СКФ, уравнения расчета СКФ, креатинин, цистатин С, CKiD U25, glomerular filtration rate (GFR), children and adolescents, GFR markers, GFR calculation equations, creatinine, cystatin C, CKiD U25

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