Early Detection of Acute Renal Lesions by Serum Cystatin C in Children at Hospital and University Centre of Brazzaville

Abstract

 Introduction: Acute Kidney Injury (AKI) is considered one of the main public health problems. The effective management of these alterations is based on the early detection of renal lesions. The objective of this study was to evaluate the contribution of the Cystatin C (CysC) assay in the early diagnosis of acute kidney injury (AKI) in children hospitalized in pediatric intensive care units in Brazzaville.

Materials and Methods: Sixty children at high risk of developing AKI were included. Consent form signed was obtained from parents, socio-demographic data, weight and height of children recorded. Creatinine (Cr), CysC and urea were assayed in serum 24 hours after admission. Glomerular filtration clearance was estimated using serum creatinine and CysC. Glomerular filtration rate (GFR) was calculated from CysC and Cr. The diagnostic accuracy was determined by comparing the results of CysC to those of Cr (considered as a reference biomarker).

Results: The median age was 5 years (with extremes ranging from 1 month to 17 years). Cr, CysC, urea, and GFR/Cr (mean ± standard deviation [range]) were 0.94±1.17 (0.2–1.4 mg/dl), 0.14 ± 0.062 (0.053-0.095 mg/l), 46.65±47.75 (15.0–45.0 mg/dl), 81.85±31.90 (≥190 ml/min per 1.73 m² , respectively. The level of CysC in patients with ARL was significantly higher than that of children with normal renal function (p<0.001). CysC detected 71.7% of children with AKI versus 26.7% with Cr. The performance characteristics (area under the curve, sensitivity, specificity) were 0.63, 89.6% and 37.5% for creatinine and 0.76, 92.9% and 54.8% for cystatin respectively. Analysis of the characteristics of the two curves revealed that CysC had a significantly higher diagnostic capacity (p<0.001).

Conclusion: Our results show that the performance of serum CysC in detecting AKI early was superior to that of serum Cr in children hospitalized in pediatric intensive care units in Brazzaville.