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

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.

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