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Beta-2 microglobulin-based equation for estimating glomerular filtration rates in Japanese children and adolescents
Yohei Ikezumi1,2, Osamu Uemura3, Takuhito Nagai3
1The Committee of Measures for Pediatric CKD, The Japanese Society for Pediatric Nephrology, Tokyo, Japan. ikezumi@med.niigata-u.ac.jp.
Insights
A new formula using serum beta-2 microglobulin (β2MG) offers improved estimation of glomerular filtration rate (GFR) in Japanese children with chronic kidney disease (CKD). This β2MG-based equation is more accurate than the traditional creatinine (Cr)-based method for assessing renal function in this population.
Area of Science:
- Pediatric Nephrology
- Biomarker Discovery
- Renal Function Assessment
Background:
- Creatinine (Cr)-based equations for estimating glomerular filtration rate (GFR) have limitations in children, particularly those with low body weight or under 2 years old.
- Chronic kidney disease (CKD) in pediatric populations requires accurate GFR estimation for effective management.
- Serum beta-2 microglobulin (β2MG) is explored as a potential alternative biomarker for GFR estimation in children.
Purpose of the Study:
- To develop and validate a new equation for estimating GFR in Japanese children with CKD using serum β2MG levels.
- To compare the diagnostic accuracy of the β2MG-based GFR estimation with the conventional Cr-based equation.
- To assess the utility of β2MG as a biomarker for early detection of reduced GFR in pediatric CKD.
Main Methods:
- Inulin clearance, serum β2MG, and serum Cr levels were measured in 137 Japanese pediatric CKD patients (1 month-18 years).
- Receiver operating characteristic (ROC) analyses were conducted to compare the accuracy of β2MG- and Cr-based GFR estimations.
- A new equation for GFR estimation based on serum β2MG was derived: inulin GFR = 149.0 × (1/serum β2MG) + 9.15.
Main Results:
- Serum β2MG concentrations showed a significant inverse correlation with GFR (r=-0.74) and a positive correlation with 1/GFR (r=0.86).
- The derived β2MG-based equation accurately estimated inulin clearance in pediatric CKD patients.
- ROC analysis demonstrated superior diagnostic accuracy for the β2MG-based GFR estimation (<95 mL/min/1.73 m²) compared to the Cr-based eGFR in children over 2 years (AUC 0.960 vs. 0.948).
Conclusions:
- The novel β2MG-based eGFR formula is a valuable tool for the clinical screening of renal function in Japanese children and adolescents.
- Measuring both serum β2MG and Cr levels can aid in the early detection of mildly reduced GFR in pediatric CKD.
- This β2MG-based approach offers a more reliable method for GFR estimation in pediatric patients compared to traditional Cr-based equations.
Background:
Although the creatinine (Cr)-based equation is widely used for estimating glomerular filtration rate (GFR), this equation is not ideally suited for children with low body weight or aged <2 years. Therefore, we established a new equation using serum beta-2 microglobulin (β2MG) levels for Japanese children with chronic kidney disease (CKD).
Methods:
Inulin clearance and standardized serum β2MG and Cr levels were measured in 137 CKD patients aged 1 month-18 years. Using the previously established normal β2MG levels, Cr reference values, and Cr-based equation of estimated GFR (eGFR) in Japanese children, receiver operating characteristics (ROC) analyses were performed to compare the diagnostic accuracy between β2MG- and Cr-based estimations of GFR.
Results:
Serum β2MG concentrations progressively increased as GFRs reduced. The correlation coefficients between GFR and β2MG, and between GFR and 1/β2MG were -0.74 (p < 0.001) and 0.86 (p < 0.001), respectively. The inulin clearance, as based on 1/serum β2MG expression, in pediatric CKD patients resulted in the equation: inulin GFR (mL/min/1.73 m(2)) = 149.0 × 1/serum β2MG (mg/L) +9.15. ROC analyses indicated that the ability of serum β2MG-based GFR <95 mL/min/1.73 m(2) in children >2 years was better than the Cr-based estimated GFR (areas under the ROC curve 0.960 vs. 0.948, respectively).
Conclusion:
The new β2MG-based eGFR formula is useful for clinical screening of renal function in Japanese children and adolescents, and measurement of serum β2MG and Cr levels as markers for predicting glomerular function may aid the early detection of mildly reduced GFR in this population.
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