Serum and urine cystatin C levels in children with post-pyelonephritic renal scarring: a pilot study
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We aimed to investigate in children with a history of acute pyelonephritis the influence of unilateral post-pyelonephritic renal scarring detected by DMSA scan on serum (SCysC) and urine cystatin C (UCysC) as well as upon other traditional markers of renal damage.
Children with DMSA proven pyelonephritis (n = 28) were grouped as either scar [+] (n = 19, unilateral renal scarring) or scar [−] (no scarring, n = 9). The scar [+] group was further divided into scar-1 (differential DMSA uptake, ΔDMSA ≤ 10%; n = 8) and scar-2 (ΔDMSA > 10%, n = 11) subgroups. SCysC, serum creatinine, urine NAG, microalbumin, protein, fractional sodium excretion (FENa), tubular phosphate reabsorption (TPR), and UCysC/Cr were evaluated in all patients.
Neither SCysC nor UCysC were affected by age, height, and weight. scar [+] versus scar [−] groups and scar-1 versus scar-2 subgroups were not different with regard to all studied parameters. SCysC did not increase in children with post-pyelonephritic unilateral renal scarring. However, 11 children with slightly increased (>0.95 mg/l) SCysC levels in scar [+] group tended to have higher ΔDMSA, albeit not significantly. Furthermore, UCysC/Cr correlated well with urine microalbumin, NAG, and FENa in all children and the scar [+] group (P < 0.05).
SCysC and UCysC did not differ among pediatric patients with and without unilateral post-pyelonephritic renal scarring. However, ΔDMSA uptake between the two kidneys tended to be raised in children with SCysC levels higher than the reference ranges. Additionally, UCysC/Cr exhibits parallelism with tubular functions.
KeywordsDMSA Glomerular filtration rate Pyelonephritis Renal scarring Serum cystatin C Tubular functions Urinary cystatin C
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