Εργαστηριακή Προσέγγιση στη Διάγνωση Νεφρικών...

of 38/38
ΒΑΗΛΗΚΖ Υ. ΠΗΣΤΡΗΓΚΑ ΛΔΚΣΟΡΑ ΜΗΚΡΟΒΗΟΛΟΓΗΑ ΠΑΝ. ΑΘΖΝΩΝ ΔΡΓΑΣΖΡΗΑΚΖ ΠΡΟΔΓΓΗΖ ΣΖ ΔΓΚΑΗΡΖ ΓΗΑΓΝΩΖ ΝΔΦΡΗΚΩΝ ΝΟΖΜΑΣΩΝ

Embed Size (px)

Transcript of Εργαστηριακή Προσέγγιση στη Διάγνωση Νεφρικών...

Slide 1

. .

(acute kidney injury, AKI) , . , .., 125% 5080% AKI (Barrantes et al. 2009) 7- , 4- : [de Mendona A et al. 2000].

~ 2 . /

[Chertow GM et al. 2005]. (acute renal failure, ARF) (Acute Renal Injury, )

( ) ( ), , Lameire, Acute Renal Failure, Lancet 2005; 365: 41730

RIFLE [Bellomo R, et al. 2004]. , (cut-off) , GFR. 30 , , [Mehta RL, Chertow GM. 2003].3 : // (70%) ( , ) (25%) ( ) (5%) ( )Shock , () , , / : - - : ,

(GFR) O GFR

/

GFR:

ESRD GFR:

(GFR)1. (125I-, Iohexol,51Cr-EDTA,99mTc-DTPA, ..) GFR . 2. 3. 4. 24/2 5. 6. ( -C)

Cockcroft-Gault MDRD Schwartz Counahan-Barratt, 4.1 X (Cx) ( ml/min). GFR : , , 4.1.1. GFR: Cockcroft-Gault MDRD, Schwartz Counahan-Barratt, 4.1.2. 4.1.3. GFR Cockcroft-Gault: GFR (ml/min) = (140-)* / 72* (mg/dl) (*0,85 ) MDRD (Modification of Diet in Renal Disease): GFR (ml/min/1.73m2)= 186.3* (mg/dl) -1.154 * .-0.203 (*0.742 , *1.212 )

7 , , , , . : 1040% . sCr : GFR - sCr >50% GFR.

. ... ! GFR , Three problems are associated with the use of serum creatinine to quantitatively define AKI:Serum creatinine does not accurately reflect the GFR in a patient in whom it is not in steady state. In the early stages of AKI, the serum creatinine may be low, even though the actual (not estimated) GFR is markedly reduced, since there may not have been sufficient time for the creatinine to accumulate (see "Assessment of kidney function"). When the serum creatinine is rising, estimates of GFR based on creatinine values will overestimate the true GFR; conversely, estimates of GFR will underestimate the true GFR during recovery of kidney function, when the serum creatinine concentration is declining., indicating recovery of renal function.

8 !!!! , GFR, (, , ) /

40-50% () .

FeNa=(a x )/ (a x ) FeNa=( x )/ ( x )

RFI= /( / )

- /

/ / /

Uosm: UNa: Na U/P : /, P /P : / , FENa: a=UNaPNa/Ucr x PCr x 100, FE : =U x P /UcrxPcrx100. Uosm>400-500 mosm/kg~300mosm /kgUNa40U/P>404080% 3

Glomerular Bleeding ( 87,38% 97,16% 1999, 76:273)

: ( )

, , , - (dirty brown casts) : ( )

:

( )

(, ) / pH . pH / + +_ _ Cystatin C ( )NGAL (neutrophil gelatinase-associated lipocalin) ( ) KIM-1 (kidney injury molecule-1) () 1IL-18 ()LFABP (Liver-type Fatty Acid-Binding Protein) ()

Cystatin C C , . Cr ( GFR) . (, , ) .

122 , 13kDa / .. ( 0.51-0.98 mg/L) / .

NGAL (neutrophil gelatinase-associated lipocalin) 25 KD . (, , , ) , , Cr : Western-Blot ELISA

J Am Soc Nephrol 14: 25342543, 2003

NGAL (neutrophil gelatinase-associated lipocalin) . / : . :

NGAL , , .

2548 19 (, / , ) (, ) Am J Kidney Dis, Vol 54 (6) (December), 2009: pp 1012-1024

> x10 2-6 Cr 1-3 .

kim-1 (kidney injury molecule-1)

1. , . . , 50% 24 kim-1 (kidney injury molecule-1) . ,

Nephrol Dial Transplant (2009) 24: 32653268. : (, , , ..) IL-18 TNF, IL-1, , . . / , , (ARDS) IL-8 : , . - ILS18 =

Liver-type Fatty Acid-Binding Protein (L-FABP)FABPs: . stress . (4 ) ( 3,3% )

: : . : , ,

!