Pomen določanja razmerja sečnina/kreatinin in mioglobina v diagnostiki ledvičnih obolenj

Fijačko, Amanades (author), Osredkar, Joško (mentor), Možina, Hugon (comentor)

Bolezni ledvic predstavljajo klinični izziv, ki zahteva natančno in pravočasno diagnostiko za ustrezno zdravljenje in preprečevanje zapletov. Med mogočimi biokemičnimi parametri pri oceni ledvične funkcije sta razmerje sečnina/kreatinin (S/K) in koncentracija mioglobina, saj omogočata vpogled v patofiziološke procese. Razmerje sečnina/kreatinin (običajno okoli 40) pomaga razlikovati med prerenalno, renalno in postrenalno odpovedjo ledvic. Povišano razmerje kaže na prerenalno okvaro, nizko pa na renalno okvaro. S popuščanjem ledvične funkcije se tudi očistek mioglobina zmanjšuje in posledično naraščata koncentracija mioglobina v serumsku in urinu. Mioglobin je ključen pri diagnosticiranju rabdomiolize in posledične akutne poškodbe ledvic. Sočasna ocena obeh parametrov izboljša diagnostiko in omogoča zgodnje ukrepanje. V magistrski nalogi smo izračunali razmerje obeh analitov in ga primerjali z izračunano oceno hitrosti GF (oGF). Z izračunom smo poskusili ugotoviti ali gre za prerenalno ali pa postrenalno ledvično okvaro. Ugotovitev na osnovi izračuna smo primerjali s kliničnim zaključkom. Med skupinama smo primerjali tudi vrednosti mioglobina in ugotavljali, kako dober označevalec tipa okvare ledvic je. Za potrebe raziskave smo zbrali podatke o 126 bolnikih, ki so bili sprejeti v obdobju petih mesecev. Mann-Whitneyjev U-test je pokazal, da razlika v razmerju S/K med bolniki z akutno ledvično okvaro in kronično ledvično boleznijo ni statistično značilna (p = 0,0801). Tudi razlika med S-mioglobinom med obema skupinama ni bila statistično značilna (p = 0,7042). Prav tako ni bilo statistično značilne razlike v oGF (p = 0,5247), kot nakazujejo mediane, kjer je imela akutna skupina mediano 40 in kronična skupina 40,5 ml/min/1,73 m². S-mioglobin je ključni označevalec akutne poškodbe ledvic. Njegova korelacija z oGF (Spearmanov korelacijski koeficient -0,630) je trikrat večja od korelacije razmerja S/K z oGF (0,188). Nižji oGF pri akutnih bolnikih potrjuje akutni stres, pri kroničnih pa postopno upadanje ledvične funkcije. Prihodnje raziskave bi morale vključiti dodatne označevalce in multivariatne modele za natančnejšo oceno glomerularne filtracije ter upoštevati zunanje dejavnike, večji vzorec in različne populacije za boljšo posplošitev zaključkov.

• Language: Slovenian
• Keywords: bolezni ledvic, razmerje sečnina/kreatinin, mioglobin
• Work type: Master's thesis/paper
• Organization: FFA - Faculty of Pharmacy
• Year: 2025
• PID: 20.500.12556/RUL-168496
• Publication date in RUL: 16.04.2025

Secondary language

• Language: English
• Title: The importance of urea/creatinine ratio and myoglobin determination in diagnostics of renal diseases

Abstract

Kidney disease is a clinical challenge that requires accurate and timely diagnosis for appropriate treatment and prevention of complications. The urea/creatinine (U/C) ratio and myoglobin concentration are among the possible biochemical parameters to assess renal function, as they provide insight into the pathophysiological processes. The urea/creatinine ratio (usually around 40) helps to differentiate between prerenal, renal, and postrenal renal failure. An elevated ratio indicates prerenal impairment and a low ratio indicates renal impairment. As renal function declines, myoglobin clearance also decreases and, as a consequence, serum and urine myoglobin concentrations rise. Myoglobin is crucial in the diagnosis of rhabdomyolysis and subsequent acute kidney injury. Simultaneous assessment of both parameters improves diagnosis and allows early intervention. In this thesis, we calculated the ratio of the two analytes and compared it with the calculated estimate of the GF velocity (eGFR). The calculation was performed to determine whether the renal impairment is prerenal or postrenal. The conclusion based on the calculation was compared with the clinical conclusion. We also compared myoglobin values between the two groups to see how good a marker of the type of renal impairment is. For this study, we collected data on 126 patients admitted over five months. The Mann-Whitney U-test showed that the difference in U/C ratio between patients with acute kidney injury and chronic kidney disease was not statistically significant (p = 0,0801). The difference in S-myoglobin between the two groups was also not statistically significant (p = 0,7042). There was also no significant difference in eGFR (p = 0,5247), as indicated by the medians, where the acute group had a median of 40 and the chronic group 40,5 ml/min/1.73 m². S-myoglobin is a key marker of acute kidney injury. Its correlation with eGFR (Spearman correlation coefficient -0,630) is three times higher than the correlation of the U/C ratio with eGFR (0,188). Lower eGFR in acute patients confirms acute stress, whereas in chronic patients it confirms a progressive decline in renal function. Future research should include additional markers and multivariate models to estimate glomerular filtration more accurately, and consider external factors, larger sample sizes and different populations to better generalise conclusions.

• Keywords: kidney disease, urea/creatinine ratio, myoglobin