Abstract
The concentration of cystatin C has been shown to be independent of age, gender and height, but the effect of malnutrition has not been studied. Levels of serum creatinine and cystatin C were estimated in 77 malnourished and 77 normally nourished boys between 2 years and 6 years of age without evidence of renal disease. The mean (95% confidence interval) serum creatinine level in the malnourished boys was significantly lower than that in the normally nourished boys [0.42 (0.38–0.45) mg/dl and 0.51 (0.48–0.55)] mg/dl, respectively, (P < 0.01)]. The mean level of serum cystatin C was 1.05 (0.94–1.17) mg/l and 1.12 (1.01–1.24) mg/l, respectively, in normally nourished and malnourished boys (P = 0.35). Mean glomerular filtration rate (GFR) estimated by the Schwartz equation in the malnourished boys was significantly higher than that in normally nourished children [141.8 (123.3–160.2) ml/min per 1.73 m2 body surface area and 119.4 (109.3–129.5) ml/min per 1.73 m2 body surface area], respectively (P = 0.04). However, the mean cystatin C-derived GFR was similar in the malnourished and normally nourished boys [99.70 (85.8–113.5) ml/min per 1.73 m2 and 109.2 (94.4–124.0) ml/min per 1.73 m2], respectively (P = 0.35). The mean bias between GFR estimates using Bland and Altman analysis was greater in the malnourished children than in the normally nourished children (32.3% and 17.6%, respectively) (P = 0.15). Serum creatinine levels are lower in malnourished children and lead to overestimation of GFR, while cystatin C levels are unaffected.
Similar content being viewed by others
References
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants and adolescents. Pediatr Clin North Am 34:571–590
International Institute for Population Sciences. National Family Health Survey—1998–99 (NFHS-II) (2002) International Institute for Population Sciences, Mumbai & ORC Macro, Calverton, pp 128–131
Tenstad O, Ronald AB, Grubb A, Aukland K (1966) Renal handling of radiolabelled human cystatin C in the rat. Scand J Clin Lab Invest 56:409–414
Filler G, Witt I, Priem F, Ehrich JH, Jung K (1997) Are cystatin C and beta 2-microglobulin better markers than serum creatinine for prediction of a normal glomerular filtration rate in pediatric subjects? Clin Chem 43:1077–1078
Boekenkamp A, Domenatezki M, Schumann G, Byrd D, Brodehl J (1998) Cystatin C—a new marker of glomerular filtration rate in children independent of age and height. Pediatrics 101:875–881
Boekenkamp A, Domenatezki M, Zinck R, Schumann G, Brodehl J (1998) Reference values for cystatin C serum concentration in children. Pediatr Nephrol 12:125–129
Schuck O, Teplan V, Stollova M, Skibova J (2004) Estimation of glomerular filtration rate in obese patients with chronic renal impairment based on serum cystatin C levels. Clin Nephrol 62:92–96
Hamill PV, Drizd TA, Johnson CL, Reed RB, Roche AF (1977) NCHS growth curves for children birth-18 years. United States. Vital Health Stat 11:1–74
Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP (1995) Serum cystatin C as measured by automated immunoassay, a more sensitive marker for changes in GFR than serum creatinine. Kidney Int 47:312–318
Cottrell DB, Frings CS (1979) Evaluation of the Beckman creatinine analyzer 2. Clin Biol Chem 12:159–161
Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985
United Nations (UN) Administrative Committee on Coordination, Subcommittee on Nutrition (ACC/SCN) (1987) First report on the world nutrition situation. Geneva, Switzerland
Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263
Brion LP, Boeck MA, Gauthier B, Nussbaum MP, Schwartz GJ (1989) Estimation of glomerular filtration rate in anorectic adolescents. Pediatr Nephrol 3:16–21
Schwartz GJ (1992) Does kL/PCr estimate GFR, or does GFR determine k? Pediatr Nephrol 6:512–515
Grubb A, Nyman U, Bjork J, Lindstrom V, Rippe B, Sterner G, Christensson A (2005) Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem 51:1420–1431
Bouvet Y, Bouissou F, Coulais Y, Seronie-Vivien S, Tafani M, Decramer S, Chatelut E (2006) GFR is better estimated by considering both serum cystatin C and creatinine levels. Pediatr Nephrol 21:1299–1306
Cimerman N, Brguljan PM, Krasovec M, Suskovic S, Kos J (2000) Serum cystatin C, a potent inhibitor of cysteine proteinases, is elevated in asthmatic patients. Clin Chim Acta 300:83–95
Kos J, Stabuc B, Cimerman N, Brunner N (1998) Serum cystatin C, a new marker of glomerular filtration rate, is increased during malignant progression. Clin Chem 44:2556–2557
Fricker M, Wiesli P, Brandle M, Schwegler B, Schmid C (2003) Impact of thyroid dysfunction on serum cystatin C. Kidney Int 63:1944–1947
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
Shlipak MG, Katz R, Cushman M, Sarnak MJ, Stehman-Breen C, Psaty BM, Siscovick D, Tracy RP, Newman A, Fried L (2005) Cystatin-C and inflammatory markers in the ambulatory elderly. Am J Med 118:1416
Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M (1999) Cystatin C as a marker for glomerular filtration rate in pediatric patients. Pediatr Nephrol 13:506–509
Schuck O, Teplan V, Jabor A, Stollova M, Skibova J (2003) Glomerular filtration rate estimation in patients with advanced chronic renal insufficiency based on serum cystatin C levels. Nephron Clin Pract 93:146–151
Wasen E, Isoaho R, Mattila K, Vahlberg T, Kivela SL, Irjala K (2004) Renal impairment associated with diabetes in the elderly. Diabetes Care 27:2648–2653
Christensson AG, Grubb AO, Nilsson JA, Norrgren K, Sterner G, Sundkvist G (2004) Serum cystatin C advantageous compared with serum creatinine in the detection of mild but not severe diabetic nephropathy. J Intern Med 256:510–518
Kocak H, Oner-Iyidogan Y, Gurdol F, Kocak T, Nane I, Genc S (2005) Cystatin-C and creatinine as indices of glomerular filtration rate in the immediate follow-up of renal transplant patients. Clin Exp Med 5:14–19
Herget-Rosenthal S, Marggraf G, Husing J, Goring F, Pietruck F, Janssen O, Philipp T, Kribben A (2004) Early detection of acute renal failure by serum cystatin C. Kidney Int 66:1115–1122
Schwartz GJ, Furth SL (2007). Glomerular filtration rate measurement and estimation in chronic kidney disease. Pediatr Nephrol DOI https://doi.org/10.1007/s00467-006-0358-1
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hari, P., Bagga, A., Mahajan, P. et al. Effect of malnutrition on serum creatinine and cystatin C levels. Pediatr Nephrol 22, 1757–1761 (2007). https://doi.org/10.1007/s00467-007-0535-x
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00467-007-0535-x