Cystatin C-calculated Glomerular Filtration Rate—A Marker of Early Renal Dysfunction in Patients With Neuropathic Bladder

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• 作者：Pankaj P. Dangle^a ; ^{pankajdangle@gmail.com} ; Omar Ayyash^a ; Audry Kang^a ; Carlton Bates^b ; Janelle Fox^c ; Heidi Stephany^a ; Glenn Cannon Jr^a
• 刊名：Urology
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：100
• 期：Complete
• 页码：213-217
• 全文大小：276 K
• 卷排序：100

文摘

To asses if cystatin c-calculated glomerular filtration rate (GFR) can reveal chronic kidney disease (CKD) not detected by creatinine-based calculations in a larger prospective cohort of children with myelomeningocele (MMC). Wheelchair-bound MMC patients frequently have low muscle mass, and assessing renal deterioration based on creatinine-based GFR is imprecise. MMC patients are also at risk for end-stage renal disease.MethodsProspectively enrolled patients with MMC underwent annual serum creatinine and cystatin c testing. Anthropometric measurements were obtained from clinic visit. The modified (bedside) Schwartz formula for creatinine-based GFR and the Zappitelli cystatin C formula were utilized for calculation. The exclusion criteria were patients with reduced GFR (CKD stage 2) or chronic CKD (CKD stage 3 and greater); these patients were excluded from analysis on the premise that they had already been identified for closer renal monitoring.ResultsA total of 131 patients were included in the analysis. The median creatinine-based estimated GFR was 126.5 mL/min/1.73 m2 (range: 22-310). The median cystatin C-based estimated rate was 98.5 mL/min/1.73 m2 (range: 16-171), yielding an absolute median rate reduction of 30.2%. Using cystatin c-calculated GFR, CKD stage was upgraded from stage 1 to ≥2 in 34 patients (26%).ConclusionIn MMC patients with poor muscle mass, cystatin C-based GFR is more sensitive than creatinine-based GFR in detecting early CKD. In this high-risk population, serial cystatin C estimation is a valuable tool in identifying children who may benefit from early nephrology referral and intervention.