medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2020-15-44-48medalphabet-1601Research ArticleСтатьиОсобенности определения скорости клубочковой фильтрации при оценке функции почек у больных ревматоидным артритомFeatures of glomerular filtration rate evaluation for kidney function assessment in patients with rheumatoid arthritisАлександровВ. А.AleksandrovV. A.

Младший научный сотрудник   

Волгоград 

ШиловаЛ. Н.ShilovaL. N.

Доктор медицинских наук, доцент, заведующий кафедрой госпитальной терапии   

Волгоград 

АлександровА. В.AleksandrovA. V.

Доктор медицинских наук, заведующий лабораторией   

Волгоград

ФГБНУ «Научно-исследовательский институт клинической и экспериментальной ревматологии имени А.Б. Зборовского»РоссияResearch Institute for Clinical and Experimental Rheumatology n.a. A. B. ZborovskyRussian FederationФГБОУ ВО «Волгоградский государственный медицинский университет» Минздрава РоссииРоссияVolgograd State Medical UniversityRussian Federation202012092020015 (2020)Ревматология в общей практике4448Copyright © Александров В.А., Шилова Л.Н., Александров А.В., 20202020Александров В.А., Шилова Л.Н., Александров А.В.Aleksandrov V.A., Shilova L.N., Aleksandrov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-alphabet.com/jour/article/view/1601

Развитие почечной дисфункции у больных ревматоидным артритом (РА) обусловлено наличием и выраженностью аутоиммунных нарушений, хроническим системным воспалением, множественностью коморбидных состояний и особенностями фармакотерапии. Наиболее востребованным параметром, лучше всего характеризующим общее состояние почек, является скорость клубочковой фильтрации (СКФ). В настоящем обзоре представлены данные о возможностях современных методов определения расчетной СКФ (рСКФ) и особенностях их использования в различных клинических ситуациях, сопровождающих течение РА. Для первоначальной оценки СКФ у больных РА целесообразно проводить измерение рСКФкр на основе креатинина сыворотки крови с использованием уравнения CKD-EPI от 2009 года (с или без индексации по площади поверхности тела), а в случаях, когда уравнения рСКФкр не обладают достаточной надежностью или для принятия клинических решений результатов данного теста недостаточно, следует измерять уровень цистатина Св сыворотке крови и использовать расчет комбинированной СКФ на основе креатинина и цистатина С (рСКФкр-цис).

The development of renal dysfunction in patients with rheumatoid arthritis (RA) is due to the presence and severity of autoimmune disorders, chronic systemic inflammation, a multiplicity of comorbid conditions, and pharmacotherapy features. The most important parameter that describes the general condition of the kidneys is glomerular filtration rate (GFR). This review presents the data on the possibilities of modern methods for determining estimated GFR (e-GFR) and the specificity of their use in various clinical situations that accompany the course of RA. For the initial assessment of GFR in patients with RA it is advisable to use the measurement of e-GFR based on serum creatinine concentration using the CKD-EPI equation (2009) (with or without indexing by body surface area). In cases where the e-GFR equations are not reliable enough or the results of this test are insufficient for clinical decision making, the serum cystatin C level should be measured and the combined GFR calculation based on creatinine and cystatin C should be used.

скорость клубочковой фильтрациикреатининцистатинревматоидный артритglomerular filtration ratecreatinincystatinrheumatoid arthritisReferencesСмирнов А.В., Шилов Е.М., Добронравов В.А., Каюков И. Г., Бобкова И.Н., Швецов М.Ю., Цыгин А.Н., Шутов А. М. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению // Нефрология. 2012; 16 (1): 89–115. https://doi.org/10.24884/1561–6274–2012–16–1–89–115.Смирнов А.В., Шилов Е.М., Добронравов В.А., Каюков И. Г., Бобкова И.Н., Швецов М.Ю., Цыгин А.Н., Шутов А. М. Национальные рекомендации. Хроническая болезнь почек: основные принципы скрининга, диагностики, профилактики и подходы к лечению // Нефрология. 2012; 16 (1): 89–115. https://doi.org/10.24884/1561–6274–2012–16–1–89–115.Клинические рекомендации. Хроническая болезнь почек (ХБП) в редакции 2019 года. URL: http://nonr.ru/?p=4092 (дата обращения: 23.03.2020).Клинические рекомендации. Хроническая болезнь почек (ХБП) в редакции 2019 года. URL: http://nonr.ru/?p=4092 (дата обращения: 23.03.2020).National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. // Am J Kidney Dis. 2002; 39: S1–S266.National Kidney Foundation. K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. // Am J Kidney Dis. 2002; 39: S1–S266.Seegmiller J.C., Eckfeldt J.H., Lieske J.C. Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective // Adv Chronic Kidney Dis. 2018; 25 (1): 84–92. DOI: https://doi.org/10.1053/j.ackd.2017.10.006.Seegmiller J.C., Eckfeldt J.H., Lieske J.C. Challenges in Measuring Glomerular Filtration Rate: A Clinical Laboratory Perspective // Adv Chronic Kidney Dis. 2018; 25 (1): 84–92. DOI: https://doi.org/10.1053/j.ackd.2017.10.006.Chardon L., Dubourg L., Barin-Le Guellec C., Guinard F., Hannedouche T., Halimi J.M., Mariat C. Measurement of glomerular filtration rate using a reference method. // Ann Biol Clin (Paris). 2019 Aug 1; 77 (4): 371–374. DOI: 10.1684/abc.2019.1455.Chardon L., Dubourg L., Barin-Le Guellec C., Guinard F., Hannedouche T., Halimi J.M., Mariat C. Measurement of glomerular filtration rate using a reference method. // Ann Biol Clin (Paris). 2019 Aug 1; 77 (4): 371–374. DOI: 10.1684/abc.2019.1455.Chaves A. A., Buchpiguel C. A., Praxedes J. N., Bortolotto L. A., Sapienza M. T. Glomerular filtration rate measured by (51) Cr-EDTA clearance: Evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis. // Clinics (Sao Paulo). 2010; 65 (6): 607–612. DOI: 10.1590/S1807–59322010000600008.Chaves A. A., Buchpiguel C. A., Praxedes J. N., Bortolotto L. A., Sapienza M. T. Glomerular filtration rate measured by (51) Cr-EDTA clearance: Evaluation of captopril-induced changes in hypertensive patients with and without renal artery stenosis. // Clinics (Sao Paulo). 2010; 65 (6): 607–612. DOI: 10.1590/S1807–59322010000600008.Soveri I., Berg U.B., Björk J., Elinder C.G., Grubb A., Mejare I., Sterner G., Bäck S. E.; SBU GFR Review Group. Measuring GFR: a systematic review // Am J Kidney Dis. 2014 Sep; 64 (3): 411–24. DOI: 10.1053/j.ajkd.2014.04.010.Soveri I., Berg U.B., Björk J., Elinder C.G., Grubb A., Mejare I., Sterner G., Bäck S. E.; SBU GFR Review Group. Measuring GFR: a systematic review // Am J Kidney Dis. 2014 Sep; 64 (3): 411–24. DOI: 10.1053/j.ajkd.2014.04.010.Delanaye P., Melsom T., Ebert N. et al. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 2: Why to measure glomerular filtration rate with iohexol? // Clin Kidney J. 2016; 9 (5): 700–704. DOI: 10.1093/ckj/sfw071.Delanaye P., Melsom T., Ebert N. et al. Iohexol plasma clearance for measuring glomerular filtration rate in clinical practice and research: a review. Part 2: Why to measure glomerular filtration rate with iohexol? // Clin Kidney J. 2016; 9 (5): 700–704. DOI: 10.1093/ckj/sfw071.Greenberg N., Roberts W.L., Bachmann L.M. Specificity characteristics of 7 commercial creatinine measurement procedures by enzymatic and Jaffe method principles // Clin Chem. 2012; 58: 391–401.Greenberg N., Roberts W.L., Bachmann L.M. Specificity characteristics of 7 commercial creatinine measurement procedures by enzymatic and Jaffe method principles // Clin Chem. 2012; 58: 391–401.McGill M.R., Vijayan A., Trulock E. P., Witt C. A., Kohler G.D., Scott M.G. Falsely elevated plasma creatinine due to an Immunoglobulin M Paraprotein. // Am J Kidney Dis. 2016; 68: 789–79226.McGill M.R., Vijayan A., Trulock E. P., Witt C. A., Kohler G.D., Scott M.G. Falsely elevated plasma creatinine due to an Immunoglobulin M Paraprotein. // Am J Kidney Dis. 2016; 68: 789–79226.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease// Kidney Int Suppl. 2013; 3: 1–150.KDIGO 2012 clinical practice guideline for the evaluation and management of chronic kidney disease// Kidney Int Suppl. 2013; 3: 1–150.Vart P., Grams M.E. Measuring and assessing kidney function. SeminNephrol. // 2016; 36: 262–272.Vart P., Grams M.E. Measuring and assessing kidney function. SeminNephrol. // 2016; 36: 262–272.Bostan Gayret Ö., Taşdemir M., Erol M., et al. Are there any new reliable markers to detect renal injury in obese children? // Ren Fail. 2018; 40: 416–422.Bostan Gayret Ö., Taşdemir M., Erol M., et al. Are there any new reliable markers to detect renal injury in obese children? // Ren Fail. 2018; 40: 416–422.Liu X., Foster M.C., Tighiouart H., et al. Non-GFR Determinants of Low-Molecular-Weight Serum Protein Filtration Markers in CKD // Am J Kidney Dis. 2016; 68 (6): 892–900. DOI: 10.1053/j.ajkd.2016.07.021.Liu X., Foster M.C., Tighiouart H., et al. Non-GFR Determinants of Low-Molecular-Weight Serum Protein Filtration Markers in CKD // Am J Kidney Dis. 2016; 68 (6): 892–900. DOI: 10.1053/j.ajkd.2016.07.021.Schei J., Stefansson V. T.N., Mathisen U. D. et al. Residual associations of inflammatory markers with eGFR after accounting for measured GFR in a community-based cohort without CKD. // Clin J Am Soc Nephrol. 2016; 11: 2802–2886.Schei J., Stefansson V. T.N., Mathisen U. D. et al. Residual associations of inflammatory markers with eGFR after accounting for measured GFR in a community-based cohort without CKD. // Clin J Am Soc Nephrol. 2016; 11: 2802–2886.Stevens L.A., Schmid C.H., Greene T. et al. Factors other than glomerular filtration rate affect serum cystatin C levels. // Kidney Int. 2009; 75: 652–660.Stevens L.A., Schmid C.H., Greene T. et al. Factors other than glomerular filtration rate affect serum cystatin C levels. // Kidney Int. 2009; 75: 652–660.Inker L. A., Schmid C.H., Tighiouart H. Estimating glomerular filtration rate from serum creatinine and cystatin C. // N Engl J Med. 2012; 367: 20–2921.Inker L. A., Schmid C.H., Tighiouart H. Estimating glomerular filtration rate from serum creatinine and cystatin C. // N Engl J Med. 2012; 367: 20–2921.Levey A. S., Eckfeldt J.H. Using glomerular filtration rate estimating equations: clinical and laboratory considerations. // Clin Chem. 2015; 61: 1226–1229.Levey A. S., Eckfeldt J.H. Using glomerular filtration rate estimating equations: clinical and laboratory considerations. // Clin Chem. 2015; 61: 1226–1229.Inker L. A., Okparavero A. Cystatin C as a marker of glomerular filtration rate: prospects and limitations. // Curr Opin Nephrol Hypertens. 2011; 20: 631–639.Inker L. A., Okparavero A. Cystatin C as a marker of glomerular filtration rate: prospects and limitations. // Curr Opin Nephrol Hypertens. 2011; 20: 631–639.Grubb A., Blirup-Jensen S., Lindstrom V., Schmidt C., Althaus H., Zegers I. First certified reference material for cystatin C in human serum ERM-DA471/ IFCC. // Clin Chem Lab Med. 2010; 48: 1619–1621.Grubb A., Blirup-Jensen S., Lindstrom V., Schmidt C., Althaus H., Zegers I. First certified reference material for cystatin C in human serum ERM-DA471/ IFCC. // Clin Chem Lab Med. 2010; 48: 1619–1621.Bargnoux A.S., Pieroni L., Cristol J.P. et al. Multicenter evaluation of cystatin C measurement after assay standardization. // Clin Chem. 2017; 63: 833–841.Bargnoux A.S., Pieroni L., Cristol J.P. et al. Multicenter evaluation of cystatin C measurement after assay standardization. // Clin Chem. 2017; 63: 833–841.Frazee E., Rule A. D., Lieske J. C. Cystatin C-Guided Vancomycin dosing in critically ill patients: a quality Improvement project. // Am J Kidney Dis. 2017; 69: 658–666.Frazee E., Rule A. D., Lieske J. C. Cystatin C-Guided Vancomycin dosing in critically ill patients: a quality Improvement project. // Am J Kidney Dis. 2017; 69: 658–666.Eppenga W. L., Kramers C., Derijks H.J., Wensing M., Wetzels J. F., De Smet P.A. Individualizing pharmacotherapy in patients with renal impairment: the validity of the modification of diet in renal disease formula in specific patient populations with a glomerular filtration rate below 60 ml/min. A systematic review. // PLoS One. 2015; 10 (3): e0116403. DOI: 10.1371/journal.pone.0116403.Eppenga W. L., Kramers C., Derijks H.J., Wensing M., Wetzels J. F., De Smet P.A. Individualizing pharmacotherapy in patients with renal impairment: the validity of the modification of diet in renal disease formula in specific patient populations with a glomerular filtration rate below 60 ml/min. A systematic review. // PLoS One. 2015; 10 (3): e0116403. DOI: 10.1371/journal.pone.0116403.Delanaye P., Mariat C. The applicability of eGFR equations to different populations. // Nat Rev Nephrol. 2013; 9: 513–522.Delanaye P., Mariat C. The applicability of eGFR equations to different populations. // Nat Rev Nephrol. 2013; 9: 513–522.Brück K., Jager K. J., Dounousi E. et al. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. // Nephrol Dial Transplant. 2015; 30: iv6–iv16.Brück K., Jager K. J., Dounousi E. et al. Methodology used in studies reporting chronic kidney disease prevalence: a systematic literature review. // Nephrol Dial Transplant. 2015; 30: iv6–iv16.Delanaye P., Cavalier E., Moranne O. et al. Creatinine- or cystatin C-based equations to estimate glomerular filtration in the general population: impact on the epidemiology of chronic kidney disease. // BMC Nephrol. 2013; 14: 57.Delanaye P., Cavalier E., Moranne O. et al. Creatinine- or cystatin C-based equations to estimate glomerular filtration in the general population: impact on the epidemiology of chronic kidney disease. // BMC Nephrol. 2013; 14: 57.Pottel H., Hoste L., Dubourg L. et al. A new estimating glomerular filtration rate equation for the full age spectrum. // Nephrol Dial Transplant. 2016; 31: 798–806.Pottel H., Hoste L., Dubourg L. et al. A new estimating glomerular filtration rate equation for the full age spectrum. // Nephrol Dial Transplant. 2016; 31: 798–806.Nordin G. Cystatin C–Incremental Improvement in measurement and understanding of results. // Clin Chem. 2017; 63: 802–803.Nordin G. Cystatin C–Incremental Improvement in measurement and understanding of results. // Clin Chem. 2017; 63: 802–803.Filler G., Kusserow C., Lopes L., Kobrzynski M. Beta-trace protein as a marker of GFR–history, indications, and future research. // Clin Biochem. 2014; 47: 1188–1194.Filler G., Kusserow C., Lopes L., Kobrzynski M. Beta-trace protein as a marker of GFR–history, indications, and future research. // Clin Biochem. 2014; 47: 1188–1194.Wong J., Sridharan S., Berdeprado J. et al. Predicting residual kidney function in hemodialysis patients using serum β-trace protein and β2-microglobulin. // Kidney Int. 2016; 89: 1090–1098.Wong J., Sridharan S., Berdeprado J. et al. Predicting residual kidney function in hemodialysis patients using serum β-trace protein and β2-microglobulin. // Kidney Int. 2016; 89: 1090–1098.Sekula P., Goek O.N., Quaye L. et al. A Metabolome-Wide association study of kidney function and disease in the general population. // J Am SocNephrol. 2016; 27: 1175–1188.Sekula P., Goek O.N., Quaye L. et al. A Metabolome-Wide association study of kidney function and disease in the general population. // J Am SocNephrol. 2016; 27: 1175–1188.Saisho K., Yoshikawa N., Sugata K., Hamada H., Tohma S. Prevalence of chronic kidney disease and administration of RA-related drugs in patients with RA: The NinJa 2012 study in Japan // Mod Rheumatol. 2016; 26 (3): 331–5. DOI: 10.3109/14397595.2015.1088620.Saisho K., Yoshikawa N., Sugata K., Hamada H., Tohma S. Prevalence of chronic kidney disease and administration of RA-related drugs in patients with RA: The NinJa 2012 study in Japan // Mod Rheumatol. 2016; 26 (3): 331–5. DOI: 10.3109/14397595.2015.1088620.Кабалык М. А., Бондарева Ж. В., Дубровина М.С. Математические модели исследования факторов риска прогрессирования дисфункции почек у больных ревматоидным артритом // Молодой ученый.– 2015.– № 20.– С. 127– 132.– URL https://moluch.ru/archive/100/22222 (дата обращения: 27.02.2020).Кабалык М. А., Бондарева Ж. В., Дубровина М.С. Математические модели исследования факторов риска прогрессирования дисфункции почек у больных ревматоидным артритом // Молодой ученый.– 2015.– № 20.– С. 127– 132.– URL https://moluch.ru/archive/100/22222 (дата обращения: 27.02.2020).Hannawi S., Hannawi H., Alokaily F., Al Salmi I. Variables associated with subclinical atherosclerosis among rheumatoid arthritis patients of Gulf Cooperative Council countries. // Saudi Med J. 2020 Feb; 41 (2): 128–137. DOI: 10.15537/smj.2020.2.24900.Hannawi S., Hannawi H., Alokaily F., Al Salmi I. Variables associated with subclinical atherosclerosis among rheumatoid arthritis patients of Gulf Cooperative Council countries. // Saudi Med J. 2020 Feb; 41 (2): 128–137. DOI: 10.15537/smj.2020.2.24900.Hickson L.J., Crowson C.S., Gabriel S.E., McCarthy J.T., Matteson E.L. Development of reduced kidney function in rheumatoid arthritis. // Am J Kidney Dis. 2014; 63 (2): 206–213. DOI: 10.1053/j.ajkd.2013.08.010.Hickson L.J., Crowson C.S., Gabriel S.E., McCarthy J.T., Matteson E.L. Development of reduced kidney function in rheumatoid arthritis. // Am J Kidney Dis. 2014; 63 (2): 206–213. DOI: 10.1053/j.ajkd.2013.08.010.Wagan A.A., Nasir S., Rahim A., Khan D. Impaired renal functions in Pakistani cohort of rheumatoid arthritis. // Pak J Med Sci. 2019; 35 (4): 905–910. DOI: 10.12669/pjms.35.4.564.Wagan A.A., Nasir S., Rahim A., Khan D. Impaired renal functions in Pakistani cohort of rheumatoid arthritis. // Pak J Med Sci. 2019; 35 (4): 905–910. DOI: 10.12669/pjms.35.4.564.Nozawa Y., Sato H., Wakamatsu A., Kobayashi D., Nakatsue T., Wada Y., Kuroda T., Kazama J. J., Suzuki Y., Nakano M., Narita I. Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy // Clin Chim Acta. 2018 Dec; 487: 299–305. DOI: 10.1016/j.cca.2018.10.022.Nozawa Y., Sato H., Wakamatsu A., Kobayashi D., Nakatsue T., Wada Y., Kuroda T., Kazama J. J., Suzuki Y., Nakano M., Narita I. Utility of estimated glomerular filtration rate using cystatin C and its interpretation in patients with rheumatoid arthritis under glucocorticoid therapy // Clin Chim Acta. 2018 Dec; 487: 299–305. DOI: 10.1016/j.cca.2018.10.022.Zhu X. R., Ge N., Wang Y., Zhai J. L., Liu C. Corticosteroids significantly increase cystatin C levels in the plasma by promoting cystatin C production in rats. // Ren Fail. 2019; 41 (1): 698–703. DOI: 10.1080/0886022X.2019.1638798.Zhu X. R., Ge N., Wang Y., Zhai J. L., Liu C. Corticosteroids significantly increase cystatin C levels in the plasma by promoting cystatin C production in rats. // Ren Fail. 2019; 41 (1): 698–703. DOI: 10.1080/0886022X.2019.1638798.Levey A. S., Becker C., Inker L.A. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. // JAMA. 2015; 313 (8): 837–846. DOI: 10.1001/jama.2015.0602.Levey A. S., Becker C., Inker L.A. Glomerular filtration rate and albuminuria for detection and staging of acute and chronic kidney disease in adults: a systematic review. // JAMA. 2015; 313 (8): 837–846. DOI: 10.1001/jama.2015.0602.

The authors declare that there are no conflicts of interest present.