Acta bioquímica clínica latinoamericana
versión impresa ISSN 0325-2957
ALLES, Alberto et al. Early detection of Chronic Kidney Disease. Multidisciplinary document. Acta bioquím. clín. latinoam. [online]. 2010, vol.44, n.3, pp. 377-384. ISSN 0325-2957.
The increase in prevalence of patients with Chronic Kidney Disease (CKD) has turned it a worldwide public health problem not only due to its requirement of a kidney replaceable treatment, but also because cardiovascular disease is now the main cause of death among these patients. Plasma Creatinine (Crp) is not always an early marker, due to the fact that its blood levels exceed the highest limit of the reference range when the Glomerular Filtration Rate (GFR) decreases to a half. GFR measurement with exogenous markers is the best indicator to test renal function (RF), although its use in the clinical practice is only restricted to special situations. Creatinine Clearance (CC) may have errors caused by an inadequate urine collection. Moreover, it overestimates the GFR considering that creatinine is not only excreted but also secreted at the tubular level. The utilization of formulas associated to Crp is recommended by most of the Scientific Societies. The MDRD-4 equation has been adopted by consensus "eGFR (mL/min/1.73 m2)= 186 x (Crp) -1.154 x (age) -0.203 x (0.742 woman) x (1.212 black people)". When the creatinine results are traceable to isotope Dilution/Mass Spectrometry reference method, the initial factor is 175. This formula does not apply to pregnant women, hospitalized patients, people under 18 or older than 70 years old, amputees, etc. Given that the measurement of Crp is the biggest cause of error for the calculation of eGFR, the lab should validate the analytical procedure to determine creatinine. The Total Error should not exceed 8% in order not to yield an increase over 10% of GFR estimation. For CKD detection, it is recommended as follows: 1) Estimate the GFR using MDRD-4´s equation associated to Crp. (Strength of Recommendation C); 2) Report values over 60 mL/min/1.73 m2 only as "over 60" and values under 60 as the exact number obtained; 3) Exclude from automatic calculation systems, situations that limit the use of the equation.
Palabras clave : Chronic kidney disease; Plasma creatinine; Glomerular filtration rate; Associated formulas; Estimated glomerular filtration rate using MDRD equation.