title: Serum cystatin C for acute kidney injury evaluation in children treated with aminoglycosides.
abstract: Serum cystatin C (CysC) is a more accurate glomerular filtration rate marker than serum creatinine (SCr) and may rise more quickly with acute kidney injury (AKI).
  
  
  
  We performed a prospective cohort study of 81 non-critically ill children during 110 aminoglycoside (AG) treatments. We calculated area under the curve (AUC) for CysC to diagnose SCr-defined AKI and predict persistent AKI. SCr-AKI definition was based on the Kidney Disease: Improving Global Outcomes (≥stage 1: ≥50 % or 26.5 μmol/l SCr rise from baseline; stage 2: SCr doubling); CysC-AKI was based on a modified version using CysC rise.
  
  
  
  SCr-AKI and CysC-AKI developed in 45 and 48 % treatments, respectively. CysC rise predicted stage 1 (AUC = 0.75, 95 % CI 0.60-0.90) and 2 (AUC = 0.85, 95 % CI 0.75-0.95) SCr-AKI 2 days before SCr-AKI attainment. The best combined sensitivity/specificity for percent CysC rise to predict stage 1 SCr-AKI was with a 44 % CysC rise (sensitivity = 65 %, specificity = 83 %). CysC rise on day of SCr-AKI development was associated with SCr-AKI ≥48 h (AUC = 0.73, 95 % CI 0.56-0.90) and ≥50 % persistent SCr rise at treatment end (AUC = 0.76, 95 % CI 0.61-0.90).
  
  
  
  CysC is as an early AKI biomarker and predictive of persistent AKI on aminoglycoside treatment.
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Lau
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Zubaida
authors.initials: Z
authors.lastname: Al-Ismaili
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Maya
authors.initials: M
authors.lastname: Harel-Sterling
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Pizzi
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Jillian S
authors.initials: JS
authors.lastname: Caldwell
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Piccioni
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada.
authors.forename: Larry C
authors.initials: LC
authors.lastname: Lands
authors.affiliation: Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Theresa
authors.initials: T
authors.lastname: Mottes
authors.affiliation: Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.affiliation: Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Stuart L
authors.initials: SL
authors.lastname: Goldstein
authors.affiliation: Nephrology & Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Bennett
authors.affiliation: Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper, Room E-213, Montreal, Quebec, H3H 1P3, Canada. mzaprdr@yahoo.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Zappitelli
mesh_terms: D058186:Acute Kidney Injury / Q000097:blood* / Q000150:complications / Q000453:epidemiology; D000293:Adolescent; D000617:Aminoglycosides / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D015415:Biomarkers / Q000097:blood; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D016896:Treatment Outcome
chemical_list: D000617:Aminoglycosides; D000900:Anti-Bacterial Agents; D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D003404:Creatinine
keywords: Acute renal failure; Antibiotics; Diagnostic testing; Early biomarker; Nephrotoxicity; Pediatric nephrology