- 期刊
- OpenAccess
A Simple Estimation of Glomerular Filtration Rate in Taiwanese Children Using the Schwartz Formula
以Schwartz公式快速評估台灣兒童腎功能
摘要
對吾人來說評估病人的腎功能是非常重要的，尤其是當需要知道病人的腎功能去調整藥物的劑量及水分和電解質的給予。一般常用24小時小便肌酐酸的清除率代替腎絲球過濾率，來評估病人的腎功能。可是在有些情況下，小便的收集不易又或者是需要立即估算病人的腎功能來調整藥物的劑量，所以發展出來許多公式來預估腎功能。Schwartz公式（Ccr=kxL/Pcr；k為常數，在2歲以上的兒童為0.55，L為身高，Pcr為血中肌酐酸濃度）是評估兒童腎功能最常使用的公式之一。過去有許多研究在探討k值的數值，有學者建議不同地區的k值應重新評估。由於缺乏台灣地區兒童k值的參考數據，故我們選取了本院91個年紀1到15歲，不同性別疾病腎功能的住院病人，量身高和體重並檢驗血中肌酐酸的濃度和24小時小便肌酐酸的量，探討Ccr和L/Pcr的關係，以線性迴歸計算出來預估的Ccr=0.435×L/Pcr（R值為0.964, Adjust R平方值為0.925, k值95%信賴區間為0.410~0461）。對台灣地區的兒童而言，Schwartz公式高估了病人腎功能值，k值應修正為0:435較為適當。
並列摘要
Background: It is important to evaluate the kidney Junction of patients and usually we collect urine for 24 hours to estimate creatinine clearance as a substitute for glomerular filtration rate (GFR). However, in daily practice, we usually need to immediately evaluate the kidney function of patients. Therefore, several formulae have been developed to rapidly assess GFR. The Schwartz formula is the most frequently used method for rapid assessment of GFR in children. Many studies have been done to determine the limitations of this formula, which due to the relationship between muscle mass and body height, may be influenced by genetics, age, and nutritional status. It has been recommended that the constant k value be adjusted for different localities. In Taiwan, there is no reference k value for children, so the aim of our study was to evaluate the constant k value of the Schwartz formula for Taiwanese children in order to establish an appropriate formula for estimation of GFR in Taiwanese children. Methods: The medical records of pediatric patients (aged 1-15 years) with various diseases and with renal function that was either normal or impaired and had 24-hours urine creatinine determinations completed at Taipei Veterans General Hospital from January, 2004 to December, 2005 were reviewed. Height in centimeters (L) and weight in kilometers (W) were measured. Time of urine collection and urine volume were measured to calculate urine flow (mL/min) (V). Body surface area (m^2) (BSA) was also measured. Quantitative urinary and plasma creatinine concentrations (Ucr and Pcr) were determined. Creatinine clearance (Ccr) was calculated by using the following formula. Ucr×V×1.731 (Pcr×BSA). The linear regression between Ccr and L/Pcr was studied and adjusted to the Schwartz formula Ccr=k×L/Pcr by using commercially available software for this purpose (SPSS, version 14.0 [SPSS Inc, Chicago, IL, USA]) Results: Ninety-one children (45 boys and 46 girls) were enrolled into this study. The children were aged from 1 to 15 years. The linear regression association between Ccr and L/Pcr was analyzed and adjusted to the Schwartz formula which revealed that Ccr(subscript E)=0.435×L/Pcr (R=0.964; adjust R square=0.928; the calculated 95% confidence interval of the coefficient was 0.410-0.461). Conclusions: We suggest estimating Ccr(subscript E) in Taiwanese children of either sex by using a modification of the Schwartz formula in which the coefficient is equal to 0.435.