Effect of malnutrition on serum creatinine and cystatin C levels.
The concentration of cystatin C has been shown to be independent of age, gender and height, but the effect of malnutrition has not been studied. Levels of serum creatinine and cystatin C were estimated in 77 malnourished and 77 normally nourished boys between 2 years and 6 years of age without evidence of renal disease. The mean (95% confidence interval) serum creatinine level in the malnourished boys was significantly lower than that in the normally nourished boys [0.42 (0.38-0.45) mg/dl and 0.51 (0.48-0.55)] mg/dl, respectively, (P < 0.01)]. The mean level of serum cystatin C was 1.05 (0.94-1.17) mg/l and 1.12 (1.01-1.24) mg/l, respectively, in normally nourished and malnourished boys (P = 0.35). Mean glomerular filtration rate (GFR) estimated by the Schwartz equation in the malnourished boys was significantly higher than that in normally nourished children [141.8 (123.3-160.2) ml/min per 1.73 m(2) body surface area and 119.4 (109.3-129.5) ml/min per 1.73 m(2) body surface area], respectively (P = 0.04). However, the mean cystatin C-derived GFR was similar in the malnourished and normally nourished boys [99.70 (85.8-113.5) ml/min per 1.73 m(2) and 109.2 (94.4-124.0) ml/min per 1.73 m(2)], respectively (P = 0.35). The mean bias between GFR estimates using Bland and Altman analysis was greater in the malnourished children than in the normally nourished children (32.3% and 17.6%, respectively) (P = 0.15). Serum creatinine levels are lower in malnourished children and lead to overestimation of GFR, while cystatin C levels are unaffected.
Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India. pankajhari@hotmail.com
Pankaj
P
Hari
Arvind
A
Bagga
Puneet
P
Mahajan
Ramakrishnan
R
Lakshmy
D002648:Child; D002675:Child, Preschool; D003404:Creatinine / Q000097:blood*; D055316:Cystatin C; D015891:Cystatins / Q000097:blood*; D004032:Diet; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood*; D012016:Reference Values
C525030:CST3 protein, human; D055316:Cystatin C; D015891:Cystatins; D003404:Creatinine