Introduction. Currently widely adopted benchmarks of normal levels of cystatin in blood and of GFR based on those levels in young children are non-existent. Objective: to determine the content of cystatin C in the blood and the glomerular filtration rate based on it in young children. Materials and methods. Two hundred thirty seven infants aged up 3 years without kidney diseases were examined and divided into subgroups by age, degree of maturity and birth weight. The serum cystatin C was studied by enzyme-immunoassay, GFR was calculated according to Larsson’s formula. Results. Normal levels of serum cystatin C and GFR levels were determined in young children with Larsson’s formula. The dependency of the serum level of cystatin C and GFR calculated on the basis of the age of the infant was proved. The serum cystatin C level depends on the degree of prematurity and body weight at birth. The level of GFR was not influenced by the degree of prematurity, however, infants born with extremely low body weight exhibited lower GFR levels in comparison to those born with normal body weight. Conclusion. The obtained serum cystatin C levels are deemed as normal for young children - full-term infants and those with varying degrees of prematurity.
The need to search for new markers of the functional state of the kidneys is increasing due to the gain in the number of extremely premature infants. The review analyzes publications on the possibilities of assessing kidney function using cystatin C and lipocalin in children born prematurely. The constant rate of cystatin C production in all tissues, its elimination through the renal glomerular filter, the absence of secretion in the proximal tubules, as well as independence from many factors, including gender, age, diet, inflammation are ideal conditions for its use as an endogenous biochemical marker of glomerular filtration. Due to biochemical features, the analysis of serum levels of cystatin C was established to be a promising method in the diagnosis of acute renal injury (AKI) in premature infants. For a comprehensive assessment of kidney function in premature infants, simultaneous determination of lipocalin and cystatin C levels in the blood may be important. At the same time, the evaluation of these indicators may have diagnostic significance in predicting the development of chronic kidney disease in children who underwent AKI in infancy. The absence of reference values of lipocalin and cystatin C in premature infants was concluded to hinder the clinical use of their quantitative analysis for a comprehensive assessment of the functional state of the kidneys.
Introduction. The impact of prematurity on the functional state of the kidneys in infants has not yet been sufficiently studied. Aim. To determine the influence of birth weight and gestational age on the creatinine level in the blood and glomerular filtration rate (GFR) in early childhood. Materials and methods. A retrospective analysis was conducted on medical records of 316 children aged from 1 month to 1.5 years, hospitalized at the Department of Early Childhood Pathology (National Medical Research Center for Children’s Health, Moscow) from 2012 to 2020 due to consequences of perinatal CNS damage. Children without congenital kidney diseases, with normal urine values in medical history, without structural abnormalities on ultrasound were included in this study. Serum creatinine was determined by the enzymatic method, GFR - by the Schwartz’s formula using a coefficient of 0.413, as well as, previously proposed coefficients of 0.33 for premature and 0.44 for full-term infants. Results. In premature infants, notably born with extremely low birth weight and very low birth weight, at the age of 1 year, serum creatinine is reduced compared to full-term infants, GFR in deep-premature infants exceeds the level of GFR in full-term infants by the year. The results allow concluding the method of calculating GFR by formulas based on serum creatinine to be invalid. Due to possible hyperfiltration in preterm infants, they need regular monitoring urine tests, blood pressure, due to the risk of developing chronic kidney disease. Conclusions. It is necessary to search for other methods for determining GFR in extremely premature infants. The established indices of the blood creatinine content can be used as reference values for different periods of gestation and body weight at birth in institutions using the enzymatic method for determining blood creatinine. The obtained GFR indices as a reference can be recommended for full-term and premature babies born after 32 weeks of gestation and with a birth weight of more than 1500 g.
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