Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.
Acute Kidney Injuries in Children with Severe Malaria: A comparative study of diagnostic criteria based on serum cystatin C and creatinine levels.
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DOI：
10.18295/squmj.2020.20.04.006
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发表时间：
2020-11
影响因子：
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通讯作者：
Ojuawo A
中科院分区：
文献类型：
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作者：
Afolayan FM;Adedoyin OT;Abdulkadir MB;Ibrahim OR;Biliaminu SA;Mokuolu OA;Ojuawo A
血清肌酐水平常用于诊断急性肾损伤(AKI)，但不一定能准确反映肾小球滤过率(GFR)的变化。这项研究旨在使用基于肌酐值的诊断标准与胱抑素C对比，比较重症疟疾儿童AKI的患病率。这项前瞻性横断面研究于2016年6月至2017年5月在尼日利亚伊洛林的伊洛林大学教学医院进行。共有170名患有严重疟疾的0.5-14岁儿童纳入研究范围。用颗粒增强免疫比浊法测定血清半胱氨酸氨基转移酶C水平，同时用Jaffe反应测定肌酐水平。使用胱抑素C衍生的估计GFR(EGFR)评估的肾功能与使用三套基于肌酸值的标准测量的肾功能进行了比较，其中包括肾脏疾病：改善的全球预后(KDIGO)和世界卫生组织(WHO)标准，以及肌酐的绝对值1.5毫克/分升。血清胱抑素C和肌酐水平分别为1.77±1.37 mg/L和1.23±1.80 mg/dL(P=0.002)。根据KDIGO、WHO和绝对肌酐标准，AKI的发生率分别为32.4%、7.6%和16.5%。相比之下，基于胱抑素C来源的EGFR的AKI发生率为51.8%。总体而言，与KDIGO、世卫组织和肌酐绝对标准相比，使用半胱氨酸氨基转移酶C的AKI的检出率明显更高(P分别为0.003、0.001和0.001)。基于肌酸值的AKI诊断标准可能不能表明患有严重疟疾的儿童的实际疾病负担。
Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria.