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SPİNA BİFİD ALı ÇOCUKLARDA DIETILEN TRIAMIN PENTA-ASETIK ASIT KLIRENSI TEMEL ALıNARAK SERUM SISTATIN C VE KREATININ DEĞERLERININ KARŞıLAŞTıRıLMAS

THE COMPARISON OF CREATININNE AND CYSTATIN C FOR DETECTION OF RENAL FAILURE IN SIPINA BIFIDA PATIENTS

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Abstract (2. Language): 
Glomerular filtration rate (GFR) is considered as the best marker of renal function. Although serum creatinine concentration is mostly used as an indirect marker ofGFR, practically it's not the most accurate method. Cystatin C, a cysteine proteinase inhibitor has been proposed as an indicator ofGFR since 1985. The aim of this study was to compare the clinical value of serum cystatin C and creatinine in spina bifida patients whose muscle mass and related creatinine production is low. Serum creatinine, cystatin C levels were determined and diethylenetriaminepentaasetic acid (DTPA) clearance tests were performed in 43 spina bifida patients. Serum creatinine and cystatin G levels were compared by using DTPA clearance as the gold standard method. Patients were divided into 3 groups according to DTPA clearance; Group I patients with GFR 30-49 ml/ min/1.73 m2 (n: 5), Group IIpatients with GFR 50-79ml/ min/1.73 m2 (n: 12), Group IIIpatients with GFR 3 80 ml/ min/1.73 m2 (n: 26). Children with GFR lower than 80 ml/ min/1.73 m2 were accepted as chronic renal failure patients. The mean age of the study population was 40 ± 20.8 months (1 - 9years). In 17chronic renalfailurepatients by DTPA clearance, only two of them had serum creatinine greater than 1 mg/dl (11 %). Serum cystatin C levels of these patients were high in 8patients (47 %). The upper limit ofGFR that correspond to 80 ml/min/1.73 m2 in our study was 0.4 mg/dl for creatinine and 1.1 mg/L for cystatin C. A highly significant correlation (r=0.84) was found between serum creatinine and cystatin C. The difference between the correlation coefficients of cystatin C-DTPA (r=-0.50, p<0.001) and creatinine-DTPA (r=-0.52, p<0.0001) was not statistically significant. To compare the diagnostic values Receiver Operating Characteristic (ROC) analysis was performed and the areas under the curves (AUC) were found similiar. In this study it is con¬cluded that cystatin C can also be used as an indicator of GFR safely in clinical practice especially in those patients with reduced muscle mass
Abstract (Original Language): 
Böbrek fonksiyonlarının değerlendirilmesinde glomerüler fıltrasyon hızının (GFH) indirekt belirleyicisi olarak serum kreatininin ölçülmesi pratik ancak her zaman kesin olmayan bir yöntemdir. Sistatin C, sistein proteinaz inhibitörü olup 1985' den itibaren GFH ölçütü olarak kullanılmaktadır. Çalışmamızın amacı, kas kitlesi azalmış ve bununla ilişkili olarak kreatinin üretimi azalmış spina bifida hasta grubunda serum sistatin C ile serum kreatinin düzeylerinin klinik değerlendirmede karşılaştırılmaları ve dietilen triamin penta-asetik asit (DTPA) GFH ile korelasyonlarının araştırılmasıdır. Kırküç spina bifida hastası DTPA klirens sonuçlarına göre 3 gruba ayrılmıştır; Grup I- GFH 30¬49 ml/dk/1.73 m2 (n: 5), Grup II- GFH50-79 ml/dk/1.73 m2 (n: 12), Grup III- GFH3 80 ml/dk/1.73 m2 (n: 26). GFH'si 80 ml/dk/1.73 m2 'den düşük olanlar kronik böbrek yetersizliği (KBY) olarak kabul edilmiştir. Çalışma grubunun yaş ortalaması 40 ± 20.8 aydır. DTPA klirensine göre KBY olan 17 hastadan yalnız ikisinin serum kreatinini 1 mg/dl üzerinde (% 11) ve 8 hastanın serum sistatin C düzeyi yüksek (% 47) bulunmuştur. Çalışmamızda GFH 80 ml/dk/1.73 m2 ye denk gelen değerin üst sınırı serum kreatinin için 0.4 mg/dl, sistatin C için 1.1 mg/L saptanmıştır. Sonuç olarak, hastaların serum kreatinin ve sistatin C değerlerinin birbirleri ile istatistiksel olarak anlamlı ve paralel bir ilişki gösterdikleri görülmüştür (r=0.84). Serum kreatinin-DTPA GFH (r=-0.52) ve serum sistatin C-DTPA GFH (r=-0.501) korelasyonları karşılaştırıldığında ise korelasyon katsayıları arasında anlamlı birfark olmadığı saptanmıştır. Maliyeti düşük ve pratik ölçüm yöntemleri bulunan sistatin C'nin de hastaların böbrek fonksiyonlarını idem amacıyla özellikle kas kitlesi azalmış vakalarda güvenle kullanılabileceği sonucuna varılmıştır. «
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