[fr] Les recommandations internationales de 2005 concernant l’insuffisance
rénale chronique proposent une classification basée sur le débit de filtration
glomérulaire (DFG). Depuis cette date, la question posée de la validité des
formules évaluant le DFG, et des créatininémies qui y sont insérées, se pose de
façon encore plus cruciale qu’il y a quelques années. Pour les biologistes, les
conséquences de ces recommandations cliniques sont importantes. En premier
lieu, la formule classique de Cockcroft-Gault doit être abandonnée au profit de
l’équation dite MDRD à 4 variables, et ce malgré les recommandations officielles
françaises actuelles, qui devraient être modifiées d’ici peu. D’autre part,
afin d’optimiser l’évaluation du DFG par cette formule, les biologistes doivent
choisir entre la version dite « 186 » de l’équation MDRD, adaptée aux méthodes
de dosage de la créatininémie non raccordées à la méthode de référence
(chromatographie liquide ou gazeuse couplée à la spectrométrie de masse) et la
version dite « 175 », adaptée aux méthodes de dosages raccordées. A ce jour,
seules certaines méthodes enzymatiques ont fait la preuve de leur raccordement
à une méthode de référence. L’avenir des méthodes colorimétriques
classiques est incertain.
Evolution des modalités d'évaluation de la fonction rénale basée sur la créatinine entre 2005 et 2008: conséquences pour les biologistes
Alternative titles :
[en] Consequences for clinical biochemists of the modifications of the creatinine-based evaluation of glomerular filtration rate between 2005 and 2008.
Publication date :
2008
Journal title :
Annales de Biologie Clinique
ISSN :
0003-3898
eISSN :
1950-6112
Publisher :
John Libbey Eurotext, Montrouge, France
Volume :
66
Issue :
3
Pages :
263-8
Peer reviewed :
Peer Reviewed verified by ORBi
Commentary :
Since 2005, international guidelines propose a stadification for
chronic renal failure based on the glomerular filtration rate (GFR) value. The
performance of the creatinine-based equations allowing the estimation of GFR
and the bias of the creatinine measurements is, more than ever, a crucial issue.
The consequences for the clinical biologists are of importance. First, the
Cockcroft-Gault formula must be replaced by the four variable-MDRD equation.
Second, the biologists must chose from the “175” and the “186” versions
of the MDRD equation. The first one fits the creatinine methods which are
traceable to the reference method (liquid or gas chromatography coupled to
mass spectrometry). The second equation must be used for creatinine methods,
which are not traceable to the reference method. Today, only some enzymatic
methods can prove that they are traceable to the reference method. For the
colorimetric methods, future is inclear.
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