Endogenous markers for assessing the glomerular filtration rate in newborns and children of the first year of life

Abstract

Dynamic assessment of the functional state of the kidneys in children with congenital anomalies of the kidneys and urinary tract is the main criterion for the development, progression of renal tissue remodeling processes, the effectiveness of anti-inflammatory therapy and surgical methods for restoring urodynamics. The main marker should be the glomerular filtration rate (GFR). The most reliable method for determining GFR is the method based on the clearance of exogenous markers. However, in children, especially in the first years of life, this method has not received widespread use due to its invasiveness and laboriousness of execution; therefore, GFR in children is usually assessed using the determination of the levels of endogenous markers such as creatinine, β-trace protein, β2-microglobulin, as well as the most promising at present - cystatin C.

The aim - to conduct a comparative analysis of the effectiveness of using serum cystatin C to determine the glomerular filtration rate in newborns and children of the first year of life with and without congenital anomalies of the kidneys and urinary tract.

Material and methods. The study included 66 newborns: with congenital anomalies of the kidneys and urinary tract (35 newborns) and without anomalies (31 newborns). The study excluded newborns with chromosomal diseases, treated with glucocorticosteroids, with congenital malformations of the cardiovascular system, with oncological diseases, with acute renal injury. All children underwent venous blood sampling to determine the levels of creatinine and cystatin C on the 4-6th day of life after the formation of the rate of diuresis; in the group of children with congenital anomalies of the kidneys and urinary tract, blood was taken again at the age of 3-7 months of life.

Results. In children with congenital anomalies of the kidneys and urinary tract included in the study (with diagnoses of megaureter, pyeloectasia, hydronephrosis, multicystic, autosomal recessive polycystic disease), no decrease in renal function was observed in the neonatal period. The glomerular filtration rate, calculated on the basis of creatinine at 4-6 days of life, was determined below the standard indicators (21.0-32.3 ml/min/1.73 m2), which could lead to an erroneous interpretation of the situation as impaired renal function with an incorrect definition stages of chronic kidney disease. At the same time, the glomerular filtration rate, determined using the concentration of cystatin C, was within the standard values. After 3-7 months, creatinine GFR correlates to a greater extent with cystatin C GFR, but it can also cause overdiagnosis of decreased renal function.

Conclusion. To assess GFR in children of the first year of life (especially in newborns in the first week of life), it is recommended to use formulas that uses serum cystatin C.

Keywords:cystatin C, creatinine, β-trace protein, β2-microglobulin, renal function, glomerular filtration rate, congenital anomalies of the kidneys and urinary tract, newborns

Funding. The study had no sponsor support.

Conflict of interests. The authors declare no conflict of interests.

For citation: Pavlova V.S., Kryuchko D.S., Podurovskaya Yu.L., Pekareva N.A. Endogenous markers for assessing the glomerular filtration rate in newborns and children of the first year of life. Neonatologiya: novosti, mneniya, obuchenie [Neonatology: News, Opinions, Training]. 2020; 8 (4): 18-27. DOI: https://doi.org/10.33029/2308-2402-2020-8-4-18-27 (in Russian)

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CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

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