Comparing cystatin C and creatinine in the diagnosis of pediatric acute renal allograft dysfunction

Abstract

BackgroundAllograft function following renal transplantation is commonly monitored using serum creatinine. Multiple cross-sectional studies have shown that serum cystatin C is superior to creatinine for detection of mild to moderate chronic kidney dysfunction. Recent data in adults indicate that cystatin C might also be a more sensitive marker of acute renal dysfunction. This study aims to compare cystatin C and creatinine for detection of acute allograft dysfunction in children using pediatric RIFLE (risk of renal dysfunction, injury to the kidney, failure or loss of kidney function, end stage renal disease) criteria for acute kidney injury.MethodsRetrospective chart review of post-transplant period in 24 patients in whom creatinine and cystatin C were measured every day. Allograft dysfunction was defined as a sustained rise in marker concentration above the mean of the three preceding measurements.ResultsIn total, there were 13 episodes of allograft dysfunction. Maximum RIFLE stages with creatinine were 'R' in 7, 'I' in 4, and 'F' in 2, with cystatin C ‘R’ in 6, ‘I’ in 4 and ‘F’ in 3, respectively. In 9/13 cases, both markers rose simultaneously, in three, the rise in creatinine preceded cystatin C by 1–5 days (median 4). In one case, the rise in cystatin C preceded creatinine by 1 day. The time lag was not statistically different. The maximum relative rise of creatinine was significantly higher than cystatin C. By multiple linear regression analysis, the maximum rise of cystatin C was related to the maximum rise of creatinine, but independent of patient age, gender, steroid dose, and anthropometric data.ConclusionsIn this pediatric population, cystatin C was not superior to creatinine for the detection of acute allograft dysfunction.

Discrepant Results of Serum Creatinine and Cystatin C in a Urological Patient

“…This is reflected in more rapid changes in serum cystatin C as compared to creatinine during acute changes in kidney function (6 ).…”

Renal function in children and adolescents with Duchenne muscular dystrophy

“…In contrast, CysC might be a promising marker to be used for this purpose as it is independent of muscle mass [33][34][35]. CysC is a 13.3 Da non-glycosylated basic protein produced by all nucleated cells.…”

Sensitivitas dan Spesifisitas Cystatin C dan Kreatinin Serum dalam Mendiagnosis Cedera Ginjal Akut pada Pasien Sepsis yang Dirawat di Ruang Rawat Intensif RSUP H. Adam Malik Medan

“…Penelitian yang dilakukan Slort dkk. 16 pada 24 pasien yang menjalani transplantasi ginjal pada anak menyimpulkan bahwa cystatin C serum tidak lebih superior dibanding dengan kreatinin serum untuk mendeteksi disfungsi allograft akut. 16 Masih belum begitu banyak penelitian yang membandingkan penanda cystatin C serum dengan kreatinin serum dalam mendeteksi CGA yang disebabkan oleh sepsis.…”

“…16 pada 24 pasien yang menjalani transplantasi ginjal pada anak menyimpulkan bahwa cystatin C serum tidak lebih superior dibanding dengan kreatinin serum untuk mendeteksi disfungsi allograft akut. 16 Masih belum begitu banyak penelitian yang membandingkan penanda cystatin C serum dengan kreatinin serum dalam mendeteksi CGA yang disebabkan oleh sepsis. Penelitianpenelitian sebelumnya dilakukan lebih banyak pada pasien dengan penyebab CGA lainnya seperti pada pascaoperasi jantung, obat dan zat kontras, pascatransplantasi ginjal, sirosis hepatis, dan lain-lain.…”