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Assessment of Kidney Function in Mouse Models of Glomerular Disease
Published on: June 30, 2018
Value of serum cystatin C in estimating renal function in children with non-renal solid organ transplantation
Manjula Gowrishankar1, Christina VanderPluym, Cheri Robert
1Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.
Insights
Accurate kidney function monitoring is crucial for children post-transplant. The CKiD and Filler formulas effectively estimate glomerular filtration rate (GFR), aiding in early detection of chronic kidney disease (CKD).
Area of Science:
- Pediatric Nephrology
- Transplant Medicine
- Renal Function Assessment
Background:
- Long-term survival in children with non-renal solid organ transplants is improving.
- Chronic kidney disease (CKD) remains a significant complication impacting outcomes.
- Precise and frequent renal function monitoring is essential for early intervention.
Purpose of the Study:
- To evaluate the accuracy of estimated glomerular filtration rate (eGFR) formulas against measured GFR (mGFR) in pediatric transplant recipients.
- To compare the performance of Filler, mSchwartz, and CKiD formulas in assessing renal function.
- To determine the most reliable method for monitoring CKD progression in this population.
Main Methods:
- A study involving 59 children post-non-renal solid organ transplant.
- Measured GFR (NM-GFR) served as the gold standard for comparison.
- eGFR was calculated using three formulas: Filler (serum cystatin C), mSchwartz (serum creatinine), and CKiD (cystatin C, creatinine, urea, height).
- Accuracy (P30), bias, sensitivity, and specificity were analyzed.
Main Results:
- All tested formulas (Filler, mSchwartz, CKiD) showed significant differences from mGFR and overestimated GFR.
- CKiD demonstrated the highest accuracy (P30 = 79.7%) and lowest bias (6.9 mL/min/1.73 m²).
- Filler (P30 = 67.7%, bias = 19.9) and mSchwartz (P30 = 57.6%, bias = 26.8) showed lower accuracy and higher bias.
- CKiD achieved 91.1% accuracy for GFR ≥ 90 mL/min/1.73 m², outperforming others.
- All formulas exhibited high sensitivity but low specificity at a cutoff of 90 mL/min/1.73 m².
Conclusions:
- The CKiD formula, followed by the Filler formula, provides adequate accuracy for close and frequent renal function monitoring in pediatric transplant patients.
- These eGFR estimations are valuable tools for managing CKD in this vulnerable population.
- Accurate GFR assessment is critical for timely interventions to prevent or slow CKD progression.
Abstract:
Children with non-renal solid organ transplants are surviving longer, but outcome is complicated by CKD. Accurate and frequent renal function monitoring is imperative to recognize and institute measures early to reverse, prevent, or arrest progression. This study of 59 children determined the accuracy (P30), bias, sensitivity and specificity between measured renal function by NM-GFR, and estimated GFR by three formulas: Filler (serum cystatin C), mSchwartz (serum creatinine), and CKiD (serum cystatin C, creatinine, urea, and height). Mean GFR by all formulas differed significantly from NM-GFR. Filler and mSchwartz formulas significantly increased the proportion of patients with GFR ≥ 90 mL/min/1.73 m(2) (CKD stage 1) while decreasing those with GFR 60-89 mL/min/1.73 m(2) (CKD stage 2). All formulas overestimated GFR. CKiD showed the highest P30 and lowest bias (79.7%; 6.9 mL/min/1.73 m(2) ) followed by Filler (67.7%; 19.9 mL/min/1.73 m(2) ) and Schwartz (57.6%; 26.8 mL/min/1.73 m(2) ) for all GFR values. All formulas performed best with GFR ≥ 90 mL/min/1.73 m(2) , but CKiD was the only formula to achieve 91.1% accuracy. All formulas showed high sensitivities, but low specificities at NM-GFR cutoff at 90. Thus, GFR estimated by CKiD followed by Filler formula is an adequate method to monitor renal function closely and frequently in these children.
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