Related Experiment Video
Updated: Sep 6, 2025
Ischemia-reperfusion Model of Acute Kidney Injury and Post Injury Fibrosis in Mice
Published on: August 9, 2013
Diagnostic Performance of Height-Estimated Baseline Creatinine in Diagnosing Acute Kidney Injury in Children with
Stefano Guarino1, Giulio Rivetti1, Anna Di Sessa1
1Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138 Naples, Italy.
Insights
Estimated baseline serum creatinine (ebSCr) can help diagnose acute kidney injury (AKI) in children with new-onset type 1 diabetes mellitus (T1DM) when measured baseline serum creatinine (mbSCr) is unavailable. This height-based estimation shows good agreement with measured values, aiding AKI diagnosis.
Area of Science:
- Pediatric Nephrology
- Endocrinology
- Critical Care Medicine
Background:
- Acute kidney injury (AKI) is common at type 1 diabetes mellitus (T1DM) onset.
- Diagnosing AKI requires a baseline serum creatinine (bSCr), which is often unknown in hospitalized children.
- Estimated bSCr (ebSCr) based on height may serve as a surrogate for measured bSCr (mbSCr).
Purpose of the Study:
- To evaluate the reliability of ebSCr as a surrogate for mbSCr in diagnosing AKI in children with T1DM onset.
- To compare AKI classification using ebSCr versus mbSCr.
- To assess the agreement and diagnostic accuracy of ebSCr-based AKI detection.
Main Methods:
- A cohort of 163 children with T1DM onset was studied.
- AKI was defined as serum creatinine >1.5 times baseline.
- ebSCr was calculated using height; mbSCr was measured 14 days post-T1DM onset.
- Agreement was assessed using Kappa statistics and Bland-Altman plots.
- Receiver-operating characteristic curves (AUROC) were compared.
Main Results:
- AKI prevalence was 40.5% based on mbSCr and 30.7% based on ebSCr.
- ebSCr showed good correlation with mbSCr (Spearman's rho = 0.67, r = 0.68).
- AKI classification agreement between ebSCr and mbSCr was 90% (kappa = 0.66).
- The ebSCr-based highest/baseline creatinine ratio had a significant AUROC of 0.94.
Conclusions:
- Estimated baseline serum creatinine (ebSCr) based on height is a reliable alternative when measured baseline serum creatinine (mbSCr) is unknown in T1DM patients.
- ebSCr can effectively guide clinicians in diagnosing AKI at T1DM onset.
- This method offers a practical approach to AKI assessment in pediatric T1DM.
Abstract:
At type 1 diabetes mellitus (T1DM) onset, acute kidney injury (AKI) is very common. To diagnose AKI, the availability of a baseline serum creatinine (bSCr) is pivotal. However, in most hospitalized children the bSCr is unknown. We aimed to test whether the bSCr estimated on the basis of height (ebSCr) could be a reliable surrogate for AKI diagnosis compared with the measured bSCr (mbSCr). As the mbSCr, we considered the creatinine measured 14 days after T1DM onset while ebSCr (mg/dL) = (k × height [cm])/120 mL/min/1.73 m2, where k = 0.55 for children and adolescent girls and k = 0.7 for adolescent boys. AKI was defined as serum creatinine values >1.5 times the baseline creatinine. Kappa statistics and the percentage of agreement in AKI classification by ebSCr−AKI versus mbSCr−AKI definition methods were calculated. Bland−Altman plots were used to show the agreement between the creatinine ratio (highest/baseline creatinine; HC/BC) calculated with mbSCr and ebSCr. The number of 163 patients with T1DM onset were included. On the basis of mbSCr, 66/163 (40.5%) presented AKI while, on the basis of ebSCr, 50/163 (30.7%) accomplished AKI definition. ebSCr showed good correlation with mbSCr using both the Spearman test (rho = 0.67; p < 0.001) and regression analysis (r = 0.68; p < 0.001). Moreover, at the Bland−Altman plots, the bias of the highest/baseline creatinine ratio calculated on the basis of the mbSCr compared to ebSCr was minimal (bias = −0.08 mg/dL; 95% limits of agreement = −0.23/0.39). AKI determined using ebSCr showed 90% agreement with AKI determined using mbSCr (kappa = 0.66; p < 0.001). Finally, we compared the area under a receiver−operating characteristic curve (AUROC) of HC/BC ratio calculated on the basis of ebSCr with AUROC of the gold standard HC/BC ratio calculated on the basis of mbSCr. As expected, the gold standard had an AUROC = 1.00 with a 95% confidence interval (CI) between 0.98 and 1.00, p < 0.001. The HC/BC ratio calculated on the basis of ebSCr also had significant AUROC (AUROC = 0.94; 95% CI: 0.90−0.97; p < 0.001). The comparison of the two ROC curves showed a p < 0.001. In conclusion, when mbSCr is unknown in patients with T1DM onset, the ebSCr calculated on the basis of height could be an alternative to orientate clinicians toward AKI diagnosis.
More Related Videos
Related Concept Videos
01:30Acute Kidney Injury IV: Diagnostic Studies and Prevention
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury III: Clinical Manifestations
01:17Factors Affecting Renal Clearance: Renal Impairment
One condition associated with renal failure is uremia. Uremia is characterized by impaired glomerular filtration and fluid accumulation in the body. This condition hinders the renal clearance of drugs, resulting in drug accumulation and potential...
01:24Serum Studies: Renal Function Tests
01:28Chronic Kidney Disease III: Interprofessional Care