Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison of various methods of glomerular filtration rate measurements in children

소아 환아에서 다양한 사구체 여과율 측정법의 비교

  • Lee, Na Mi (Department of Pediatrics, College of Medicine, Chung-Ang University) ;
  • Lim, In Seok (Department of Pediatrics, College of Medicine, Chung-Ang University)
  • 이나미 (중앙대학교 의과대학 소아과학교실) ;
  • 임인석 (중앙대학교 의과대학 소아과학교실)
  • Received : 2009.04.06
  • Accepted : 2009.08.14
  • Published : 2009.09.15
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Glomerular filtration rate (GFR) is a fundamental parameter in assessing renal function and predicting the progression of chronic renal disease. Because the use of serum creatinine has several disadvantages, many studies have investigated the use of cystatin C for estimating GFR. We compared creatinine clearance and GFR with formulas using serum creatinine and cystatin C. Methods : We retrospectively analyzed 211 patients with various renal diseases and classified them into two groups according to creatinine clearance (Group 1: CrCl >$90mL/min/1.73m^2$, Group 2: CrCl <$90mL/min/1.73m^2$). We measured serum creatinine, cystatin C, and creatinine clearance. We calculated GFR using the Schwartz, Counahan, Filler and Lepage, Bokencamp et al, and Grubb et al formulas. Results : GFR determined by the Schwartz formula had the highest correlation to creatinine clearance (r=0.415, P=0.00). GFR determined by various formulas using cystatin C had lower correlation to creatinine clearance (r=0.187, r=0.187, r=0.291). The Schwartz and Counahan formulas showed greater diagnostic accuracy in detecting decreased GFR than cystatin C in group 2 (areas under the curve: Schwartz, 0.596; Counahan, 0.572; Filler, 0.512; Bokencamp, 0.508; and Grubb, 0.514). Conclusion : GFR determined by the Schwartz and Counahan formulas using serum creatinine showed higher correlation coefficient than that determined by formulas using cystatin C. The formulas using cystatin C were not superior to those using serum creatinine in detecting decreased GFR. Cystatin C measurement was not satisfactory for assessing GFR in patients whose renal function was not severely decreased.

목 적 : cystatin C가 creatinine보다 연령, 성별, 근육량, 약물 등에 영향을 적게 받는 등 사구체 여과율 추정에 더 우수하다는 연구가 많이 나오면서 cystatin C를 이용하여 사구체 여과율을 추정하는 방법이 많이 나오고 있다. 그러나 이런 사구체 여과율을 추정하는 여러 방법들 간에 어느 정도 차이가 있는지에 대해 실제적인 데이터가 많지 않아 대표적으로 이용되고 있는 creatinine 청소율과 이외 다른 식에 의한 사구체 여과율 값의 관계 및 cystatin C의 유용성에 대해 확인해 보고자 하였다. 방 법 : 2005년 1월부터 2008년 3월까지 중앙대학교 용산병원 소아청소년과를 내원한 20세 미만의 환아들로서 다양한 신질환을 가지고 있는 211명을 대상으로 하였다. 사구체 여과율을 구하기 위한 여러 가지 추정 식 중 혈중 creatinine을 사용한 Schwartz 식, Counahan-Barratt 식 그리고 cystatin C를 이용한 Filler & Lepage식, Bokencamp식, Grubb 식에 의한 값을 creatinine 청소율과 비교하였다. 결 과 : 각 식에 의한 사구체 여과율과의 상관계수를 구한 결과 Schwartz식으로 구한 사구체 여과율이 Counahan식으로 구한 사구체 여과율보다 상관성이 더 높고, 또한 cystatin C를 기초로 한 세가지 식(Filler, Bokencamp, Grubb)으로 구한 사구체 여과율보다 creatinine을 기초로 한 식으로 구한 사구체 여과율 값이 상관성이 더 높은 것을 알 수 있다. 또한 진단적 정확성을 분석한 결과 Schwartz 식으로 구한 사구체 여과율이 더 진단적 가치가 있었다. 결 론 : 사구체 여과율 감소를 진단하는데 있어서도 cystatin C를 이용한 경우가 혈청 creatinine을 이용한 식보다 더 좋다고 말할 수 없다. 또한 신기능 저하가 심하지 않을 것으로 예측되는 환아들의 사구체 여과율의 추정에서 cystatin C의 유용성을 확인할 수 없었다.

Keywords

Acknowledgement

Supported by : Chung-ang University

References

  1. Campens D, Buntinx F. Selecting the best renal function tests. A meta-analysis of diagnostic studies. Int J Technol Assess Health Care 1997;13:343-56 https://doi.org/10.1017/S0266462300010400
  2. Schwartz GJ, Brion LP, Spitzer A. The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 1987;34:571-90
  3. Kim KJ, Kim JA, Shin JI, Hwang YS, Cheung IC, Lee JS, et al. The clinical usefulness of cystatin C in evaluating renal function in children with various renal diseases. J Korean Soc Pediatr Nephrol 2007;11:161-7 https://doi.org/10.3339/jkspn.2007.11.2.161
  4. Stevens LA, Stoycheff N. Standardization of serum creatinine and estimated GFR in the Kidney Early Evaluation Program (KEEP). Am J Kidney Dis 2008;51:S77-82 https://doi.org/10.1053/j.ajkd.2008.01.001
  5. Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976;16:31-41 https://doi.org/10.1159/000180580
  6. Froissart M, Rossert J, Jacquot C, Paillard M, Houillier P. Predictive performance of the modification of diet in renal disease and Cockcroft-Gault equations for estimating renal function. J Am Soc Nephrol 2005;16:763-73 https://doi.org/10.1681/ASN.2004070549
  7. Schwartz GJ, Haycock GB, Edelmann CM, Jr., Spitzer A. A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 1976;58: 259-63
  8. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999;130:461-70 https://doi.org/10.7326/0003-4819-130-6-199903160-00002
  9. Chang YS, Methods for glomerular filtration rate measurement. Korean J Nephrol 2006;25:521-4
  10. Han KH, Han SY, Kang YS, Cha DR. Serum cystatin C concentration compared with serum creatinine concentration as a marker of glomerular filtration rate. Korean J Nephrol 2006; 25:737-44
  11. Stevens LA, Coresh J, Greene T, Levey AS. Assessing kidney function-measured and estimated glomerular filtration rate. N Engl J Med 2006;354:2473-83 https://doi.org/10.1056/NEJMra054415
  12. Hoek FJ, Kemperman FA, Krediet RT. A comparison between cystatin C, plasma creatinine and the Cockcroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003;18:2024-31 https://doi.org/10.1093/ndt/gfg349
  13. Delanghe JR. How to estimate GFR in children. Nephrol Dial Transplant 2009;24:714-6 https://doi.org/10.1093/ndt/gfn306
  14. Kim Y, Min WK, Rhew J. Assessment of the accuracy and precision of cystatin C-based GFR estimates and Cr-based GFR estimates in comparison with Cr51-EDTA GFR. Korean J Lab Med 2007;27:34-9 https://doi.org/10.3343/kjlm.2007.27.1.34
  15. Hojs R, Bevc S, Ekart R, Gorenjak M, Puklavec L. Serum cystatin C as an endogenous marker of renal function in patients with mild to moderate impairment of kidney function. Nephrol Dial Transplant 2006;21:1855-62 https://doi.org/10.1093/ndt/gfl073
  16. Jung YS, Lim IS. The value of serum concentration of cystatin C as a marker for glomerular filtration rate in children and adolescents. Korean J Pediatr 2005;48:614-8
  17. Hojs R, Bevc S, Ekart R, Gorenjak M, Puklavec L. Serum cystatin C-based equation compared to serum creatinine- based equations for estimation of glomerular filtration rate in patients with chronic kidney disease. Clin Nephrol 2008;70: 10-7
  18. Filler G, Lepage N. Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 2003;18:981-5 https://doi.org/10.1007/s00467-003-1271-5
  19. Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C serum concentrations underestimate glomerular filtration rate in renal transplant recipients. Clin Chem 1999;45:1866-8
  20. Grubb A, Nyman U, Bjork J, Lindstrom V, Rippe B, Sterner G, et al. Simple cystatin C-based prediction equations for glomerular filtration rate compared with the modification of diet in renal disease prediction equation for adults and the Schwartz and the Counahan-Barratt prediction equations for children. Clin Chem 2005;51:1420-31 https://doi.org/10.1373/clinchem.2005.051557
  21. Hahn H, Park KM, Ha IS, Cheong HI, Choi Y, Song JH. Reference values for cystatin C serum concentrations in children. Korean J Nephrol 2001;20:75-9 https://doi.org/10.1007/s004670050419
  22. Bingham SA, Cummings JH. The use of creatinine output as a check on the completeness of 24-hour urine collections. Hum Nutr Clin Nutr 1985;39:343-53
  23. Burtis CA, Ashwood ER, Bruns. DE. Tietz textbook of clinical chemistry and molecular diagnostics. 4th ed. ed: St Louis: Elsevier Saunders, 2006
  24. Toffaletti JG, McDonnell EH. Variation of serum creatinine, cystatin C, and creatinine clearance tests in persons with normal renal function. Clin Chim Acta 2008;395:115-9 https://doi.org/10.1016/j.cca.2008.05.020
  25. Zappitelli M, Parvex P, Joseph L, Paradis G, Grey V, Lau S, et al. Derivation and validation of cystatin C-based prediction equations for GFR in children. Am J Kidney Dis 2006;48: 221-30 https://doi.org/10.1053/j.ajkd.2006.04.085
  26. Stevens LA, Coresh J, Schmid CH, Feldman HI, Froissart M, Kusek J, et al. Estimating GFR using serum cystatin C alone and in combination with serum creatinine: a pooled analysis of 3,418 individuals with CKD. Am J Kidney Dis 2008;51: 395-406 https://doi.org/10.1053/j.ajkd.2007.11.018
  27. Bakoush O, Grubb A, Rippe B. Inaccuracy of GFR predictions by plasma cystatin C in patients without kidney dysfunction and in advanced kidney disease. Clin Nephrol 2008;69: 331-8
  28. Franco MC, Nishida SK, Sesso R. GFR estimated from cystatin C versus creatinine in children born small for gestational age. Am J Kidney Dis 2008;51:925-32 https://doi.org/10.1053/j.ajkd.2008.02.305