Cystatin C- an early marker indicative of renal dysfunction in critically ill children: a prospective cohort study


  • Hawwa M.S. Siddiqua Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Mathew John Jubilee Centre for Medical Research, Thrissur, Kerala, India
  • V. C. Manoj Department of Neonatology, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India
  • Rati Santhakumar Department of Pediatrics, Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India



Acute kidney injury, Cystatin C, Serum creatinine


Background: Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few hours or a few days and can also affect other organs such as brain, heart and the lungs. Hence early diagnosis and intervention is needed to improve the outcome of the children. In these studies this objective was to determine if cystatin C is an early marker indicative of renal dysfunction in critically ill children and to determine if Cystatin C can detect Acute kidney injury earlier than serum creatinine.

Methods: This prospective cohort study was undertaken in PICU at Jubilee Mission Medical College from December 2016- May 2018. Blood samples were collected from 34 critically ill children for serum creatinine estimation at 0,24 and 48 hours of admission and serum and urine were collected for cystatin C estimation at admission. Children were categorized into AKI and NON-AKI based on pRIFLE criteria. Comparison of cystatin C values with serum creatinine was performed and Statistical analysis was done using IBM SPSS version 20.

Results: A total of 34 critically ill children were enrolled in this study, out of which 12 children progressed to AKI during the course of illness according to modified Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE) criteria. We found a strong positive correlation between cystatin C at 0 hours and serum creatinine at 48 hours among AKI groups.

Conclusions: Serum and Urine cystatin C are early markers to diagnose AKI in critically ill children. Serum cystatin C is more sensitive than urine cystatin C for the diagnosis of AKI.


Krishnamurthy S, Mondal N, Narayanan P, Biswal N, Srinivasan S, Soundravally R. Incidence and etiology of acute kidney injury in southern India. Indian J Pediatr. 2013;80(3):183-9.

Lameire NH, Bagga A, Cruz D, De Maeseneer J, Endre Z, Kellum JA, Liu KD, Mehta RL, Pannu N, Van Biesen W, Vanholder R. Acute kidney injury: an increasing global concern. Lancet. 2013;382(9887):170-9.

Shemesh O, Golbetz H, KRIss JP, Myers BD. Limitations of creatinine as a filtration marker in glomerulopathic patients. Kidney Int. 1985;28(5):830-8.

Schrier RW. Editor. Diseases of the kidney and urinary tract. Lippincott Williams & Wilkins; 2007.

Akcay A, Turkmen K, Lee D, Edelstein CL. Update on the diagnosis and management of acute kidney injury. Int J Nephrol Renovasc Dis. 2010;3:129.

Seikaly MG, Browne R, Bajaj G, Arant Jr BS. Limitations to body length/serum creatinine ratio as an estimate of glomerular filtration in children. Pediatr Nephrol. 1996;10(6):709-11.

Perrone RD, Madias NE, Levey AS. Serum creatinine as an index of renal function: new insights into old concepts. Clin Chem. 1992;38(10):1933-53.

Lawson N, Lang T, Broughton A, Prinsloo P, Turner C, Marenah C. Creatinine assays: time for action?. Ann Clin Biochem. 2002;39(6):599-602.

Grubb A, Löfberg H. Human gamma-trace, a basic microprotein: amino acid sequence and presence in the adenohypophysis. Proc Natl Acad Sci U S A. 1982;79(9):3024-7.

Naik S, Sharma J, Yengkom R, Kalrao V, Mulay A. Acute kidney injury in critically ill children: Risk factors and outcomes. Indian J Crit Care Med. 2014;18(3):129.

Herrero-Morín JD, Málaga S, Fernández N, Rey C, Diéguez MÁ, Solís G, et al. Cystatin C and beta2-microglobulin: markers of glomerular filtration in critically ill children. Crit Care. 2007;11(3):R59.

Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C-a new marker of glomerular filtration rate in children independent of age and height. Pediatrics. 1998;101(5):875-81.

Herget-Rosenthal S, Marggraf G, Hüsing J, Göring F, Pietruck F, Janssen O, et al. Early detection of acute renal failure by serum cystatin C. Kidney International. 2004 Sep 1;66(3):1115-22.

Randers E, Krue S, Erlandsen EJ, Danielsen H, Hansen LG. Reference interval for serum cystatin C in children. Clinical Chem. 1999;45(10):1856-8.

Filler G, Witt I, Priem F, Ehrich JH, Jung K. Are cystatin C and β2-microglobulin better markers than serum creatinine for prediction of a normal glomerular filtration rate in pediatric subjects?. Clin Chem. 1997;43(6):1077-8.






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