The role of cystatin C and various methods of glomerular filtration rate calculation in evaluation of renal dysfunction in children with acute infectious diarrhea

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Abstract

Rationale: Acute infectious diarrhea (AID) is the fourth leading cause of death among children < 5 years worldwide. Kidney damage is one of the poorly studied aspects of pediatric AID. The level of serum cystatin C is independent on gender and age, and it is highly informative even in the early stages of renal dysfunction.

Aim: To optimize diagnosis of renal dysfunction in children with moderate AID through comparison of different methods of glomerular filtration rate (GFR) calculation and determination of serum cystatin C level.

Materials and methods: Observational cross-sectional study enrolled 80 children in pediatric hospital with moderate AID not followed by hemolytic uremic syndrome. Serum creatinine and serum cystatin C levels were determined in all the patients in acute period with GFR calculating according to Schwartz equation in unmodified (1976) and modified (2009) versions. GFR was also calculated using a single-factor equation based on serum cystatin C level.

Results: GFR in acute period, calculated according to unmodified and to modified Schwartz equation was in patients < 3 years (n = 40) 115.47 ± 3.33 ml/min/1.73 m2 and 98.56 ± 2.84 ml/min/1.73 m2 (p < 0.001), in patients 3-7 years 132.13 ± 4.2 ml/min/1.73 m2 and 108.85 ± 3.84 ml/min/1.73 m2 (p < 0.001), respectively. Increased serum cystatin C level (> 950 ng/ml) occurred in 18 patients (22%). In other patients level of serum cystatin C remained within the reference range or lower. The risk of acute kidney injury development based on two indicators - GFR according to the modified Schwartz equation and GFR according to the equation used cystatin C level - occurred in 4 (10%) patients aged 1-3 years and in 1 (2.5%) child in the age group 3-7 years; risk, based on one indicator - the calculation of GFR according to the formula using cystatin C - in 8 (20%) and 9 (22.5%) children, respectively, and based on the assessment of only GFR according to the modified Schwartz equation - in 3 (7.5%) children of both age groups.

Conclusion: We have confirmed that the GFR values calculated with usage of unmodified Schwartz equation (1976) are higher than those calculated with usage of modified Schwartz equation (2009) and taking into account the level of cystatin C.

Thus, usage of unmodified Schwartz equation for GFR calculation in infants and preschool children seems incorrect. Level of serum cystatin C is promising marker permitted to select patients with risk of acute kidney injury development among children in acute period of moderate AID.

About the authors

O. L. Chugunova

N.I. Pirogov Russian National Research Medical University

Author for correspondence.
Email: ol_chugunova@mail.ru
ORCID iD: 0000-0003-1547-0016

Olga L. Chugunova - MD, PhD, Professor, Chair of Hospital Pediatrics named after V.A. Tabolin, Faculty of Pediatrics.

1 Ostrovityanova ul., Moscow, 117997.

Tel.: +7 (499) 254 67 62.

Russian Federation

E. Yu. Grebеnkina

Speransky Moscow Children Hospital No. 9; Central Research Institute of Epidemiology

Email: liza09@mail.ru
ORCID iD: 0000-0001-6567-1401

Elizaveta Yu. Grebenkina - Pediatrician, Department of Infectious Diseases No. 2, Speransky Moscow Children Hospital No. 9; Laboratory Researcher, Clinical Department of Infectious Pathology, Central Research Institute of Epidemiology.

29 Shmitovskiy proezd, Moscow, 123317; 3a Novogireevskaya ul., Moscow, 111123.

Tel.: +7 (903) 552 67 63.

Russian Federation

D. V. Usenko

Central Research Institute of Epidemiology

Email: dusenko@rambler.ru
ORCID iD: 0000-0001-5232-7337

Denis V. Usenko - MD, PhD, Leading Research Fellow, Clinical Department of Infectious Pathology; Head of Educational Center.

3a Novogireevskaya ul., Moscow, 111123.

Tel.: +7 (495) 672 11 36.

Russian Federation

I. I. Volodina

N.F. Filatov Children's City Hospital of Moscow Healthcare Ministry

Email: catira@rambler.ru
ORCID iD: 0000-0003-4013-396X

Irina I. Volodina - MD, PhD, Pediatrician, Pediatric Day Hospital, Center of Outpatient Surgery.

15 Sadovaya-Kudrinskaya ul., Moscow, 103001.

Tel.: +7 (903) 779 37 26.

Russian Federation

E. V. Galeeva

Speransky Moscow Children Hospital No. 9

Email: elengaleeva@yandex.ru
ORCID iD: 0000-0003-1307-3463

Elena V. Galeeva - Chief Specialist in Laboratory Services, Head of Clinical Laboratory.

29 Shmitovskiy proezd, Moscow, 123317.

Tel.: +7 (964) 649 12 53.

Russian Federation

E. A. Drozhzhin

Speransky Moscow Children Hospital No. 9

Email: doctorlit@yandex.ru
ORCID iD: 0000-0002-4885-5505

Evgenii А. Drozhzhin - Pediatrician, Department of Infectious Diseases No. 2.

29 Shmitovskiy proezd, Moscow, 123317.

Tel.: +7 (499) 259 66 55.

Russian Federation

А. А. Korsunskiy

Speransky Moscow Children Hospital No. 9; I.M. Sechenov First Moscow State Medical University

Email: doctorlit@yandex.ru
ORCID iD: 0000-0002-9087-1656

Anatoly A. Korsunskiy - MD, PhD, Professor, Chief Physician, Speransky Moscow Children Hospital No. 9; Head of Chair of Pediatrics and Pediatric Infectious, I.M. Sechenov First Moscow State Medical University.

29 Shmitovskiy proezd, Moscow, 123317; 8/2 Trubetskaya ul., Moscow, 119991.

Tel.: +7 (499) 256 21 61.

Russian Federation

N. Yu. Legoshina

Speransky Moscow Children Hospital No. 9

Email: doctorlit@yandex.ru
ORCID iD: 0000-0003-0006-0743

Nataliya Yu. Legoshina - Infectiologist, Head of Department of Infectious Diseases No. 2.

29 Shmitovskiy proezd, Moscow, 123317.

Tel.: +7 (499) 259 66 55.

Russian Federation

A. D. Muzyka

Central Research Institute of Epidemiology

Email: nikolitch-anna@yandex.ru
ORCID iD: 0000-0002-2269-2533

Anna D. Muzyka - MD, PhD, Senior Research Fellow, Clinical Department of Infectious Pathology; Head of Educational Center.

3a Novogireevskaya ul., Moscow, 111123.

Tel.: +7 (916) 878 46 85.

Russian Federation

M. I. Naryshkina

Speransky Moscow Children Hospital No. 9

Email: doctorlit@yandex.ru
ORCID iD: 0000-0001-7489-5861

Mariya I. Naryshkina - Pediatrician, Department of Infectious Diseases No. 2.

29 Shmitovskiy proezd, Moscow, 123317.

Tel.: +7 (499) 259 66 55.

Russian Federation

L. V. Pavlushkina

N.F. Filatov Children's City Hospital of Moscow Healthcare Ministry

Email: lpavlywkina@yandex.ru
ORCID iD: 0000-0002-4738-879X

Lyudmila V. Pavlushkina - Head of Clinical and Biochemical Laboratory.

15 Sadovaya-Kudrinskaya ul., Moscow, 103001.

Tel.: +7 (903) 792 54 59.

Russian Federation

А. S. Rykova

Speransky Moscow Children Hospital No. 9

Email: doctorlit@yandex.ru
ORCID iD: 0000-0002-6522-4430

Anna S. Rykova - Pediatrician, Department of Infectious Diseases No. 2.

29 Shmitovskiy proezd, Moscow, 123317.

Tel.: +7 (499) 259 66 55.

Russian Federation

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Copyright (c) 2021 Chugunova O.L., Grebеnkina E.Y., Usenko D.V., Volodina I.I., Galeeva E.V., Drozhzhin E.A., Korsunskiy А.А., Legoshina N.Y., Muzyka A.D., Naryshkina M.I., Pavlushkina L.V., Rykova А.S.

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