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Published on: May 10, 2013
[Evaluation of glomerular filtration rate in children--serum markers and prediction equations]
Keiko Nakai1, Masayuki Kikuchi, Tomiko Koyamaa
1Department of Laboratory Medicine, Iwate Medical University, Morioka, Japan. keikoyn@iwate-med.ac.jp
Insights
Serum cystatin C is a better marker for estimating glomerular filtration rate (GFR) in children than serum creatinine (CRE). The Shwartz and Rule equations are practical for predicting GFR in pediatric populations.
Area of Science:
- Pediatric Nephrology
- Biomarker Discovery
- Renal Function Assessment
Context:
- Estimating glomerular filtration rate (GFR) in children is challenging due to physiological changes and difficulties in urine collection.
- Serum creatinine (CRE) levels are influenced by growth, complicating accurate GFR assessment in pediatric populations.
- Existing GFR markers and prediction equations require validation for reliable use in children.
Purpose:
- To evaluate serum GFR markers including cystatin C, beta2-microglobulin (beta2mG), and CRE in children.
- To assess the utility of various prediction equations for GFR estimation in pediatric subjects.
- To establish age- and gender-specific reference values for GFR markers in children.
Summary:
- Serum cystatin C demonstrated superior utility as a GFR marker compared to CRE in children aged 0-16 years.
- Serum CRE levels showed significant age-related differences, necessitating age- and gender-specific reference values.
- The Shwartz (CRE-based) and Rule (cystatin C-based) prediction equations were identified as practically useful for GFR estimation in children.
Impact:
- Highlights cystatin C as a more reliable GFR marker in pediatrics, potentially improving diagnostic accuracy.
- Provides validated reference values and practical prediction equations for pediatric GFR assessment.
- Aids clinicians in better monitoring and managing kidney function in children.
Background:
In children, determination of glomerular filtration rate(GFR) is not easy, because serum creatinine (CRE) level changes by their growth and collection of urine is difficult. In this study, we evaluated serum GFR markers and prediction equations of GFR.
Methods:
Serum samples were obtained from 200 healthy children; 100 children aged 9 to 10 years and 100 children aged 12 to 13 years (50 males and 50 females respectively). Serum levels of three GFR markers i.e., CRE, cystatin C, and beta2-microglobulin (beta2mG) were measured, and prediction equations of GFR were calculated. Another 110 serum samples were obtained from children aged 0 to 16 years, and the same three markers were measured.
Results:
In comparing healthy children aged 9 to 10 years and 12 to 13 years, serum CRE levels were significantly higher in the latter group. Serum cystatin C levels were not different between these two groups. Although serum levels of CRE, cystatin C, and beta2mG were not significantly different between males and females aged 9 to 10 years, significantly higher levels of these three markers were observed in males than females aged 12 to 13 years. The reference values of cystatin C and CRE were < or = 0.760 mg/l, < or = 0.623 mg/dl in children aged 9 to 10 years, and < or = 0.835 mg/l, < or = 0.785 mg/dl in children aged 12 to 13 years. Investigation of serum samples obtained from children aged 0 to 16 years suggested the better utility of cystatin C as a GFR marker compared to CRE. The Shwartz prediction equation is considered to be useful among the three CRE-based prediction equations, while the Rule prediction equation is considered to be useful among the three cystatin C-based prediction equations.
Conclusions:
We need the reference value of serum CRE in each age and gender to evaluate GFR. And we concluded serum cystatin C is the better GFR marker than CRE in children. As to the prediction equations, the Shwartz and the Rule prediction equation are considered to be practically useful in children.
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