Diagnostic sensitivity of serum cystatin for impaired glomerular filtration rate |
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Authors: | G Filler F Priem I Vollmer J Gellermann K Jung |
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Institution: | Department of Paediatric Nephrology, Charité Hospital, Humboldt University, Schumannstra?e 20–21, D-10098 Berlin, Germany e-mail: guido.filler@charite.de Fax: +49-30-2802-8844, DE Department of Clinical Biochemistry, Charité Hospital, Humboldt University, Berlin, Germany, DE Department of Urology, Charité Hospital, Humboldt University, Berlin, Germany, DE
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Abstract: | Recently, the reciprocal of cystatin C (Cys-C), a non-glycosylated 13-kilodalton protein that is produced by all investigated
nucleated cells, was found to correlate closely with glomerular filtration rate (GFR). In order to determine the diagnostic
validity in children for the detection of impaired GFR, venous blood samples from 381 children (aged 1.7–18 years) with various
renal pathology referred for 51Cr-EDTA clearance investigations were obtained for measurement of Cys-C as well as β2-microglobulin (β2-MG) and serum creatinine. Two hundred and sixteen children with clearance values >90 ml/min per 1.73 m2 constituted a control group, with a normal GFR. In the control group, Cys-C values were normally distributed with a mean
of 0.94±0.27 mg/l and an upper reference limit (97.5th percentile) of 1.47 mg/l. In all children, there was a positive correlation
between 51Cr-EDTA clearance and the reciprocal of Cys-C (r=0.64, P<0.0001), β2-MG (r=0.59, P<0.0001), creatinine (r=0.55, P<0.0001), and the height/creatinine ratio (r=0.73, P<0.0001). Receiver-operating characteristics analysis showed that there were no significant differences between these three
parameters for discriminating between patients with normal and reduced GFR, although there was a tendency towards the best
diagnostic sensitivity of the GFR estimate according to the Schwartz formula. We conclude that for the detection of mildly
impaired GFR, a full clearance study cannot be replaced by measurement of serum Cys-C or β2-MG concentrations.
Received: 15 June 1998 / Revised: 22 September 1998 / Accepted: 23 September 1998 |
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Keywords: | 51Cr-EDTA clearance Cystatin C β 2-Microglobulin Schwartz formula Diagnostic sensitivity |
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