Abstract
BackgroundThis study aims to establish age- and gender-specific cystatin C (CysC) reference values for healthy infants, children, and adolescents and to relate them to pubertal stage, height, weight, and body mass index (BMI).MethodsSerum CysC and creatinine levels of 6217 fasting, morning venous blood samples from 2803 healthy participants of the LIFE Child study (age 3 months to 18 years) were analyzed by an immunoassay. Recruitment started in 2011; 1636 participants provided at least one follow-up measurement. Percentiles for CysC were calculated. Age- and gender-related effects of height, weight, BMI, and puberty status were assessed through linear regression models.ResultsOver the first 2 years of life, median CysC levels decrease depending on height (ß = − 0.010 mg/l/cm, p < 0.001) and weight (ß = − 0.033 mg/l/kg, p < 0.001) from 1.06 to 0.88 mg/l for males and from 1.04 to 0.87 mg/l for females. Following the second year of age, the levels remain stable for eight years. From 11 to 14 years of age, there is an increase of median CysC levels in males to 0.98 mg/l and a decrease in females to 0.86 mg/l. The change is associated with puberty (ß = 0.105 mg/l/Tanner stage, p < 0.001 in males and ß = − 0.093 mg/l/Tanner stage, p < 0.01 in females) and in males with height (ß = 0.003 mg/l/cm, p < 0.001).ConclusionsCysC levels depend on age, gender, and height, especially during infancy and puberty. We recommend the use of age- and gender-specific reference values for CysC serum levels for estimating kidney function in clinical practice.
Highlights
Cystatin C (CysC), a cysteine protease inhibitor and low molecular weight protein, is an endogenous marker for glomerular filtration rate (GFR)
The distribution of cystatin C (CysC) levels in the Leipzig Research Centre for Civilization Diseases (LIFE) Child cohort, the percentiles and the degree of freedom spread, skewness, location, and kurtosis parameters are shown in Fig. 3 and Table 3
We found an increase of CysC levels in male and a decrease in female adolescents associated with pubertal development
Summary
Cystatin C (CysC), a cysteine protease inhibitor and low molecular weight protein, is an endogenous marker for glomerular filtration rate (GFR). The kidney function may be estimated based on CysC [1] It is produced by all human nucleated cells at a stable rate, as it is the product of a housekeeping gene [2]. The currently used GFR estimation formula (0.413 × height/sCrea(mg/dl)) must consider serum creatinine (sCrea) levels as well as the body height [4] due to varying body composition (especially muscle mass) causing inter- and intra-patient variability in sCrea levels [5,6,7,8]. This study aims to establish age- and gender-specific cystatin C (CysC) reference values for healthy infants, children, and adolescents and to relate them to pubertal stage, height, weight, and body mass index (BMI). Age- and gender-related effects of height, weight, BMI, and puberty status were assessed through linear regression models
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