CYSTATIN C AS AN ADJUNCT MARKER IN THE EARLY DETECTION OF RENAL INSUFFICIENCY IN PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER

You have accessJournal of UrologyPediatrics: Neuropathic Bladder/Reconstruction1 Apr 2013483 CYSTATIN C AS AN ADJUNCT MARKER IN THE EARLY DETECTION OF RENAL INSUFFICIENCY IN PEDIATRIC PATIENTS WITH NEUROGENIC BLADDER Anne Dudley, Janelle Fox, Carlton Bates, and Glenn Cannon Anne DudleyAnne Dudley Pittsburgh, PA More articles by this author , Janelle FoxJanelle Fox Pittsburgh, PA More articles by this author , Carlton BatesCarlton Bates Pittsburgh, PA More articles by this author , and Glenn CannonGlenn Cannon Pittsburgh, PA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.1875AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Ultrasound, cystometrogram and serum creatinine surveillance have improved detection of renal failure in children with congenital neurogenic bladder, however irreversible renal impairment may precede visible structural or laboratory changes. Due to decreased muscle mass, the accuracy of creatinine based GFR calculations may be poor. Cystatin C is a low molecular weight protein filtered by the kidney and produced at a constant rate independent of body habitus. It has been demonstrated to be highly sensitive and specific at measuring changes in GFR. We hypothesize that cystatin C calculated GFR is more sensitive than the standard creatinine based bedside Schwartz equation for detection of renal insufficiency in children with congenital neurogenic bladder. METHODS We prospectively followed children with neurogenic bladder ages 0-18yrs in a multi-disciplinary, outpatient Spina Bifida clinic who underwent serum creatinine and serum cystatin C testing at initial or routine followup evaluations. Patient characteristics such as height, weight, and BMI were recorded at each visit. When available, renal anatomy, serum electrolytes, bone age, blood pressure and hemoglobin were also recorded. Creatinine based GFR was estimated using the bedside Schwartz formula; cystatin C based GFR was calculated by Sunquest laboratories. RESULTS Thirty-two children (median 10.7yrs) underwent dual GFR calculation. Absolute creatinine values were within or below the normal range for every patient, including one patient with CKD Stage 3A. Median creatinine based GFR calculated was 123.6mL/min (range 58-212). Median cystatin C based GFR was 98.9 mL/min (range 47-138), conferring an absolute median GFR reduction of 16.1% compared with bedside Schwartz estimation. Using cystatin C GFR values for CKD staging, CKD stage classification was raised in severity from stage 1 to stage 2 in 9 patients. This resulted in management changes that would not have occurred had serum creatinine calculated GFR been assessed alone. Two patients had improvement in CKD stage from 2 to 1. CONCLUSIONS In children with neurogenic bladder, cystatin C calculated GFR can identify worsening renal insufficiency not detected by creatinine-based GFR calculations . This demonstrates the need for accurate and aggressive monitoring of renal function by measures other than serum creatinine alone. Further follow-up is required to determine if cystatin C can help avert chronic or end stage kidney disease by early identification of renal insufficiency. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e198-e199 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Anne Dudley Pittsburgh, PA More articles by this author Janelle Fox Pittsburgh, PA More articles by this author Carlton Bates Pittsburgh, PA More articles by this author Glenn Cannon Pittsburgh, PA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...