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Is serum CRP level a reliable inflammatory marker in pediatric nephrotic syndrome?

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Abstract

Background

This study tested the hypothesis that during massive proteinuria, C-reactive protein (CRP) may be lost into the urine along with other proteins, making serum CRP (sCRP) level an unreliable marker of infection severity in nephrotic syndrome (NS).

Methods

Children with active NS (n = 23) were compared with two matched control groups: patients with febrile non-renal infectious disease (n = 30) and healthy subjects (n = 16). Laboratory measurements included sCRP, urine protein, creatinine, IgG, and protein electrophoresis. Urinary CRP (uCRP) was measured by ELISA.

Results

Sixty-nine patients were enrolled: 23 patients with NS, 30 patients with non-renal febrile infectious diseases, and 16 healthy children. Median uCRP concentrations were 0 mcg/gCr (0–189.7) in NS, 11 mcg/gCr (0–286) in the febrile group, and 0 mcg/gCr (0–1.8) in the healthy group. The uCRP/creatinine ratio was similar in the NS and healthy groups (p > 0.1) and significantly higher in the febrile group than the other two groups (p < 0.0001). There was no association of uCRP concentration with severity of proteinuria or IgG excretion.

Conclusions

NS in children is not characterized by significant loss of CRP into the urine. Therefore, sCRP may serve as a reliable marker of inflammation in this setting. The significant urinary excretion of CRP in children with transient non-renal infectious disease might be attributable to CRP synthesis in renal epithelial cells.

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Acknowledgments

We thank Professor Lewis Reisman for the editing and finalization of the manuscript.

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Authors and Affiliations

  1. Pediatric Intensive Care Unit, Schneider Children’s Medical Center of Israel, 14 Kaplan Street, PO Box 559, Petach Tikva, 49202, Israel

    Eran Shostak

  2. Institute of Pediatric Nephrology, Schneider Children’s Medical Center of Israel, Petach Tikva, 49202, Israel

    Irit Krause, Amit Dagan, Meital Keidar & Miriam Davidovits

  3. Multidisciplinary Laboratories, Schneider Children’s Medical Center of Israel, Petach Tikva, 49202, Israel

    Anat Ben-Dor

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    Eran Shostak, Irit Krause, Amit Dagan & Miriam Davidovits

Authors
  1. Eran Shostak
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  2. Irit Krause
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  3. Amit Dagan
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  4. Anat Ben-Dor
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  5. Meital Keidar
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  6. Miriam Davidovits
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Corresponding author

Correspondence to Eran Shostak.

Ethics declarations

The study was approved by the Institutional Review Boards of Rabin Medical Center and Schneider Children’s Medical Center of Israel. Patients were enrolled in the study after written informed consent was obtained from a parent or legal guardian.

Competing interests

The authors declare no conflicts of interest.

Funding

No financial assistance was received in support of the study.

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Shostak, E., Krause, I., Dagan, A. et al. Is serum CRP level a reliable inflammatory marker in pediatric nephrotic syndrome?. Pediatr Nephrol 31, 1287–1293 (2016). https://doi.org/10.1007/s00467-016-3328-2

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  • DOI: https://doi.org/10.1007/s00467-016-3328-2

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