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Early detection of acute kidney injury by serum cystatin C in critically ill children

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Abstract

Background

We prospectively evaluated whether serum cystatin C (CysC) detected acute kidney injury (AKI) earlier than basal serum creatinine (Cr).

Methods

In 107 pediatric patients at high risk of developing AKI, serum Cr and serum CysC were measured upon admission. Baseline estimated creatinine clearance (eCCl) was calculated using a CysC-based glomerular filtration rate (GFR) equation from a serum Cr measured at the pediatric intensive care unit (PICU) entrance.

Results

The median age was 10 months (interquartile range, 3–36 months). Serum Cr, serum CysC, and eCCl (mean ± standard deviation [range]) were 0.5 ± 0.18 mg/dl (0.2–1.1 mg/dl), 0.53 ± 0.78 (0.01–3.7 mg/l), and 72.55 ± 28.72 (20.6–176.2) ml/min per 1.73 m2, respectively. The serum CysC level in patients with AKI was significantly higher than children with normal renal function (p < 0.001). The values for the cut-off point, sensitivity, specificity, and the area under curve (AUC) were determined for CysC as 0.6 mg/l, 73.9 %, 78.9 %, and 0.92 [95 % confidence interval (0.82–1)], respectively, and for Cr the values were 0.4 mg/dl, 68 %, 46.2 %, and 0.39, [95 % confidence interval (0.24–0.54)], respectively. The receiver operating characteristics (ROC) curve analysis revealed that CysC had a significantly higher diagnostic accuracy than eCCl (p < 0.001).

Conclusions

Our results identify that the sensitivity of serum CysC for detecting AKI is higher than that of serum Cr in a heterogeneous pediatric intensive care unit (PICU) population.

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Acknowledgments

We thank the medical and nursing staff of the PICU for their cooperation and support, particularly Mrs. Fereshteh Ghavinchian and Mrs. Jaleh Ghasemi. We are very grateful to Dr. Farnaz Khatami for her assistance in the statistical analysis.

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Authors and Affiliations

  1. Department of Pediatric Nephrology, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Dr. Gharib St. Azadi Avenue, 14197, Tehran, Iran

    Neamatollah Ataei, Behnaz Bazargani, Sonbol Ameli, Abbas Madani, Faezeh Javadilarijani, Mastaneh Moghtaderi, Arash Abbasi & Fatemeh Ataei

  2. Department of Pediatric Pathology, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Sedigheh Shams

  3. Pediatric Chronic Kidney Disease Research Center, Children’s Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran

    Neamatollah Ataei, Behnaz Bazargani, Sonbol Ameli, Abbas Madani, Faezeh Javadilarijani, Mastaneh Moghtaderi, Arash Abbasi & Fatemeh Ataei

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  1. Neamatollah Ataei
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Correspondence to Faezeh Javadilarijani.

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Ataei, N., Bazargani, B., Ameli, S. et al. Early detection of acute kidney injury by serum cystatin C in critically ill children. Pediatr Nephrol 29, 133–138 (2014). https://doi.org/10.1007/s00467-013-2586-5

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