Serum Cystatin C and N-Acetyl-Beta-(D)‑Glucosaminidase as Bio-markers in the Diagnosis of Acute Kidney Disease in Children
Journal Title: INTERNATIONAL JOURNAL OF SCIENTIFIC STUDY - Year 2018, Vol 6, Issue 4
Abstract
Background: Acute kidney injury (AKI) is one of the main public health issues all over the world. Its accurate prevalence in children and adolescents in India is unknown. The main cause of death in children with kidney failure is cardiovascular disease and infections. Unfortunately, AKI is asymptomatic, and their signs and symptoms become evident only when a great proportion of kidneys have lost their function. Hence, the early diagnosis and treatment of AKI in children are of paramount importance. Many physicians base their diagnosis is based on reduced urine output, and serum creatinine (Scr) levels apart from the clinical symptomatology. Measuring the serum level of certain biomarkers as a new method for early diagnosis of AKI, among which major attention has been drawn to Cystatin C and N-acetyl-beta-(D)-glucosaminidase (NAG). Aim of the Study: The aim of the study was to evaluate the roles of Scr, Cystatin C, and NAG levels in the early diagnosis of AKI. Materials and Methods: A total of 62 children with AKI and 50 healthy children as control group were included to study the importance of biomarkers in its diagnosis. In addition to, Scr used in the protocol for the diagnosis of AKI, Cystatin C and NAG estimations were done for all the children. The lab values were analyzed to find the specificity and sensitivity of the biomarkers in relation to Scr. Observations and Results: Among the 112 children included in this study, Group A was 62 children with clinical features of AKI and 50 healthy children as control Group B. In Group A there were 38 (61.29%) male and 24 (38.70%) female children. The mean age was 08.65 ± 2.40 years in males and 08.03 ± 2.15 years in females. The mean body surface area was 0.59 ± 0.32. The mean body mass index was 16.93 ± 1.85. There was no statistical difference in the demographic features (P taken significant at <0.05). The most common clinical symptom was decreased urine output in 57/62 (91.93%), swelling legs, ankle, and feet in 48/62 (77.41%). The most common cause of AKI was post-renal 20/62 (32.25%), acute glomerulonephritis in 16/62 (25.80%), and nephrotoxic drugs in 13/62 (20.96%) children. The mean Scr was 03.23 ± 1.25 mg/dL in Group A and normal 0.6.10 ± 0.15 mg/dL in Group B children. The mean urine creatinine was 4.14 ± 1.50 g/L in Group A and 1.1 ± 0.65 g/L in Group B children. The mean Serum Cystatin C was 1.59 ± 0.64 mg/L in Group A and 0.63± 0.17 in Group B children. The mean values of NAG were 149.61 ± 22.84 in Group A and 19.0 ± 2.80 in Group B children. The U.NAG/U. creatinine ratio was 526.62 ± 78.49 in Group A and 53.12 ± 7.35 Group B children. The specificity of Scr was 78.94% and sensitivity was 86.36%. Cystatin C as a diagnostic marker was with a specificity of 60% and sensitivity of 96.49%. NAG as a diagnostic marker was with a specificity of 66.66% and sensitivity of 96.55%. U.NAG/U creatinine as a diagnostic marker was with a specificity of 71.42% and sensitivity of 94.54%. Conclusions: Cystatin C and urinary NAG have an acceptable diagnostic value for early detection of AKI when compared to Scr in children. Since the serum level of Cystatin C and urinary NAG raises within the first 24 h of admission in patients with AKI, this biomarker can be a suitable alternative for traditional diagnostic measures.
Authors and Affiliations
Suritha Ponnen Kandy, Anjana Valiyaveetil
Keywords
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