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GFR is better estimated by considering both serum cystatin C and creatinine levels

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Serum cystatin C (cysC) is a potential marker of the glomerular filtration rate (GFR) that has generated conflicting reports in children. A prospective study was conducted to assess the benefit of considering cysC together with serum creatinine (SCr) and demographic and morphologic characteristics to better estimate the 51Cr-ethylenediaminetetraacetate (EDTA) clearance (CL), i.e., the GFR. Plasma 51Cr-EDTA data from 100 children or young adults (range: 1.4–22.8 years old) were analyzed according to the population pharmacokinetic approach by using the nonlinear mixed effects model (NONMEM) program. The actual CL was compared to the CL predicted according to different covariate equations. The best covariate equation (±95% confidence interval) was: GFR (ml/min)=63.2(±3.4) . [(SCr (μM)/96)−0.35 (±0.20)] . [(cysC (mg/l)/1.2)−0.56 (±0.19)] . [(body weight (kg)/45)0.30 (±0.17)] . [age (years)/14)0.40 (±0.16)]. This equation was associated with a less biased and more precise estimation than the Schwartz equation. CysC improves the estimation of the GFR in children if considered with other covariates within the mathematical formula.

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  1. Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590

    PubMed  CAS  Google Scholar 

  2. Newman DJ (2002) Cystatin C. Ann Clin Biochem 39:89–104

    Article  PubMed  CAS  Google Scholar 

  3. Dharnidharka VR, Kwon C, Stevens G (2002) Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 40:221–226

    Article  PubMed  CAS  Google Scholar 

  4. Finney H, Newman DJ, Thakkar H, Fell JM, Price CP (2000) Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 82:71–75

    Article  PubMed  CAS  Google Scholar 

  5. Helin I, Axenram M, Grubb A (1998) Serum cystatin C as a determinant of glomerular filtration rate in children. Clin Nephrol 49:221–225

    PubMed  CAS  Google Scholar 

  6. Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985

    Article  PubMed  Google Scholar 

  7. White C, Akbari A, Hussain N, Dinh L, Filler G, Lepage N, Knoll GA (2005) Estimating glomerular filtration rate in kidney transplantation: a comparison between serum creatinine and cystatin C-based methods. J Am Soc Nephrol 16:3763–3770

    Article  PubMed  CAS  Google Scholar 

  8. Thomas F, Seronie-Vivien S, Gladieff L, Dalenc F, Durrand V, Malard L, Lafont T, Poublanc M, Bugart R, Chatelut E (2005) Cystatin C as a new covariate to predict the renal elimination of drugs: application to carboplatin. Clin Pharmacokinet 44:1305–1316

    Article  PubMed  CAS  Google Scholar 

  9. Calvert AH, Newell DR, Gumbrell LA, O’Reilly S, Burnell M, Boxall FE, Siddick ZH, Judson IR, Gore ME, Wiltshaw E (1989) Carboplatin dosage: prospective evaluation of a simple formula based on renal function. J Clin Oncol 7:1748–1756

    PubMed  CAS  Google Scholar 

  10. Whiting B, Kelman AW, Grevel J (1986) Population pharmacokinetics. Theory and clinical application. Clin Pharmacokinet 11:387–401

    Article  PubMed  CAS  Google Scholar 

  11. Léger F, Bouissou F, Coulais Y, Tafani M, Chatelut E (2002) Estimation of glomerular filtration rate in children. Pediatr Nephrol 17:903–907

    Article  PubMed  Google Scholar 

  12. Wright JG, Boddy AV, Highley M, Fenwick J, McGill A, Calvert AH (2001) Estimation of glomerular filtration rate in cancer patients. Br J Cancer 84:452–459

    Article  PubMed  CAS  Google Scholar 

  13. Chantler C, Garnett ES, Parsons V, Veall N (1969) Glomerular filtration rate measurement in man by the single injection methods using 51Cr-EDTA. Clin Sci 37:169–180

    PubMed  CAS  Google Scholar 

  14. Beal SL, Sheiner LB (1982) Estimating population kinetics. Crit Rev Biomed Eng 8:195–222

    PubMed  CAS  Google Scholar 

  15. Haycock GB, Schwartz GJ, Wisotsky DH (1978) Geometric method for measuring body surface area: a height-weight formula validated in infants, children, and adults. J Pediatr 93:62–66

    Article  PubMed  CAS  Google Scholar 

  16. Schwartz GJ (1992) Does kL/PCr estimate GFR, or does GFR determine k? Pediatr Nephrol 6:512–515

    Article  PubMed  CAS  Google Scholar 

  17. Van Rossum LK, Mathot RAA, Cransberg K, Zietse R, Vulto AG (2005) Estimation of the glomerular filtration rate in children: which algorithm should be used? Pediatr Nephrol 20:1769–1775

    Article  PubMed  Google Scholar 

  18. Bokenkamp A, van Wijk JA, Lentze MJ, Stoffel-Wagner B (2002) Effect of corticosteroid therapy on serum cystatin C and beta2-microglobulin concentrations. Clin Chem 48:1123–1126

    PubMed  CAS  Google Scholar 

  19. Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela SL, Irjala K (2003) Serum cystatin C in the aged: relationships with health status. Am J Kidney Dis 42:36–43

    Article  PubMed  CAS  Google Scholar 

  20. Lemann J, Bidani AK, Bain RP, Lewis EJ, Rohde RD (1990) Use of the serum creatinine to estimate glomerular filtration rate in health and early diabetic nephropathy. Collaborative Study Group of Angiotensin Converting Enzyme Inhibition in Diabetic Nephropathy. Am J Kidney Dis 16:236–243

    PubMed  CAS  Google Scholar 

  21. Shemesh O, Golbetz H, Kriss JP, Myers BD (1985) Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int 28:830–838

    Article  PubMed  CAS  Google Scholar 

  22. Knight EL, Verhave JC, Spiegelman D, Hillege HL, de Zeeuw D, Curhan GC, de Jong PE (2004) Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 65:1416–1421

    Article  PubMed  CAS  Google Scholar 

  23. Shlipak MG, Katz R, Cushman M, Sarnak MJ, Stehman-Breen C, Psaty BM, Siscovik D, Tracy RP, Newman A, Fried L (2005) Cystatin-C and inflammatory markers in the ambulatory elderly. Am J Med 118:1416

    Article  PubMed  Google Scholar 

  24. Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Brodehl J (1998) Reference values for cystatin C serum concentrations in children. Pediatr Nephrol 12:125–129

    Article  PubMed  CAS  Google Scholar 

  25. Martini S, Prevot A, Mosig D, Werner D, van Melle G, Guignard JP (2003) Glomerular filtration rate: measure creatinine and height rather than cystatin C! Acta Paediatr 92:1052–1057

    Article  PubMed  CAS  Google Scholar 

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The authors thank Dade Behring (Marburg, Germany) for providing the analyzer and kits for the measurement of cystatin C. None of the authors has any conflict of interest to declare with respect to the contents of this article.

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Correspondence to Etienne Chatelut.

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Bouvet, Y., Bouissou, F., Coulais, Y. et al. GFR is better estimated by considering both serum cystatin C and creatinine levels. Pediatr Nephrol 21, 1299–1306 (2006).

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