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Cystatin C: A Marker for Inflammation and Renal Function Among HIV-infected Children and Adolescents
Àngela Deyà-Martínez1, Clàudia Fortuny, Pere Soler-Palacín
1From the *Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; †Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain; ‡Unidad de Enfermedades Infecciosas e Inmunopatologias, Hospital Infantil Virgen del Rocio, Instituto de Biomedicina de Sevilla, Sevilla, Spain; §Blanquerna School of Health Science, Universitat Ramon Llull, Barcelona, Spain; and ¶Nephrology Department and ‖Laboratory Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain.
Insights
Cystatin C may serve as a reliable marker for kidney function in children with HIV, even with inflammation. This study found cystatin C levels correlate with glomerular filtration rate and inflammation markers.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Biomarkers
Background:
- Renal disease is a significant complication in HIV-infected adults on highly active antiretroviral therapy (HAART).
- Cystatin C is a potential marker for renal function but may be influenced by inflammation.
- This study investigated cystatin C in HIV-infected pediatric patients.
Purpose of the Study:
- To evaluate cystatin C levels as a marker of renal function in HIV-infected children.
- To assess the relationship between cystatin C, renal function, and inflammation markers in this population.
Main Methods:
- A multicenter, cross-sectional observational study was conducted.
- Renal function was assessed using urine protein/creatinine and albumin/creatinine ratios, and estimated glomerular filtration rates (GFRs).
- Inflammation markers including cystatin C, C-reactive protein, β-2-microglobulin, and 25(OH)-vitamin D were measured. A control group of healthy children was included.
Main Results:
- Eighty-three HIV-infected children and 44 healthy controls were analyzed.
- No significant difference in cystatin C levels was found between HIV-infected patients and controls.
- In HIV-infected patients, cystatin C correlated with GFR (r = -0.27; P = 0.01), age at first HAART (r = -0.21; P = 0.05), and β-2-microglobulin (r = 0.569; P < 0.01).
- Multivariate analysis identified lower GFR and higher β-2-microglobulin as independent predictors of higher cystatin C levels.
Conclusions:
- Cystatin C levels are associated with glomerular filtration rate and β-2-microglobulin in HIV-infected pediatric patients.
- Cystatin C may be a valuable marker for assessing renal function in this cohort, independent of inflammation or HIV viremia.
Background:
Renal disease is a leading cause of morbidity in HIV-infected adults in the highly active antiretroviral therapy (HAART) era. Cystatin C has been proposed as a more sensitive marker of renal function, but it may be affected by ongoing inflammation. We aimed to study the cystatin C levels in a cohort of HIV-infected pediatric patients at 3 Spanish centers.
Methods:
This is a multicenter cross-sectional observational study. Renal function was assessed by means of first morning urine protein/creatinine and albumin/creatinine ratios and creatinine-estimated glomerular filtration rates (GFRs), together with the following inflammation markers: cystatin C, reactive C protein, β-2-microglobulin and 25(OH)-vitamin D levels. A control group of healthy children and adolescents was used.
Results:
Eighty-three patients (51 females, median age: 13.3 years; 32 males, median age: 13.6 years) and 44 controls (24 females, median age: 12.2 years; 20 males, median age: 10.9 years) were included. Among the former, mean CD4 cell count was 860/mm, 29(35%) patients had a previous AIDS diagnosis, 73(88%) were on HAART and HIV viremia was undetectable in 61(73%). No differences in cystatin C levels were observed between the 2 groups. In HIV-infected patients, cystatin C levels correlated with GFR (r = -0.27; P = 0.01), age at first HAART (r = -0.21; P = 0.05), and β-2-microglobulin (r = 0.569; P < 0.01). In multivariate analysis, lower GFR (P = 0.014) and higher β-2-microglobulin levels (P = 0.001) remained as independent risk factors for higher cystatin C values.
Conclusions:
Cystatin C values were associated with GFR and β-2-microglobulin. Cystatin C may be useful as a marker of renal function in HIV-infected pediatric patients, independently of ongoing inflammation or viremia.
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