El-Gammacy Tarek Mohey, Shinkar Dina Mohamed, Mohamed Noha Refaat, Al-Halag Amany Rasmy
a Department of Pediatrics, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
b Clinical Pathology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt.
Scand J Clin Lab Invest. 2018 Sep;78(5):352-357. doi: 10.1080/00365513.2018.1472803. Epub 2018 May 22.
Preterm neonates with respiratory distress syndrome (RDS) are at increased risk of acute kidney injury (AKI). Our study aimed at determining whether serum cystatin C (sCysC) on day 3 of life (D3) can early predict AKI in preterm neonates with RDS. This prospective study was conducted on 75 preterm neonates; 50 with RDS and 25 without RDS. On D3, sCysC, serum creatinine (sCr) and blood urea nitrogen (BUN) were measured and estimated glomerular filtration rate (eGFR) was calculated. sCr and BUN levels were measured again on days 5 and 7. Neonates were evaluated for development of AKI during first week of life according to the modified pediatric RIFLE (pRIFLE) criteria. Thirteen neonates with RDS developed AKI (26%).There was no significant difference between RDS and control groups with respect to sCysC. RDS neonates with AKI had significantly higher sCysC than those without AKI (1.62 ± 0.12 versus 1.16 ± 0.09 mg/l; p < .001). RDS grade III-IV neonates had significantly higher sCysC than RDS grade I-II. There was a significant positive correlation between D3 sCysC and (D5 and D7 sCr and BUN). Receiver operating characteristic (ROC) curve showed that D3 sCysC can predict AKI in preterm neonates with RDS at a cutoff point of >1.3 mg/l with sensitivity of 92.30% and specificity of 96%. We conclude that neonates with RDS are at increased risk of AKI. sCysC on day 3 of life can predict AKI earlier than Cr and eGFR.
患有呼吸窘迫综合征（RDS）的早产儿发生急性肾损伤（AKI）的风险增加。我们的研究旨在确定出生第3天（D3）的血清胱抑素C（sCysC）是否能早期预测患有RDS的早产儿的AKI。这项前瞻性研究对75例早产儿进行；50例患有RDS，25例未患RDS。在D3时，测量sCysC、血清肌酐（sCr）和血尿素氮（BUN），并计算估计肾小球滤过率（eGFR）。在第5天和第7天再次测量sCr和BUN水平。根据改良的儿科RIFLE（pRIFLE）标准，评估新生儿在出生后第一周内AKI的发生情况。13例患有RDS的新生儿发生了AKI（26%）。RDS组和对照组在sCysC方面无显著差异。患有AKI的RDS新生儿的sCysC显著高于未患AKI的新生儿（1.62±0.12对1.16±0.09mg/l；p<0.001）。III-IV级RDS新生儿的sCysC显著高于I-II级RDS新生儿。D3时的sCysC与（D5和D7时的sCr和BUN）之间存在显著正相关。受试者操作特征（ROC）曲线显示，D3时的sCysC可以在>1.3mg/l的临界值时预测患有RDS的早产儿的AKI，敏感性为92.30%，特异性为96%。我们得出结论，患有RDS的新生儿发生AKI的风险增加。出生第3天的sCysC比肌酐和eGFR能更早地预测AKI。
