Systematic Review Of Laboratory Diagnostic Markers That Indicate Glomerular Filtration Function Injury

Objective To evaluate diagnostic value of serum biochemical markers, such as cystatin C, creatinine, β₂-microglobulin, creatinine clearance rate, and estimated creatinine clearance rate by Cock-Gault formula, which indicate glomerular filtration function injury.Methods Selected subject words are indexed by computer in medline, embase, and Chinese biomedical literature database from 1993 to 2003. Thirty eight articles that are involved in those biomedical markers indicating glomerular filtration function injury are selected according to including and excluding criteria, these articles are evaluated systematically by using SPSS, EXCEL, and Revman statistical softwares.Results Systematic odds ratios of cystatin C, Crea, Ccr, Ccr_CG and β₂-MG are 42.31, 24.23, 17.37, 23.29, respectively. Areas under summary receiver operator characteristic curve are 0.935, 0.871, 0.898, 0.903, 0.844, respectively. Selected articles are subgrouped according to diagnostic standards, such as inulin, iohexol, ¹25I-iothalamate,⁵1Cr-EDTA, ⁹9mTc-DTPA, and so on. Inter-group analysis of Crea is not statistically different (p = 0.32),intra-group analysis of inulin, 51Cr-EDTA, 99mTc-DTPA, and iohexol are not statistically different, p value are 0.61, 0.50, 0.36, 0.32, respectively, intra-group analysis of 125I-iothalamate is statistically different (p = 0.02). Selected articles are subgrouped according to different analytic techniques of Crea and cystatin C, Inter-group analysis of Crea is not statistically different (p = 0.27), intra-group analysis of Jaffe method is statistically different (p = 0.03), intra-group analysis of enzymatic method is not statistically different (p - 0.22). Inter-group analysis of cystatin C is not statistically different (p = 0.21), intra-group analysis of particle- enhanced turbidimetric immunoassay and particle-enhanced nephelometric immunoassay are statistically different (p = 0.02, 0.04, respectively), intra-group analysis of enzyme-linked immunoadsorbent assay is not statistically different (p = 1.00). Conclusion In systematic review, odds ratios, combined with relevant sensitivity, specificity, accuracy, et al, indicate diagnostic efficiency. Consequently, cystatin C is considered as the best useful marker indicating glomerular filtration function injury, PETIA is commended to measure cystatin C, 51Cr-EDTA is selected for intermediary to measure glomerular filtration rate in investigation of cystatin C. Diagnostic efficiency of Crea is little inferior to cystatin C, enzymatic method is commended to measure crea, inulin or 51Cr-EDTA is selected to measure glomerular filtration rate in investigation of Crea.