The comparison of serum cystatin C and creatinine levels in determination of glomerular filtration rate in children

Bu çalışmada Uludağ Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı, Çocuk Nefroloji Bilim Dalı tarafından, kronik böbrek hastalığı tanısıyla takipte olan hastalarda, serum kreatinin ve sistatin C düzeylerinin belirlenmesi, elde edilen sonuçlarla kreatinin ve sistatin C ilişkili glomerüler filtrasyon hızı değerlerinin tespit edilerek bu değerlerin karşılaştırılması amaçlanmıştır.Veriler 01 Nisan 2009 ile 30 Haziran 2009 tarihleri arasında Uludağ Üniversitesi Tıp Fakültesi Pediatrik Nefroloji Bilim Dalı tarafından kronik böbrek hastalığı tanısıyla takipte olan 166 hastadan elde edilmiştir. Yaş ve cinsiyet bakımından benzer 29 sağlıklı çocuk kontrol grubu olarak alınmıştır.Hastalarımız 86'ı kız (%51.8), 80'i erkek (%48.2) toplam 166 hastadan oluşmakta idi. Yaş ort±SH 10.3±0.4 yıl (1?18 yaş arasında), boy ort±SH 132.6±2.0 cm, ağırlık ort±SH 36.4±1.5 kg, ort±SH vücut kitle indeksi 19.1±0.3 , ort±SH kreatinin düzeyi 0.69±0.03 mg/dl (0.27?3.0 mg/dl arasında), ort±SH sistatin C düzeyi 0.76±0.03 mg/L (0.17?3.20 mg/L arasında), ort±SH Schwartz GFH 121.5±2.6 ml/dk/1.73m2 olarak bulundu. Kontrol grubunda ort±SH kreatinin düzeyi 0.55±0.01 mg/dl (0.42-0.80 mg/dl), ort±SH sistatin C düzeyi 0.60±0.02 mg/L (0.25-0.89 mg/L) olarak bulundu.Hasta ve kontrol grubunda kreatinin ile yaş, boy ve vücut kitle indeksi arasında anlamlı ilişki saptanırken, sistatin C ile bir ilişki saptanmamıştır.Kreatinin ve sistatin C'nin düşük glomerüler filtrasyon hızını saptamadaki duyarlılığı Receiver Operating Characteristic analizi yapılarak değerlendirildi. Sistatin C sınır değeri 0.62 mg/L, duyarlılığı %70.8, eğri altında kalan alan 0.63±0.05 (p0.05) olarak saptandı. Düşük glomerüler filtrasyon hızının belirlenmesinde sistatin C'nin, kreatinine göre daha duyarlı olduğu görüldü.Elde edilen kreatinin ve sistatin C sonuçları ile glomerüler filtrasyon hızları hesaplandı. Bu glomerüler filtrasyon hızı sonuçları ile kreatinin klirensi arasındaki uyum değerlendirildi. Sistatin C ilişkili glomerüler filtrasyon hızı değerlerinin kreatinin klirensi ile daha uyumlu olduğu görüldü.Sonuç olarak, kronik böbrek hastalığının tanısında, yaş, boy ve vücut kitle indeksi gibi faktörlerden etkilenmeyen sistatin C'nin daha pratik ve uygulanabilir bir belirteç olduğu sonucuna varıldı.The aim of this study was to establish serum cystatin C and creatinine levels in patients with chronic kidney disease. We also aimed to determine glomerular filtration rate both assosiated with serum cystatin C and creatinine levels and compare them.Data were collected from 166 patients with chronic kidney disease followed-up at the Uludag University Medical Faculty, Department of Pediatric Nephrology between 01 April 2009 and 30 June 2009. Age and sex matched 29 healtly children were included as control group.The study included a total of 166 children (86 female, 80 male). The mean age was 10.3±0.4 years (1-18 years), the mean height was 132.6±2.0 cm, the body mass index was 19.1±0.3, serum creatinine level was 0.69±0.03 mg/dl (0.27?3.0 mg/dl), mean cystatin C level was 0.76±0.03 mg/L (0.17?3.20 mg/L), mean Schwartz glomerular filtration rate 121.5±2.6 ml/dk/1.73m2. The mean serum creatinine and cystatin C levels of the control group was 0.55±0.01 mg/dl (0.42-0.80 mg/dl) and 0.60±0.02 mg/L (0.25-0.89 mg/L).Although there was a significant corelation between serum creatinine and age, height and body mass index in both patient and control groups, no corelation was determined according to cystatin C.Receiver Operating Characteristic analysis was used to evaluate sensitivity of the serum creatinine and cystatin C for determining low glomerular filtration rate. For cystatin C, cut-off level was 0.62 mg/L, sensitivity was 70.8%, and area under curve was 0.63±0.05 (p0.05). Cystatin C was found to be more sensitive than creatinine for determining low glomerular filtration rate.Glomerular filtration rate calculated according to cystatin C and creatinine levels. The corelation between glomerular filtration rate result and creatinine clearance was evaluated. It was found that cystatin C assosiated glomerular filtration rate was in accordance with creatinine clearance.As a result it is concluded that serum cystatin C, which is not affected from age, height and body mass index, might be used as a more practically and appreciatle marker in diagnosis of chronic kidney disease

Food-induced anaphylaxis in early childhood and factors associated with its severity.

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified

Food-induced anaphylaxis in early childhood and factors associated with its severity

Background: Several factors that increase the risk of severe food-induced anaphylaxis have been identified. Objective: We aimed to determine the demographic, etiologic, and clinical features of food-induced anaphylaxis in early childhood and also any other factors associated with severe anaphylaxis. Methods:We carried out a medical chart review of anaphylaxis cases from 16 pediatric allergy and immunology centers in Turkey. Results: The data of 227 patients with 266 food-induced anaphylaxis episodes were included in the study. The median (interquartile range) age of the first anaphylaxis episode was 9 months (6-18 months); 160 of these patients were boys (70.5%). The anaphylaxis episodes were mild in 75 cases (28.2%), moderate in 154 cases (57.9%), and severe in 37 cases (13.9%). The most frequent food allergens involved were cow's milk (47.4%), nuts (16.7%), and hen's egg (15.8%). Epinephrine was administered in only 98 (36.8%) of these anaphylaxis episodes. A logistic regression analysis revealed two statistically significant factors that were independently associated with severe anaphylaxis: the presence of angioedema and hoarseness during the anaphylactic episode. Urticaria was observed less frequently in patients who developed hypotension. In addition, confusion and syncope were associated with 25.9- and 44.6-fold increases, respectively, in the risk of concomitant hypotension. Conclusion: Cow's milk, nuts, and hen's egg caused the majority of mild and moderate-to-severe anaphylaxis episodes. The presence of angioedema and hoarseness in any patient who presents with a history of food-induced anaphylaxis should alert clinicians that the reaction may be severe. In addition, the presence of confusion, syncope, or stridor probably indicates concomitant hypotension