Diagnostic Value of Creatinine for Indicating Glomerular Filtration Function Injury: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

Li Ping , Zhao Ying , Yu ting

Department of Laboratory Medicine; West China Hospital; Sichuan University; Chengdu; 610041; China;

Corresponding author：

Keywords：

Glomerular filtration function injury; Meta-analysis; Summary ROC curve; Laboratory diagonosis

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Objective 　To evaluate the diagnostic value of creatinine, as an indicator of glomerular filtration function injury.
Methods 　MEDLINE, EMBASE and CBM-disc were searched from 1993 to 2003. Thirty four articles that described biomedical markers to indicate glomerular filtration function injury were selected according to specified inclusion criteria. These articles were evaluated systematically using SPSS, EXCEL, and RevMan software.
Results 　The odds ratios of creatinine was 24.23. Areas under summarized receiver operator characteristic curve were 0.871. Selected articles were divided to groups for analysis according to diagnostic standards, such as inulin, iohexol, 125I-iothalamate, 51Cr-EDTA, 99mTc-DTPA and sodium thiosulfate. Inter-group analysis of creatinine was not statistically different (P=0.32). Intra-group analysis of inulin, 51Cr-EDTA, 99mTc-DTPA, and iohexol was not statistically different, P value were 0.61, 0.50, 0.36, 0.32, respectively. Intra-group analysis of 125I-iothalamate was statistically different (P=0.02). Selected articles were sub-grouped according to different analytic techniques of creatinine. Intra-group analysis by the Jaffe method was statistically different (P=0.03), intra-group analysis of enzymatic method was not statistically different (P=0.22).
Conclusion 　The diagnostic value of creatinine was not qualified enough to indicate glomerular filtration function injury. Enzymatic methods are recommended to measure creatinine. Inulin or 51Cr-EDTA is suggusted to measure glomerular filtration rate in investigation of creatinine，and feedforward cohort is recommended to apply.

Citation： Li Ping,Zhao Ying,Yu ting. Diagnostic Value of Creatinine for Indicating Glomerular Filtration Function Injury: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2004, 04(11): 752-758. doi: Copy

1.	［1］Joronen I,Hopsu-Havu VK,M,Rinne A,Jarvinen M,Halonen P.detection of low molecular weight cysteine proteinase inhibitors by time-resolved fluoroimmunoassay[J]. J Immunal Meth, 1986; 86(23): 243-247.
2.	［2］Colle A,Tavera C,Prevot D,Leung-Tack J,Thomas Y,Manuel Y. Cystatin C levels in sera of patein with human immunodeficiency virus infection[J]. J immunoassay, 1992; 13: 47-60.
3.	［3］Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism[J]. Physiol Rev. 2000; 80(3): 1 107-1 213.
4.	［4］Qi HM,Xing Gang,Li JZ,Deng LR,Zhang CL,Wang HY.Evaluation of four methods about glomerular filtration function[J]. Laboratory Journal of Chinses Medicine, 2002; 25(3):150152齐慧敏,幸岗,李惊子,邓利荣,张春丽,王洪源.四种肾小球滤过功能测定方法的评估分析[J]. 中华检验医学杂志,2002;25(3):150～152.
5.	［5］Harmoinen A,Lehtimaki T,Korpela M,Turjanmaa V,Saha H.Diagnostic Accuracies of Plasma creatinine,Cystatin C,and Glomerular flitration rate Calcuated by the Cockcroft-Gault and Levey(MDRD) formulas[J]. Clin Chem, 2003; 49(7): 1 223-1 225.
6.	［6］Christensson A, Ekberg J, Grubb A, Ekberg H, Lindstrom V. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation[J]. Nephron Physiol, 2003; 94(2): 19-27.
7.	［7］Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, Erlich D.Clin Chem. Plasma cystatin C is superior to 24h creatinine clearance and plasma creatinine for estimation of glomerular filtration rate 3 months after kidney[J].Transplantation, 2000; 46(8): 1 206-1 207.
8.	［8］Burkhardt H, Bojarsky G, Gladisch R. Diagnostic efficiency of cystatin C and serum creatinine as markers of reduced glomerular filtration rate in the elderly[J]. Clin Chem Lab Med, 2002; 40(11): 1 135-1 138.
9.	［9］Perlemoine C, Beauvieux MC, Rigalleau V, Baillet L, Barthes N, Derache P, Gin H. Interest of cystatin C in screening diabetic patients for early impairment of renal function[J]. Metabolism, 2003; 52(10): 1 258-1 264.
10.	［10］F Chantrel,A grin,M offner,C koehl,B Moulin,T hannedouche. Comparison of cystatin C versus creatinine for mild renal failure[J]. Clin Nephron, 2000; 5(235): 374-381.
11.	［11］Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, Vera M, Piera C,Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerularfiltration rate and as a marker for early renal impairment[J]. Am J Kidney Dis, 2000; 36(1): 29-34.
12.	［12］Donadio C, Lucchesi A, Ardini M, Giordani R. Cystatin C, beta 2-microglobulin, and retinol-binding protein as indicators of glomerular filtration rate: comparison with plasma creatinine[J]. J Pharm Biomed Anal, 2001; 24(5): 835-842.
13.	［13］Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K. Related Articles, Links Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children[J]. Clin Chem, 2002; 48(5): 729-736.
14.	［14］Harmoinen AP, Kouri TT, Wirta OR, Lehtimaki TJ, Rantalaiho V, Turjanmaa VM,Pasternack AI. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes[J]. Clin Nephrol, 1999; 52(6): 363-370.
15.	［15］Helin I, Axenram M, Grubb A. Serum cystatin C as a determinant of glomerular filtration rate in children[J]. Clin Nephrol, 1998; 49(4): 221-225.
16.	［16］Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P,Lindstrom V, Grubb A.Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate[J]. Clin Chem, 1994; 40(10): 1 921-1 926.
17.	［17］Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration rate to replace creatinine[J]. Nephron, 1995; 70(3): 370-371.
18.	［18］Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases[J]. Nephron, 2002; 91(1): 13-20.
19.	［19］Pergande M, Jung K. Sandwich enzyme immunoassay of cystatin C in serum with commercially available antibodies[J]. Clin Chem, 1993; 39(9): 1 885-1 890.
20.	［20］Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine[J]. Kidney Int, 1995; 47(1): 312-318.
21.	［21］Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renalimpairment in patients with diabetes[J]. Am J Kidney Dis, 2001; 38(2): 310-316.
22.	［22］Orlando R, Mussap M, Plebani M, Piccoli P, De Martin S, Floreani M, Padrini R, Palatini P. Related Articles, Links Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis[J]. Clin Chem, 2002; 48(6): 850-858.
23.	［23］Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function[J]. Clin Nephrol, 2000; 54(3): 203-209.
24.	［24］Randers E, Kristensen JH, Erlandsen EJ, Danielsen H. Serum cystatin C as a marker of the renal function[J]. Scand J Clin Lab Invest, 1998; 58(7): 585-592.
25.	［25］Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C[J]. Nephrol Dial Transplant, 1999; 14(8): 1 991-1 996.
26.	［26］O’Riordan Shelagh E,Webb Michelle C,Stowe Helen J,Simpson David E,Kandarpa Madhu.Cystatin C improves the detection of mild renal dysfunction in older parients[J]. Ann clin biochem, 2003; 40(23): 648-655.
27.	［27］Stickle D, Cole B, Hock K, Hruska KA, Scott MG. Correlation of plasma concentrations of cystatin C and creatinine to inulin clearance in a pediatric population[J]. Clin Chem, 1998; 44(6): 1 334-1 338.
28.	［28］Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC. Related Articles, Links Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance[J]. Diabetes Care, 2002; 25(11): 2 004-2 009.
29.	［29］Van Den Noortgate NJ, Janssens WH, Delanghe JR, Afschrift MB, Lameire NH. Related Articles, Links Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old[J]. J Am Geriatr Soc, 2002; 50(7): 1 278-1 282.
30.	［30］Willems HL, Hilbrands LB, van de Calseyde JF, MonnensLA, Swinkels DW. Is serum cystatin C the marker of choice to predict glomerular filtration rate in paediatric patients[J]? Ann Clin Biochem, 2003; 40(1): 60-64.
31.	［31］Woitas RP, Stoffel-Wagner B, Poege U, Schieldermaier P, Spengler u, Sauerbruch T.lower-molecular weight proteins as markers for glomerular filtration rate[J]. Clin Chem, 2001; 47(724): 2 179-2 180.
32.	［32］Woitas RP, Stoffel-Wagner B, Flommersfeld S, Poege U, Schiedermaier P,Klehr HU, Spengler U, Bidlingmaier F, Sauerbruch T. Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis[J]. Clin Chem, 2000; 46(5): 712-715.
33.	［33］Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M. Cystatin C as a marker for glomerular filtration rate in pediatric patients[J]. Pediatr Nephrol, 1999; 13(6): 506-509.
34.	［34］Couched C, Pozet N, Labeeuw M, Pouteil-Noble C.Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment[J]. Kidney Int, 1999; 55(5): 1 878-1 884.
35.	［35］Kingdon EJ, Knight CJ, Dustan K, Irwin AG, Thomas M, Powis SH, Burns A,Hilson AJ, Black CM. Calculated glomerular filtration rate is a useful screening tool to identify scleroderma patients with renal impairment[J]. Rheumatology, 2003; 42(1): 26-33.
36.	［36］Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A, AlberinoF, Gatta A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis[J].Arch Intern Med, 1994; 154(2): 201-205.
37.	［37］Tezuka M, Murata Y, Ishida R, Sawada Y, Shibuya H. Tc-99m DTPA renography in patients with collagen disease[J]. Clin Nucl Med, 2001; 26(3): 187-192.
38.	［38］Priem F,Althaus H,Brinbaum M,Sinha P,Conradt HS,Jung K.β-trace protein in serum:a new marker of glomerular filtration rate in the creatinine-blind range[J]. Clin Chem, 1999; 45(21): 467-468.
39.	［39］Liu GJ,Wu TX.Meta analysis of diagnostic test--introduction about summary receiver operator characteristic curve[J]. Chineses Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
40.	刘关键,吴泰相.诊断性试验的Meta分析-SROC曲线法介绍[J]. 中国循证医学杂志,2003, 3(1): 41～44.
41.	［40］Moses LE, Shapiro D, Littenberg B, combining independent studies of a diagnostic test into a summary ROC curve:data analytic and some additional considerations[J]. Stat Med, 1993, 12: 1 293-1 316.
42.	［41］Wang JL .Clinical Epidemiology[M]. Shanghai scientific and technique Publisher. 2th, 2001, p323-325.
43.	王家良主编.临床流行病学[M].第2版. 上海: 上海科学技术出版社; 2001. p.323～325.
44.	［42］Kang GF.Clinical biochemistry and biochemical laboratory[M]. people’s health publisher.2th.1998,p272-273.
45.	康格非主编.临床生物化学和生物化学检验[M].第2版. 北京: 人民卫生出版社; 1998. p.272～273.

1. ［1］Joronen I,Hopsu-Havu VK,M,Rinne A,Jarvinen M,Halonen P.detection of low molecular weight cysteine proteinase inhibitors by time-resolved fluoroimmunoassay[J]. J Immunal Meth, 1986; 86(23): 243-247.
2. ［2］Colle A,Tavera C,Prevot D,Leung-Tack J,Thomas Y,Manuel Y. Cystatin C levels in sera of patein with human immunodeficiency virus infection[J]. J immunoassay, 1992; 13: 47-60.
3. ［3］Wyss M, Kaddurah-Daouk R. Creatine and creatinine metabolism[J]. Physiol Rev. 2000; 80(3): 1 107-1 213.
4. ［4］Qi HM,Xing Gang,Li JZ,Deng LR,Zhang CL,Wang HY.Evaluation of four methods about glomerular filtration function[J]. Laboratory Journal of Chinses Medicine, 2002; 25(3):150152齐慧敏,幸岗,李惊子,邓利荣,张春丽,王洪源.四种肾小球滤过功能测定方法的评估分析[J]. 中华检验医学杂志,2002;25(3):150～152.
5. ［5］Harmoinen A,Lehtimaki T,Korpela M,Turjanmaa V,Saha H.Diagnostic Accuracies of Plasma creatinine,Cystatin C,and Glomerular flitration rate Calcuated by the Cockcroft-Gault and Levey(MDRD) formulas[J]. Clin Chem, 2003; 49(7): 1 223-1 225.
6. ［6］Christensson A, Ekberg J, Grubb A, Ekberg H, Lindstrom V. Serum cystatin C is a more sensitive and more accurate marker of glomerular filtration rate than enzymatic measurements of creatinine in renal transplantation[J]. Nephron Physiol, 2003; 94(2): 19-27.
7. ［7］Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, Erlich D.Clin Chem. Plasma cystatin C is superior to 24h creatinine clearance and plasma creatinine for estimation of glomerular filtration rate 3 months after kidney[J].Transplantation, 2000; 46(8): 1 206-1 207.
8. ［8］Burkhardt H, Bojarsky G, Gladisch R. Diagnostic efficiency of cystatin C and serum creatinine as markers of reduced glomerular filtration rate in the elderly[J]. Clin Chem Lab Med, 2002; 40(11): 1 135-1 138.
9. ［9］Perlemoine C, Beauvieux MC, Rigalleau V, Baillet L, Barthes N, Derache P, Gin H. Interest of cystatin C in screening diabetic patients for early impairment of renal function[J]. Metabolism, 2003; 52(10): 1 258-1 264.
10. ［10］F Chantrel,A grin,M offner,C koehl,B Moulin,T hannedouche. Comparison of cystatin C versus creatinine for mild renal failure[J]. Clin Nephron, 2000; 5(235): 374-381.
11. ［11］Coll E, Botey A, Alvarez L, Poch E, Quinto L, Saurina A, Vera M, Piera C,Darnell A. Serum cystatin C as a new marker for noninvasive estimation of glomerularfiltration rate and as a marker for early renal impairment[J]. Am J Kidney Dis, 2000; 36(1): 29-34.
12. ［12］Donadio C, Lucchesi A, Ardini M, Giordani R. Cystatin C, beta 2-microglobulin, and retinol-binding protein as indicators of glomerular filtration rate: comparison with plasma creatinine[J]. J Pharm Biomed Anal, 2001; 24(5): 835-842.
13. ［13］Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K. Related Articles, Links Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children[J]. Clin Chem, 2002; 48(5): 729-736.
14. ［14］Harmoinen AP, Kouri TT, Wirta OR, Lehtimaki TJ, Rantalaiho V, Turjanmaa VM,Pasternack AI. Evaluation of plasma cystatin C as a marker for glomerular filtration rate in patients with type 2 diabetes[J]. Clin Nephrol, 1999; 52(6): 363-370.
15. ［15］Helin I, Axenram M, Grubb A. Serum cystatin C as a determinant of glomerular filtration rate in children[J]. Clin Nephrol, 1998; 49(4): 221-225.
16. ［16］Kyhse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P,Lindstrom V, Grubb A.Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate[J]. Clin Chem, 1994; 40(10): 1 921-1 926.
17. ［17］Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration rate to replace creatinine[J]. Nephron, 1995; 70(3): 370-371.
18. ［18］Kazama JJ, Kutsuwada K, Ataka K, Maruyama H, Gejyo F. Serum cystatin C reliably detects renal dysfunction in patients with various renal diseases[J]. Nephron, 2002; 91(1): 13-20.
19. ［19］Pergande M, Jung K. Sandwich enzyme immunoassay of cystatin C in serum with commercially available antibodies[J]. Clin Chem, 1993; 39(9): 1 885-1 890.
20. ［20］Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine[J]. Kidney Int, 1995; 47(1): 312-318.
21. ［21］Oddoze C, Morange S, Portugal H, Berland Y, Dussol B. Cystatin C is not more sensitive than creatinine for detecting early renalimpairment in patients with diabetes[J]. Am J Kidney Dis, 2001; 38(2): 310-316.
22. ［22］Orlando R, Mussap M, Plebani M, Piccoli P, De Martin S, Floreani M, Padrini R, Palatini P. Related Articles, Links Diagnostic value of plasma cystatin C as a glomerular filtration marker in decompensated liver cirrhosis[J]. Clin Chem, 2002; 48(6): 850-858.
23. ［23］Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function[J]. Clin Nephrol, 2000; 54(3): 203-209.
24. ［24］Randers E, Kristensen JH, Erlandsen EJ, Danielsen H. Serum cystatin C as a marker of the renal function[J]. Scand J Clin Lab Invest, 1998; 58(7): 585-592.
25. ［25］Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C[J]. Nephrol Dial Transplant, 1999; 14(8): 1 991-1 996.
26. ［26］O’Riordan Shelagh E,Webb Michelle C,Stowe Helen J,Simpson David E,Kandarpa Madhu.Cystatin C improves the detection of mild renal dysfunction in older parients[J]. Ann clin biochem, 2003; 40(23): 648-655.
27. ［27］Stickle D, Cole B, Hock K, Hruska KA, Scott MG. Correlation of plasma concentrations of cystatin C and creatinine to inulin clearance in a pediatric population[J]. Clin Chem, 1998; 44(6): 1 334-1 338.
28. ［28］Tan GD, Lewis AV, James TJ, Altmann P, Taylor RP, Levy JC. Related Articles, Links Clinical usefulness of cystatin C for the estimation of glomerular filtration rate in type 1 diabetes: reproducibility and accuracy compared with standard measures and iohexol clearance[J]. Diabetes Care, 2002; 25(11): 2 004-2 009.
29. ［29］Van Den Noortgate NJ, Janssens WH, Delanghe JR, Afschrift MB, Lameire NH. Related Articles, Links Serum cystatin C concentration compared with other markers of glomerular filtration rate in the old old[J]. J Am Geriatr Soc, 2002; 50(7): 1 278-1 282.
30. ［30］Willems HL, Hilbrands LB, van de Calseyde JF, MonnensLA, Swinkels DW. Is serum cystatin C the marker of choice to predict glomerular filtration rate in paediatric patients[J]? Ann Clin Biochem, 2003; 40(1): 60-64.
31. ［31］Woitas RP, Stoffel-Wagner B, Poege U, Schieldermaier P, Spengler u, Sauerbruch T.lower-molecular weight proteins as markers for glomerular filtration rate[J]. Clin Chem, 2001; 47(724): 2 179-2 180.
32. ［32］Woitas RP, Stoffel-Wagner B, Flommersfeld S, Poege U, Schiedermaier P,Klehr HU, Spengler U, Bidlingmaier F, Sauerbruch T. Correlation of serum concentrations of cystatin C and creatinine to inulin clearance in liver cirrhosis[J]. Clin Chem, 2000; 46(5): 712-715.
33. ［33］Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M. Cystatin C as a marker for glomerular filtration rate in pediatric patients[J]. Pediatr Nephrol, 1999; 13(6): 506-509.
34. ［34］Couched C, Pozet N, Labeeuw M, Pouteil-Noble C.Screening early renal failure: cut-off values for serum creatinine as an indicator of renal impairment[J]. Kidney Int, 1999; 55(5): 1 878-1 884.
35. ［35］Kingdon EJ, Knight CJ, Dustan K, Irwin AG, Thomas M, Powis SH, Burns A,Hilson AJ, Black CM. Calculated glomerular filtration rate is a useful screening tool to identify scleroderma patients with renal impairment[J]. Rheumatology, 2003; 42(1): 26-33.
36. ［36］Caregaro L, Menon F, Angeli P, Amodio P, Merkel C, Bortoluzzi A, AlberinoF, Gatta A. Limitations of serum creatinine level and creatinine clearance as filtration markers in cirrhosis[J].Arch Intern Med, 1994; 154(2): 201-205.
37. ［37］Tezuka M, Murata Y, Ishida R, Sawada Y, Shibuya H. Tc-99m DTPA renography in patients with collagen disease[J]. Clin Nucl Med, 2001; 26(3): 187-192.
38. ［38］Priem F,Althaus H,Brinbaum M,Sinha P,Conradt HS,Jung K.β-trace protein in serum:a new marker of glomerular filtration rate in the creatinine-blind range[J]. Clin Chem, 1999; 45(21): 467-468.
39. ［39］Liu GJ,Wu TX.Meta analysis of diagnostic test--introduction about summary receiver operator characteristic curve[J]. Chineses Journal of Evidence-Based Medicine, 2003, 3(1): 41-44.
40. 刘关键,吴泰相.诊断性试验的Meta分析-SROC曲线法介绍[J]. 中国循证医学杂志,2003, 3(1): 41～44.
41. ［40］Moses LE, Shapiro D, Littenberg B, combining independent studies of a diagnostic test into a summary ROC curve:data analytic and some additional considerations[J]. Stat Med, 1993, 12: 1 293-1 316.
42. ［41］Wang JL .Clinical Epidemiology[M]. Shanghai scientific and technique Publisher. 2th, 2001, p323-325.
43. 王家良主编.临床流行病学[M].第2版. 上海: 上海科学技术出版社; 2001. p.323～325.
44. ［42］Kang GF.Clinical biochemistry and biochemical laboratory[M]. people’s health publisher.2th.1998,p272-273.
45. 康格非主编.临床生物化学和生物化学检验[M].第2版. 北京: 人民卫生出版社; 1998. p.272～273.

Chinese Journal of Evidence-Based Medicine

Diagnostic Value of Creatinine for Indicating Glomerular Filtration Function Injury: A Systematic Review

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