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Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular
Guido Filler1, Friedrich Priem, Nathalie Lepage
1Departments of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1 Canada.
Insights
Beta-trace protein (BTP) shows improved diagnostic accuracy for detecting reduced glomerular filtration rate (GFR) in children compared to serum creatinine. BTP is a viable alternative to cystatin C for assessing pediatric GFR.
Area of Science:
- Pediatric Nephrology
- Biomarker Discovery
- Diagnostic Accuracy
Background:
- Serum creatinine has limitations in accurately assessing glomerular filtration rate (GFR) in pediatric populations.
- Novel biomarkers are needed to improve the detection of reduced GFR in children.
Purpose of the Study:
- To evaluate the diagnostic accuracy of beta-trace protein (BTP) for detecting reduced GFR in children.
- To compare BTP with cystatin C (Cys-C), beta(2)-microglobulin (beta(2)-MG), and creatinine.
Main Methods:
- Serum samples were collected from 225 children with various renal pathologies.
- Measurements included BTP, Cys-C, beta(2)-MG, and creatinine.
- GFR was assessed using nuclear medicine clearance investigations.
Main Results:
- BTP and Cys-C showed higher correlations with nuclear medicine clearance than creatinine and beta(2)-MG.
- Receiver operating characteristic (ROC) analysis indicated superior diagnostic accuracy for BTP and Cys-C over serum creatinine.
- BTP increased sensitivity by approximately 30% compared to creatinine.
Conclusions:
- Beta-trace protein (BTP) is superior to serum creatinine for detecting mildly reduced GFR in children.
- BTP serves as a valuable alternative to cystatin C in this diagnostic context.
- BTP's performance is comparable to the Schwartz GFR estimate.
Background:
Because of the limitations of serum creatinine as a marker of glomerular filtration rate (GFR) in children, we assessed the diagnostic accuracy of the novel marker beta-trace protein (BTP) in comparison with cystatin C (Cys-C), beta(2)-microglobulin (beta(2)-MG), and creatinine as conventional indicators of reduced GFR.
Methods:
We obtained serum samples from 225 children (age range, 0.2-18 years) with various renal pathologies who were referred for nuclear medicine clearance investigations (technetium-diethylenetriamine pentaacetic acid or chromium-EDTA). We measured Cys-C, BTP (nephelometric tests; Dade Behring), beta(2)-MG (Tinaquant; Roche), and creatinine (enzymatic assay; Creatinine-PAP; Roche).
Results:
Seventy-five children had reduced GFR (<90 mL x min(-1) x 1.73 m(-2)). One hundred fifty children (independent of gender and age) with values >90 mL x min(-1) x 1.73 m(-2) comprised the control group with gaussian distributions of BTP and Cys-C concentrations. The upper reference limits (97.5 percentile) were 1.01 mg/L for BTP and 1.20 mg/L for Cys-C. The correlations of nuclear medicine clearance with the reciprocals of BTP, Cys-C, and the Schwartz GFR estimate were significantly higher (r = 0.653, 0.765, and 0.706, respectively; P <0.05) than with the reciprocal of creatinine or beta(2)-MG (r = 0.500 and 0.557, respectively). ROC analysis showed a significantly higher diagnostic accuracy of BTP, Cys-C, and the GFR estimate for the detection of impaired GFR than serum creatinine (P <0.05). Compared to creatinine, BTP increased the diagnostic sensitivity by approximately 30%, but it was not more sensitive than Cys-C or the Schwartz GFR estimate.
Conclusions:
BTP is superior to serum creatinine and an alternative for Cys-C to detect mildly reduced GFR in children, but it is not better than the Schwartz GFR estimate.