Cystatin c — based evaluation of the estimated glomerular filtration rate in children with chronic kidney disease 1–3 st. (3а and 3b)
Keywords:
cystatin C, estimated glomerular filtration rate, children, chronic kidney diseaseAbstract
Objective: to evaluate the estimated glomerular filtration rate (GFR) based on the cystatin C (CsC) serum concentration (eGFRc) in children with chronic kidney disease (CKD) 1–3 st. (3a and 3b) using the equations of F.J. Hoek, M. Zappitelli and Pediatric GFR Calculator — NKF.Materials and methods. CsC serum concentration was determined and GFR was calculated in 132 children aged 2 to 17 with CKD 1–3 st. (3a and 3b) using the equations of F.J. Hoek, M. Zappitelli and Pediatric GFR Calculator – NKF.
Results. CsC blood serum concentration values in children with CKD 3a st. (1.41±0.03 mg/l) and CKD 3b st. (1.97±0.1 mg/l) corresponded to the same eGFRc obtained at each of the sub-stages by equations of M. Zappitelli, F.J. Hoek, Pediatric GFR Calculator – NKF, in contrast to patients with CKD 1 st., in which eGFRc according to Pediatric GFR Calculator NKF in 62.7% of patients decreased the GFR below 90 ml/min/1.73m2, potentially transferring them into CKD 2 st. A comparative analysis of eGFRc made in patients with CKD 3a st. and CKD 3b st. showed a significant difference between the sub-stages when calculated using the three equations (p<0.001) and as compared to the combined option of CKD 3 st. and CKD 1–2 st. (p<0.01, p<0.001), respectively, which proves that it is reasonable and necessity to divide CKD 3 st. into sub-stages 3a and 3b. A regression analysis made for the whole set of patients included in the study allowed to establish that there is a high-degree correlation between the values and the inverse correlation dependence of eGFRc on the CsC level by equations of F.J. Hoek, M. Zappitelli or Pediatric GFR Calculator — NKF (r=-0.93; r=-0.92; r=-0.94, respectively).
Conclusions. eGFRc evaluation based on CsC serum concentration in children with CKD 1–3 st. (3a and 3b) confirmed that it is reasonable to divide CKD 3 st. into sub-stages 3a st. and 3b st. in the pediatric population.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of Kyiv City Children's Clinical Hospital No. 1. The informed consent of the patient was obtained for conducting the studies.
References
Velkov VV. (2015). New renal biomarkers for neonatology and pediatrics: cystatin C and NGAL. Pediatria. 94(3): 167–174.
Kayukov IG, Smirnov AV, Emanuel VL. (2012). Cystatin C in current medicine. Nephrology (Saint;Petersburg). 16(1): 22–39. doi 10.24884/1561-6274-2012-16-1-22-39.
Bjork J, Nyman U, Berg U et al. (2019). Validation of standardized creatinine and cystatin C GFR estimating equations in a large multicentre European cohort of children. Pediatric Nephrology. 34(6): 1087–1098. https://doi.org/10.1007/s00467-018-4185-y; PMid:30715595
Bouvet Y, Bouissou F, Coulais Y et al. (2006). GFR is better estimated by considering both serum cystatin C and creatinine levels. Pediatr Nephrol. 21(9): 1299-1306. https://doi.org/10.1007/s00467-006-0145-z; PMid:16794818
Dangle PP, Ayyash O, Kang A et al. (2017). Cystatin C;calculated glomerular filtration rate – a marker of early renal dysfunction in patients with neuropathic bladder. Urology. 100: 213–217. https://doi.org/10.1016/j.urology.2016.08.011
DonmezHA, YildizN, Ediz B. (2015). Comparison of serum cystatin C and creatinine levels in determining glomerular filtration rate in children with stage I to III chronic renal disease. https://doi.org/10.3109/0886022X.2015.1014771; PMid:25707515.
Fox JA, Dudley AG, Bates C, Jr.Cannon GM. (2014). Cystatin C as a marker of early renal insufficiency in children with congenital neuropathic bladder. J. Urol. 191; 5: 1602–1607. https://doi.org/10.1016/j.juro.2013.09.093; PMid:24679869.
Hoek FJ, Kemperman FA, Krediet RT. (2003). A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrology Dialysis Transplantation. 18(10): 2024–2031. https://doi.org/10.1093/ndt/gfg349; PMid:13679476
https://www.kidney.org/professionals/KDOQI/gfr_calculatorPed
Kidney Disease: Improving Global Outcomes (KDIGO) СKD Work Group. KDIGO 2012. (2013). Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Inter. Suppl. 3(1): 5–9. doi 10.1038/kisup.2012.73.
National Kidney Foundation. (2002). K/DOQI Clinical Practice Guidelines for Chronic Kidney Diseases: Evaluation, Classification and Stratification. Am. J. Kidney Dis. 39;1: 44–45.
Salvador CL, Tondel C, Rowe AD, et al. (2019). Estimating glomerular filtration rate in children: evaluation of creatinine; and cystatin C;based equations. Pediatric Nephrology. 34(2): 301–311. https://doi.org/10.1007/s00467-018-4067-3; PMid:30171354.
Schwartz GJ, Munoz A, Schneider MF et al. (2019). New equations to estimate GFR in children with CKD. J Am Soc Nephrol. 20(3): 629–637. https://doi.org/10.1681/ASN.2008030287; PMid:19158356 PMCid:PMC2653687
Schwartz GJ, Schneider MF, Maier PS et al. (2012). Improved equations estimating GFR in children with chronic kidney disease using an immunonephelometric determination of cystatin C. Kidney Int. 82(4): 445–453. https://doi.org/10.1038/ki.2012.169; PMid:22622496 PMCid:PMC3433576
Staples A, Wong C, Schwartz GJ. (2019). Iohexol;measured glomerular filtration rate in children and adolescents with chronic kidney disease: a pilot study comparing venous and finger stick methods. Pediatric Nephrology. 34(3): 459–464. https://doi.org/10.1007/s00467-018-4110-4; PMid:30315406 PMCid:PMC6581035
Zappitelli M, Parvex P, Joseph L et al. (2006). Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis. 48(2): 221—230. https://doi.org/10.1053/j.ajkd.2006.04.085; PMid:16860187
Downloads
Issue
Section
License
The policy of the Journal “MODERN PEDIATRICS. UKRAINE” is compatible with the vast majority of funders' of open access and self-archiving policies. The journal provides immediate open access route being convinced that everyone – not only scientists - can benefit from research results, and publishes articles exclusively under open access distribution, with a Creative Commons Attribution-Noncommercial 4.0 international license (СС BY-NC).
Authors transfer the copyright to the Journal “MODERN PEDIATRICS. UKRAINE” when the manuscript is accepted for publication. Authors declare that this manuscript has not been published nor is under simultaneous consideration for publication elsewhere. After publication, the articles become freely available on-line to the public.
Readers have the right to use, distribute, and reproduce articles in any medium, provided the articles and the journal are properly cited.
The use of published materials for commercial purposes is strongly prohibited.
