A comparison between plasma level of cystatin-C, creatinine and NGAL in admitted children receiving nephrotoxic antibiotics (Aminoglycosides and Vancomycin)

Abstract

Antibiotics are widely used in pediatric wards. Some of these antibiotics, including aminoglycosides and vancomycin, are nephrotoxic, and it is important to recognize the harmful effects of these drugs on all patients as soon as possible and to prevent their progression. For this purpose, the traditional method of measuring creatinine level (which is an indicator of acute kidney damage) is widely used, but in this method, the amount of creatinine increases 2 to 3 days after the onset of injury when acute kidney damage has entered more advanced stages. Therefore, it is necessary to use markers other than creatinine, which may indicate this type of damage earlier. These markers include cystatin C and NGAL, which are elevated in both serum and urine in acute renal failure. Because the levels of these two markers (cystatin C and NGAL) rise earlier than creatinine in acute renal impairment, they appear to be a more appropriate indicator for the early detection of acute renal impairment, and we have investigated this issue in this study. Methods and Materials: 25 children admitted to Tabriz Children's Hospital who received nephrotoxic drugs in the hospital were included in the study and blood samples were taken from them on days 1 (before starting the drug), 3 and 5 and the day of cessation of treatment and examined. Took. Results: A total of 25 patients were studied, 17 of whom were female and 8 of whom were male. The mean age was 1.95. 3.4 years, ranging from 8 months to 13 years. NGAL levels and Cys-C blood levels rose regularly on days 3 and 5 and discontinuation of treatment in all samples. According to the definition, in 2 patients (8%) the amount of Cr was increased by 0.3 mg / ml compared to before treatment. Examination of the ROC curve showed the parameters of NGAL at triple times 3 and 5 days after the start of treatment and at the end of treatment, as well as Cys-C blood levels at the triple times 3 and 5 days after the start of treatment and at the end of treatment. These parameters did not have the appropriate diagnostic power to detect a 0.3 mg / ml increase in Cr content compared to before treatment (p values <0.05 and AUCs <0.05).