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GFR estimated from cystatin C versus creatinine in children born small for gestational age
Maria C P Franco1, Sônia K Nishida, Ricardo Sesso
1Department of Medicine, Division of Nephrology, Federal University of São Paulo, São Paulo, Brazil. mdcfranco@nefro.epm.br
Insights
Low birth weight in full-term children is linked to higher cystatin C levels, a marker of kidney function. This association suggests potential long-term renal health implications for individuals with lower birth weights.
Area of Science:
- Pediatric Nephrology
- Developmental Origins of Health and Disease (DOHaD)
Background:
- Low birth weight, often resulting from intrauterine growth restriction, is a potential risk factor for adult renal impairment.
- Understanding early life factors influencing long-term kidney health is crucial for preventative strategies.
Purpose of the Study:
- To investigate the association between birth weight and markers of kidney function in children.
- To determine if lower birth weight correlates with impaired glomerular filtration rate (GFR) or altered cystatin C and creatinine levels.
Main Methods:
- A cross-sectional study involving 71 children aged 8-13 years in São Paulo, Brazil.
- Participants were categorized into birth weight quartiles; kidney function was assessed using serum cystatin C, creatinine, and estimated GFR (eGFR).
- Statistical analyses, including covariance analysis, were performed to adjust for confounding factors like age, sex, BMI, and systolic blood pressure.
Main Results:
- No significant differences in serum creatinine or eGFR(cr) were observed across birth weight quartiles.
- A significant trend of increasing cystatin C levels (and decreasing eGFR(cys)) was found in lower birth weight quartiles (P = 0.002).
- After adjusting for covariates, cystatin C levels remained significantly higher in the lowest birth weight quartile compared to the highest (P = 0.02).
Conclusions:
- Lower birth weight in full-term children is associated with elevated cystatin C levels, indicating potential subclinical renal dysfunction.
- Creatinine levels and eGFR(cr) did not show a similar association, highlighting cystatin C as a more sensitive marker in this context.
- These findings underscore the importance of birth weight as an early indicator of potential future kidney health issues.
Background:
Low birth weight caused by intrauterine growth restriction may be a risk factor for renal impairment in the adult life.
Study Design:
A cross-sectional study.
Setting & Participants:
71 children aged 8 to 13 years living in the community of São Paulo, Brazil, were included in the study. Gestational age was within the normal range.
Predictors:
Birth weight (range, 2,052 to 3,560 g) divided into quartiles: 2,500 g or less; 2,501 to 2,740 g; 2,741 to 3,000 g; and greater than 3,000 g. Birth weight ascertained by birth records in 43 and by recall in 28 participants.
Outcomes & Measurements:
Cystatin C, creatinine, and glomerular filtration rate (GFR) estimated by equations using cystatin C (eGFR(cys)) or creatinine (eGFR(cr)).
Results:
Overall, mean serum creatinine level was 0.8 +/- 0.01 (SE) mg/dL (range, 0.7 to 1.1 mg/dL); mean plasma cystatin C level was 0.9 +/- 0.02 mg/L (range, 0.5 to 1.6 mg/L), and eGFR(cr) and eGFR(cys) were 102.4 +/- 2.16 (range, 66 to 140) and 91.8 +/- 2.46 mL/min/1.73 m(2) (range, 49 to 139 mL/min/1.73 m(2)), respectively. No differences were found for serum creatinine or eGFR(cr) values among the birth-weight quartiles. There was a significant linear trend of increasing cystatin C levels (decreasing eGFR(cys)) in the lower birth-weight quartile groups (P = 0.002 and P = 0.02, respectively). Systolic blood pressure correlated with plasma cystatin C level (r = 0.31; P = 0.008) and eGFR(cys) (r = -0.26; P = 0.028). Covariance analysis adjusting for age, sex, body mass index for age compared with standards of the National Center for Health Statistics and expressed as a z score, and systolic blood pressure showed that cystatin C values remained greater in the lowest than highest birth-weight quartile (1.01 +/- 0.05 versus 0.83 +/- 0.05 mg/L; P = 0.02).
Limitations:
Ascertainment of birth weight by recall in some participants. Lack of measurement of microalbuminuria, absence of direct GFR measurement, and small sample size.
Conclusions:
Lower birth weight is associated with higher levels of cystatin C but not creatinine in 8-13 yr. old children born full-term.
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