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Pediatric Nephrology
Published in: Pediatric Nephrology 8/2015

01-08-2015 | Original Article

New standardized cystatin C and creatinine GFR equations in children validated with inulin clearance

Authors: Ulla B. Berg, Ulf Nyman, Rune Bäck, Magnus Hansson, Kajsa Åsling Monemi, Maria Herthelius, Jonas Björk

Published in: Pediatric Nephrology | Issue 8/2015

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Abstract

Background

This study compares glomerular filtration rate (GFR) equations in children based on standardized cystatin C (CYSC) and creatinine (CREA) and their combinations with renal clearance of inulin (C-inulin).

Methods

A total of 220 children with different renal disorders were referred for C-inulin (median 84 ml/min/1.73 m2). Bias, precision (interquartile range, IQR), and accuracy (percentage of estimates ±30 % of C-inulin; P30) were evaluated for two cystatin C equations, CAPACYSC and BergCYSC, for creatinine equations, SchwartzCREA and GaoCREA, the arithmetic mean of CAPACYSC and SchwartzCREA (MEANCAPA+Schwartz), BergCYSC and SchwartzCREA (MEANBERG+SCHWARTZ) and the composite equation ChehadeCYSC+CREA.

Results

Overall results of CAPACYSC, BergCYSC, SchwartzCREA, GaoCREA, MEANCAPA+Schwartz, MEANBERG+SCHWARTZ and ChehadeCYSC+CREA were: median bias –7.6/–4.9/–3.7/–2.3/–4.6/–4.0/–10.1 %, IQR 20.0/19.9/21.7/22.4/21.0/20.9/23.3 ml/min/1.73 m2 and P30 86/86/80/83/89/91/83 %. The cystatin C equations, MEANCAPA+Schwartz and MEANBERG+SCHWARTZ had a more stable performance across subgroups compared with SchwartzCREA, GaoCREA and ChehadeCYSC+CREA.

Conclusions

Cystatin C was the preferred filtration marker for GFR estimation in children, while the benefit of combining cystatin C and creatinine deserves further investigations.
Literature
1.
Smith HT (1951) The reliability of inulin as a measure of glomerular filtration rate. The Kidney: structure and function in health and disease. Oxford University Press, New York, NY, pp 231–238
2.
Schwartz GJ, Work DF (2009) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843PubMedCrossRef
3.
Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985PubMedCrossRef
4.
Grubb A, Nyman U, Björk J, Lindström 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 51:1420–1431PubMedCrossRef
5.
Schwartz GJ, Munoz A, Schneider MF, Mak RH, Kaskel F, Warady BA, Furth SL (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCentralPubMedCrossRef
6.
Gao A, Cachat F, Faouzi M, Bardy D, Mosig D, Meyrat BJ, Girardin E, Chehade H (2013) Comparison of the glomerular filtration rate in children by the new revised Schwartz formula and a new generalized formula. Kidney Int 83:524–530PubMedCrossRef
7.
Blirup-Jensen S, Grubb A, Lindström V, Schmidt C, Althaus H (2008) Standardization of Cystatin C: development of primary and secondary reference preparations. Scand J Clin Lab Invest Suppl 241:67–70PubMedCrossRef
8.
Grubb A, Blirup-Jensen S, Lindström V, Schmidt C, Althaus H, Zegers I, C IWGoSoC (2010) First certified reference material for cystatin C in human serum ERM-DA471/IFCC. Clin Chem Lab Med : CCLM / FESCC 48:1619–1621CrossRef
9.
Grubb A, Horio M, Hansson LO, Björk J, Nyman U, Flodin M, Larsson A, Bökenkamp A, Yasuda Y, Blufpand H, Lindström V, Zegers I, Althaus H, Blirup-Jensen S, Itoh Y, Sjöström P, Nordin G, Christensson A, Klima H, Sunde K, Hjort-Christensen P, Armbruster D, Ferrero C (2014) Generation of a new cystatin C-based estimating equation for glomerular filtration rate by use of 7 assays standardized to the international calibrator. Clin Chem 60:974–986
10.
Chehade H, Cachat F, Jannot AS, Meyrat BJ, Mosig D, Bardy D, Parvex P, Girardin E (2014) New combined serum creatinine and cystatin C quadratic formula for GFR assessment in children. Clin J Am Soc Nephrol 9:54–63PubMedCentralPubMedCrossRef
11.
Berg U (1981) Renal function in acute febrile urinary tract infection in children: pathophysiologic aspects on the reduced concentrating capacity. Kidney Int 20:753–758PubMedCrossRef
12.
Kuehnle HF, von Dahl K, Schmidt FH (1992) Fully enzymatic inulin determination in small volume samples without deproteinization. Nephron 62:104–107PubMedCrossRef
13.
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 93:62–66PubMedCrossRef
14.
Björk J, Bäck SE, Sterner G, Carlson J, Lindström V, Bakoush O, Simonsson P, Grubb A, Nyman U (2007) Prediction of relative glomerular filtration rate in adults: new improved equations based on Swedish Caucasians and standardized plasma-creatinine assays. Scand J Clin Lab Invest 67:678–695PubMedCrossRef
15.
Spinler SA, Nawarskas JJ, Boyce EG, Connors JE, Charland SL, Goldfarb S (1998) Predictive performance of ten equations for estimating creatinine clearance in cardiac patients. Iohexol Cooperative Study Group. Ann Pharmacother 32:1275–1283PubMedCrossRef
16.
Earley A, Miskulin D, Lamb EJ, Levey AS, Uhlig K (2012) Estimating equations for glomerular filtration rate in the era of creatinine standardization: a systematic review. Ann Intern Med 156:785–795PubMedCrossRef
17.
National Kidney Foundation (2002) K/DOQI clinical practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Part 5. Evaluation of laboratory measurements for clinical assessment of kidney disease. Guideline 4. Estimation of GFR. Am J Kidney Dis 39:S 76–S 92
18.
Soveri I, Berg UB, Björk J, Elinder CG, Grubb A, Mejare I, Sterner G, Bäck SE, Group SGR (2014) Measuring GFR: a systematic review. Am J Kidney Dis 64:411–424PubMedCrossRef
19.
Andersen TB, Jodal L, Boegsted M, Erlandsen EJ, Morsing A, Frokiaer J, Brochner-Mortensen J (2012) GFR prediction from cystatin C and creatinine in children: effect of including body cell mass. Am J Kidney Dis 59:50–57PubMedCrossRef
20.
Bacchetta J, Cochat P, Rognant N, Ranchin B, Hadj-Aissa A, Dubourg L (2011) Which creatinine and cystatin C equations can be reliably used in children? Clin J Am Soc Nephrol 6:552–560PubMedCentralPubMedCrossRef
21.
Berg UB, Bäck R, Celsi G, Halling SE, Homberg I, Krmar RT, Åsling Monemi K, Öborn H, Herthelius M (2011) Comparison of plasma clearance of iohexol and urinary clearance of inulin for measurement of GFR in children. Am J Kidney Dis 57:55–61
22.
Blufpand HN, Tromp J, Abbink FC, Stoffel-Wagner B, Bouman AA, Schouten-van Meeteren AY, van Wijk JA, Kaspers GJ, Bokenkamp A (2011) Cystatin C more accurately detects mildly impaired renal function than creatinine in children receiving treatment for malignancy. Pediatr Blood Cancer 57:262–267PubMedCrossRef
23.
Pottel H, Mottaghy FM, Zaman Z, Martens F (2010) On the relationship between glomerular filtration rate and serum creatinine in children. Pediatr Nephrol 25:927–934PubMedCrossRef
24.
25.
Nyman U, Björk J, Lindström V, Grubb A (2008) The Lund-Malmo creatinine-based glomerular filtration rate prediction equation for adults also performs well in children. Scand J Clin Lab Invest 68:568–576PubMedCrossRef
26.
Björk J, Grubb A, Larsson A, Hansson LO, Flodin M, Sterner G, Lindström V, Nyman U (2014) Accuracy of GFR estimating equations combining standardized cystatin C and creatinine assays: a cross-sectional study in Sweden. Clin Chem Lab Med. doi:10.​1515/​cclm-2014-0578 PubMed
27.
Inker LA, Schmid CH, Tighiouart H, Eckfeldt JH, Feldman HI, Greene T, Kusek JW, Manzi J, Van Lente F, Zhang YL, Coresh J, Levey AS, Investigators C-E (2012) Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 367:20–29PubMedCentralPubMedCrossRef
28.
Nyman U, Grubb A, Sterner G, Björk J (2009) Different equations to combine creatinine and cystatin C to predict GFR. Arithmetic mean of existing equations performs as well as complex combinations. Scand J Clin Lab Invest 69:619–627PubMedCrossRef
Metadata
Title
New standardized cystatin C and creatinine GFR equations in children validated with inulin clearance
Authors
Ulla B. Berg
Ulf Nyman
Rune Bäck
Magnus Hansson
Kajsa Åsling Monemi
Maria Herthelius
Jonas Björk
Publication date
01-08-2015
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Nephrology / Issue 8/2015
Print ISSN: 0931-041X
Electronic ISSN: 1432-198X
DOI
https://doi.org/10.1007/s00467-015-3060-3

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