— 生理適應 · EASY · MCQ —
護理師照護一位急性腎損傷病人。下列哪項檢驗數據最能反映腎功能惡化？
A nurse is caring for a client with acute kidney injury. Which laboratory value is most indicative of worsening renal function?
- ASerum potassium 4.2 mEq/L血清鉀 4.2 mEq/L。
- BSerum creatinine 2.8 mg/dL from a baseline of 1.0 mg/dL✓ 正解血清肌酸酐 2.8 mg/dL，基線為 1.0 mg/dL。
- CBlood urea nitrogen 35 mg/dL尿素氮 35 mg/dL。
- DSerum sodium 138 mEq/L血清鈉 138 mEq/L。
— Explanation · 中文詳解 —
血清肌酸酐（Creatinine）是評估腎絲球過濾率（GFR）最可靠的指標。當基線值從 1.0 升至 2.8 mg/dL，明確顯示腎功能顯著下降。尿素氮（BUN）易受脫水、飲食蛋白質及出血影響，不如肌酸酐具有特異性；電解質數值在早期腎損傷中可能維持正常。
Serum creatinine is the most reliable indicator of glomerular filtration rate and worsening renal function, as it specifically reflects kidney clearance capacity. Unlike BUN, which is influenced by hydration and diet, or electrolytes that may remain normal initially, a significant rise in creatinine clearly indicates declining renal status.
✦ 台美臨床差異
台美臨床均高度依賴 Creatinine 變化，但台灣在評估腎功能時會同步計算 eGFR 數值。