Reference ranges for plasma cystatin C and creatinine measurements in premature infants, neonates, and older children

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Abstract
AIM To establish a reference range in the paediatric population for the new glomerular filtration rate (GFR) marker, cystatin C, and to compare it with that of creatinine. METHODS Cystatin C and creatinine were measured by particle enhanced nephelometric immunoassay (PENIA) and fixed interval Jaffé methods, respectively, in 291 children aged 1 day to 17 years, including 30 premature infants with gestational ages ranging from 24 to 36 weeks. RESULTS In the premature infants, concentrations of both cystatin C and creatinine were significantly raised compared with term infants, with cystatin C concentrations being between 1.10 and 2.06 mg/litre and creatinine between 32 and 135 μmol/litre. In premature infants, there was no significant relation between gestational age and cystatin C or creatinine concentration. Creatinine concentrations fell to a nadir at 4 months of age, rising gradually to adult values by about 15–17 years of age, in contrast to cystatin C, which fell to a mean concentration of 0.80 mg/litre by the 1st year of life, and remained constant throughout adulthood up to the age of 50 years. Neither analyte showed any influence of sex. CONCLUSION The measurement of cystatin C, rather than creatinine, is more practical for monitoring GFR changes in the paediatric population. Cystatin C is a better marker than creatinine of glomerular filtration rate (GFR) in preterm infants A single reference range for plasma cystatin C can be used, regardless of sex, from 1 year of age Cystatin C offers a more specific and practical measure for monitoring GFR in the paediatric population than does creatinine