Serum cystatin C for acute kidney injury evaluation in children treated with aminoglycosides

Abstract

Background Serum cystatin C (CysC) is a more accurate glomerular filtration rate marker than serum creatinine (SCr) and may rise more quickly with acute kidney injury (AKI). Methods We performed a prospective cohort study of 81 noncritically ill children during 110 aminoglycoside (AG) treatments. We calculated area under the curve (AUC) for CysC to diagnose SCr-defined AKI and predict persistent AKI. SCr-AKI definition was based on the Kidney Disease: Improving Global Outcomes (≥stage 1: ≥50 % or 26.5 μmol/l SCr rise from baseline; stage 2: SCr doubling); CysC-AKI was based on a modified version using CysC rise. Results SCr-AKI and CysC-AKI developed in 45 and 48 % treatments, respectively. CysC rise predicted stage 1 (AUC = 0.75, 95 % CI 0.60–0.90) and 2 (AUC = 0.85, 95 % CI 0.75–0.95) SCr-AKI 2 days before SCr-AKI attainment. The best combined sensitivity/specificity for percent CysC rise to predict stage 1 SCr-AKI was with a 44 % CysC rise (sensitivity = 65 %, specificity = 83 %). CysC rise on day of SCr-AKI development was associated with SCr-AKI ≥48 h (AUC = 0.73, 95 % CI 0.56–0.90) and ≥50 % persistent SCr rise at treatment end (AUC = 0.76, 95 % CI 0.61–0.90). Conclusions CysC is as an early AKI biomarker and predictive of persistent AKI on aminoglycoside treatment.

Impact of thymoquinone on cyclosporine A pharmacokinetics and toxicity in rodents

“…The nephrotoxic effects induced by CsA, marked by serum creatinine level, were also slightly attenuated by coadministration of TQ. This finding is in line with previous studies showing an improvement in increased serum creatinine due to nephrotoxicity by TQ or N. sativa extracts . Cystatin C is reported as a biomarker for prediction of early acute kidney injury (AKI) .…”

“…This finding is in line with previous studies showing an improvement in increased serum creatinine due to nephrotoxicity by TQ or N. sativa extracts. [21,22] Cystatin C is reported as a biomarker for prediction of early acute kidney injury (AKI). [23] Since a chronic administration of CsA is known to cause renal damage, our results also showed an increased level of Cystatin C in groups receiving CsA.…”

Цистатин С І Хронічна Хвороба Нирок У Дітей

“…Сироватковий цистатин С дозво-ляє передбачити розвиток ГУН на 1-2 доби рані-ше, ніж сироватковий креатинін. Він є чутливим предиктором ГУН у дітей в критичному стані і в разі лікування аміноглікозидами [4,25], прогнос-тичним біомаркером для ГУН після кардіохірургіч-них втручань [23].…”

Pediatric acute kidney injury: prevalence, impact and management challenges

“…6 In the future, we may see these definitions further expanded to include criteria using serum cystatin C or urinary biomarkers such as neutrophil gelatinaseassociated lipocalin (NGAL), both of which have recently been shown to represent earlier markers of AKI and recovery than serum creatinine. 7,8 …”