日本腎臓学会誌
Online ISSN : 1884-0728
Print ISSN : 0385-2385
ISSN-L : 0385-2385
イヌリンクリアランスを用いた糸球体濾過量の評価
クレアチニンクリアランスとの比較
折田 義正下條 文武坂爪 実椎貝 達夫前田 益孝今井 圓裕藤井 健遠藤 正之神出 毅一郎羽田 勝計杉本 俊郎菱田 明高橋 聡細谷 龍男山本 裕康洞 和彦岡田 洋一保坂 成俊小口 智雅神應 裕西尾 康英矢野 新太郎相川 一男安井 聖
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2005 年 47 巻 7 号 p. 804-812

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Inulin clearance (Cin) is widely believed to be the gold standard of the glomerular filtration rate (GFR). However, in Japan, Cin has not been officially recognized by the Ministry of Health, Labour and Welfare of Japan for clinical use. Creatinine clearance (Ccr) has been used to estimate the renal function of patients, but there have been many studies in which Ccr estimates were GFR falsely high because the metabolism and tubular excretion of creatinine widely varied according to the pathophysiological state of the patient. In the present study, we determined Cin and Ccr simultaneously in 116 adult patients with renal diseases and diabetic mellitus. The clearance study was performed by the modified Wesson's method. The inulin preparation was FFI-1010 (Fuji Yakuhin Co. Ltd.). Inulin in serum and urine was determined by the newly devised enzymatic assay (Toyobo Co. Ltd.), which is specific for inulin. The mean Cin was 35.0±14.4ml/min/1.73m2. The mean Ccr (the enzyme assay) was 63.6±24.1ml/min/1.73m2 and that of the kinetic Jaffe assay was 55.3±19.3ml/min/1.73m2. Mean Ccr/Cin was 1.93±0.73, 1.69±0.62, respectively. This ratio was significantly different (p<0.05) in the degree of reduction of Cm, with values of 2.07±0.82 (Cin<40ml/min/1.73m2) and 1.64±0.32 (40<Cin<80ml/min/1.73m2), respectively. Only 8 patients were classified into the same degree of reduced renal function (the Guideline of Japanese Society of Nephrology).
The findings of this study suggest that the GFR determined by Ccr could misjudge the renal function of patient and delay the administration of proper treatment of the patient. Introduction of Cin into the clinical field is necessary to avoid this delay.

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