Serum cystatin C for acute kidney injury evaluation in children treated with aminoglycosides

Background Serum cystatin C (CysC) is a more accurate glomerular filtration rate marker than serum creatinine (SCr) and may rise more quickly with acute kidney injury (AKI). Methods We performed a prospective cohort study of 81 non-critically ill children during 110 aminoglycoside (AG) treatments. We calculated area under the curve (AUC) for CysC to diagnose SCr-defined AKI and predict persistent AKI. SCr-AKI definition was based on the Kidney Disease: Improving Global Outcomes ([greater than or equal to]stage 1: [greater than or equal to]50 % or 26.5 [mu]mol/l SCr rise from baseline; stage 2: SCr doubling); CysC-AKI was based on a modified version using CysC rise. Results SCr-AKI and CysC-AKI developed in 45 and 48 % treatments, respectively. CysC rise predicted stage 1 (AUC = 0.75, 95 % CI 0.60-0.90) and 2 (AUC = 0.85, 95 % CI 0.75-0.95) SCr-AKI 2 days before SCr-AKI attainment. The best combined sensitivity/specificity for percent CysC rise to predict stage 1 SCr-AKI was with a 44 % CysC rise (sensitivity = 65 %, specificity = 83 %). CysC rise on day of SCr-AKI development was associated with SCr-AKI [greater than or equal to]48 h (AUC = 0.73, 95 % CI 0.56-0.90) and [greater than or equal to]50 % persistent SCr rise at treatment end (AUC = 0.76, 95 % CI 0.61-0.90). Conclusions CysC is as an early AKI biomarker and predictive of persistent AKI on aminoglycoside treatment.
Author(s): Lorraine Lau[sup.1] , Zubaida Al-Ismaili[sup.1] , Maya Harel-Sterling[sup.1] , Michael Pizzi[sup.1] , Jillian S. Caldwell[sup.1] , Melissa Piccioni[sup.1] , Larry C. Lands[sup.1] , Theresa Mottes[sup.2] , Prasad Devarajan[sup.2] , [...]