Estimating glomerular filtration rate (GFR) in children. The average between a cystatin C- and a creatinine-based equation improves estimation of GFR in both children and adults and enables diagnosing Shrunken Pore Syndrome

Felicia Leion, Josefine Hegbrant, Emil den Bakker, Magnus Jonsson, Magnus Abrahamson, Ulf Nyman, Jonas Björk, Veronica Lindström, Anders Larsson, Arend Bökenkamp, Anders Grubb

Research output: Contribution to journalArticlepeer-review

27 Citations (SciVal)

Abstract

Estimating glomerular filtration rate (GFR) in adults by using the average of values obtained by a cystatin C- (eGFRcystatin C) and a creatinine-based (eGFRcreatinine) equation shows at least the same diagnostic performance as GFR estimates obtained by equations using only one of these analytes or by complex equations using both analytes. Comparison of eGFRcystatin C and eGFRcreatinine plays a pivotal role in the diagnosis of Shrunken Pore Syndrome, where low eGFRcystatin C compared to eGFRcreatinine has been associated with higher mortality in adults. The present study was undertaken to elucidate if this concept can also be applied in children. Using iohexol and inulin clearance as gold standard in 702 children, we studied the diagnostic performance of 10 creatinine-based, 5 cystatin C-based and 3 combined cystatin C-creatinine eGFR equations and compared them to the result of the average of 9 pairs of a eGFRcystatin C and a eGFRcreatinine estimate. While creatinine-based GFR estimations are unsuitable in children unless calibrated in a pediatric or mixed pediatric-adult population, cystatin C-based estimations in general performed well in children. The average of a suitable creatinine-based and a cystatin C-based equation generally displayed a better diagnostic performance than estimates obtained by equations using only one of these analytes or by complex equations using both analytes. Comparing eGFRcystatin and eGFRcreatinine may help identify pediatric patients with Shrunken Pore Syndrome.

Original languageEnglish
Pages (from-to)338-344
JournalScandinavian Journal of Clinical and Laboratory Investigation
Volume77
Issue number5
Early online date2017 May 19
DOIs
Publication statusPublished - 2017

Subject classification (UKÄ)

  • Urology and Nephrology

Keywords

  • Children
  • creatinine
  • cystatin C
  • glomerular filtration rate
  • humans
  • inulin
  • iohexol
  • kidney function tests

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