Cystatin C: can it be more reliable marker for estimation of glomerular filtration rate in children with reduced renal function?

Abstract

nbsp;

Keywords

• -

Sistatin C: böbrek işlevleri azalmakta olan çocuklarda glomerüler filtrasyon hızı ölçümünde daha yararlı bir değişken olabilir mi?

Öz

Amaç: Bu çal›flmada böbrek ifllevleri azalmakta olan çocuklarda glomerül filtrasyon h›z› tayininde serum sistatin C’nin kreatinine göre daha iyi bir de¤iflken olup olmad›¤› araflt›r›ld›. Gereç ve

Yöntem: Göztepe E¤itim-Araflt›rma Hastanesi ve Cerrahpafla T›p Fakültesi Çocuk Nefroloji Poliklinikleri’nde izlenen 100 çocuk (53 k›z/47 erkek) çal›flmaya al›nd›. Çal›flmada alt›n standart olarak dietilen triamin penta asetat (DTPA) klirensi al›nd›. Dietilen triamin penta asetat klirensi 80mL/dak/1,73m2’nin üstünde olan olgular birinci gruba (n=64), alt›ndakiler ikinci gruba (n=36) al›nd›. Olgular›n serum sistatin C ve kreatinin düzeyleri ölçüldü, glomerül filtrasyon h›z› Schwartz formülüyle (GFH schw) hesapland›. De¤iflkenlerin tan›sal de¤erleri ROC analizi ile de¤erlendirildi. Tüm çocuklar›n ailelerinden imzalanm›fl ayd›nlat›lm›fl onay formu al›nd›.

Bulgular: Olgular›n 53’ü k›z, 47’si erkek olup yafllar› ortalama 8,4±5,1 (0,17-20,5) y›l idi. Birinci gruba 64 olgu, ikinci gruba 36 olgu al›nd›. Olgular›n serum sistatin C ve kreatinin düzeyleri ile GFHSchw aras›nda her iki grupta anlaml› bir iliflki saptand› (p<0,01). Serum kreatinin ve sistatin C düzeyleri ile GFHDTPA aras›nda böbrek ifllevi azalm›fl olgularda anlaml› bir iliflki bulundu, böbrek ifllevleri normal olgularda ise iliflki bulunmad›. Sonuçlar ROC analiziyle  ¤erlendirildi¤inde serum sistatin C ve GFHSchw için ROC e¤risi alt›nda kalan alan de¤erleri istatistiksel olarak anlaml› bulundu ancak alan de¤erleri aras›nda belirgin farkl›l›k gözlenmedi.

Çıkarımlar: Serum sistatin C düzeyleri GFH ölçümünde yararl› ancak serum kreatinin ve GFHSchw‘e üstünlü¤ü olmayan bir de¤iflkendir. Böbrek ifllevleri normal ve azalm›fl çocuklarda GFH izleminde GFHSchw basit ve yeterli bir yöntemdir.

Anahtar Kelimeler

• Böbrek işlevleri
• glomerül filtrasyon hızı
• Schwartz formülü
• sistatin C

Kaynakça

1. Rahn KH, Heidenreich S, Bruckner D. How to assess glomerular function and damage in humans. J Hypertens 1999; 17: 309-17.
2. Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem 1992; 38: 1933-53.
3. Shemesh O, Golbetz H, Kriss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 1985; 28: 830-8.
4. Blaufox MD, Aurell M, Bubeck B, et al. Report of the radionu- clides in Nephrology committee on renal clearance. J Nucl Med 1996; 37: 1883-90.
5. Peters AM, Allison H, Ussov W. Measurement of the ratio of glomerular filtration rate to plasma volume from the tech- netium-99m diethylene triamine pentaacetic acid renogram: comparison with glomerular filtration rate in relation to extra- cellular fluid volume. Eur J Nucl Med 1994; 21: 322-7.
6. Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C-a new marker of glomerular filtration rate in children independent of age and height. Pediatrics 1998; 101: 875-81.
7. Grubb A. Diagnostic value of analysis of cystatin C and protein HC in biological fluids. Clin Nephrol 1992; 38: 20-7.
8. Jung K, Jung M. Cystatin C. A promising marker of glomerular filtration rate to replace creatinine. Nephron 1995; 70: 370-1.

9. Reed CH. Diagnostic applications of cystatin C. Br J Biomed Sci 2000; 57: 323-9.
10. Ylinen EA, Ala-Houhala M, Harmoinen APT, Knip M. Cystatin C as a marker for glomerular filtration rate in pediatric patients. Pediatr Nephrol 1999; 13: 506-9.
11. Stickle D, Cole B, Hock K, Hruska KA, Scott MG. Correlation of plasma concentrations of cystatin C and creatinine to inuline clearance in a pediatric population. Clin Chem 1998; 44: 1334-8.
12. Filler G, Priem F, Lepage N, et al. Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detect- ing impaired glomerular filtration rates in children. Clin Chem 2002; 48: 729-36.
13. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children and adolescents. Pediatr Clin North Am 1987; 34: 571-90.
14. Schwartz GJ, Haycock GB, Edelman CM Jr, Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976; 58: 259-63.
15. Ham HR, Piepsz A. Estimation of glomerular filtration rate in infants and children using a single-plasma sample method. J Nucl Med 1991; 32: 1294-7.
16. Seikaly MG, Browne R, Bajaj G, Arant BS Jr. Limitations to body lenght/serum creatinine ratio as an estimate of glomerular filtration in children. Pediatr Nephrol 1996; 10: 709-11.
17. Filler G, Bökenkamp A, Hofmann W, Le Bricon T, Martinez Bru C, Grubb A. Cystatin C as a marker of GFR-history, indications, and future research. Clin Biochem 2005; 38: 1-8.
18. Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Reference values for cystatin C serum concentra- tions in children. Pediatr Nephrol 1998; 12: 125-9.
19. Newman DJ, Thakkar H, Edwards RG, et al. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney Int 1995; 47: 312-8.
20. Finney H, Newman DJ, Thakkar H, Fell JM, Price CP. Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 2000; 82: 71-5.
21. Grubb A, Nyman U, Bjork J, et al. A simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem 2005; 51: 1420-31.
22. Zappitelli M, Parvex P, Joseph L, et al. Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis 2006; 48: 221-30.
23. Hojs R, Bevc S, Ekart R, Gorenjak M, Puklave L. Serum cystatin C-based formulas for prediction of glomerular filtration rate in patients with chronic kidney disease. Nephron Clin Pract 2010; 114: 118-26.
24. Filler G, Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 2003; 18: 981-5.
25. Filler G, Priem F, Vollmer I, Gellermann J, Jung K. Diagnostic sensitivity of serum cystatin for impaired glomerular filtration rate. Pediatr Nephrol 1999; 13: 501-5.
26. Eriksen BO, Mathisen UD, Melsom T, et al. Cystatin C is not a better estimator of GFR than plasma creatinine in the general population. Kidney Int 2010; 78: 1305-11.
27. Andersen TB, Jensen AE, Frokiaer J, Brochner-Mortensen J. Measuring glomerular filtration rate in children; can cystatin C replace established methods? A review. Pediatr nephrol 2009; 24: 929-41.
28. Bouvet Y, Bouissou F, Coulais Y, et al. GFR is better estimated by considering both serum cystatin C and creatinine levels. Pediatr Nephrol 2006; 21: 1299-306.
29. Mussap M, Ruzzante N, Varagnolo M, Plebani M. Quantitative automated particle-enhanced immunonephelometric assay for the routinary measurement of human cystatin C. Clin Chem Lab Med 1998; 36: 859-65.
30. Kyhse-Andersen J, Schmidt C, Nordin G, et al. Serum Cystatin C, determined by a rapid, automated particle-enhanced tur- bidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clin Chem 1994; 40: 1921-6.
31. Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C- a new marker of glomerular filtration rate in children independent of age and height. Pediatrics 1998; 101: 875-81.
32. Çabukoğlu S, Alpay H, Bıyıklı NK, Noşari OA, Topçu G. Spina bifidalı çocuklarda dietilen triamin pentaasetik asit klirensi temel alınarak serum sistatin C ve kreatinin değerlerinin karşılaştırılması. Türk Nefroloji Diyaliz Transplantasyon Dergisi 2002; 11: 241-5.
33. Herget-Rosenthal S, Marggraf G, Hüsing J, et al. Early detection of acute renal failure by serum cystatin C. Kidney Int 2004; 66: 1115-22.
34. Nejat M, Pickering JW, Walker RJ, Endre ZH. Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit. Nephrol Dial Transplant 2010; 25: 3283-9.
35. Risch L, Herklotz R, Blumberg A, Huber AR. Effects of glucocorticoid immunosupression on serum cystatin C concentrations in renal transplant patients. Clin Chem 2001; 47: 2055-9.
36. Okura T, Jotoku M , Irita J, et al. Association between cystatin C and inflammation in patients with essential hypertension. Clin Exp Nephrol 2010; 14: 584-8.
37. den Hollander JG, Wulkan RW, Mantel MJ, Berghout A. Is cystatin C a marker of glomerular filtration rate in thyroid dysfunction? Clin Chem 2003; 49: 1558-9.
38. Sahakyan K, Klein BEK, Lee KE, Tsai MY, Klein R. Serum Cystatin C and the incidence of hypertension in type 1 diabetes mellitus. Am J Hypertens 2010; 24: 59-63.
39. Shlipak MG, Katz R, Cushman M, et al. Cystatin-C and inflammatory markers in the ambulatory elderly. Am J Med 2005; 118: 1416.