Serum Cystatin C as a Marker for Acute Kidney Injury Evaluation in Neonates Treated with Colistin

Abstract

his prospective case control study was carried out in Neonatal Intensive Care Units, Ain Shams University Hospitals and Manshyet El Bakery Hospital from November 2019 to August 2020. The Aim of the study is: Primary aim: to study the effect of colistin on serum cystatin C as an early marker for renal affection in neonates. Secondary aim: to follow up other kidney function tests (ex. serum creatinine, Glomerular Filtration Rate (GFR)) in same patients. All neonates 30 or more weeks of gestation who received colistin for 5 or more days comprised the colistin (study) group with the following exclusion criteria:  Neonates with AKI evidence before colistin initiation.  Neonates with congenital malformations.  Neonates with evidence of hypoxic ischemic encephalopathy.  Neonates receiving concomitant drugs known to be nephrotoxic  Neonates who are hemodynamically un stable (shocked) Neonates who are not receiving colistin served as non – colistin (control) group with the same exclusion criteria and were receiving antibiotics according to NICU protocol in Ain Shams University hospitals and Manshyet El Bakry Hospital. All cases were subjected to comprehensive history taking, through clinical evaluation including vital signs evaluation and individual system examination. Laboratory work up was done to all patients included blood samples for serum BUN, serum Creatinine, sodium, potassium and GFR was calculated using shwartz formula (Initially on admission and before colistin or antibiotics). The previous lab work was sampled again together with serum cystatin C 5 or more days after colistin or antibiotics initiation and the two groups were compared together. Cystatin C is more sensitive than Creatinine in detection of early kidney injury. Cystatin C is a serum protein that is filtered out from the blood by the kidneys and that serves as a measure of kidney function. Cystatin C is produced by type of nucleated cells in the body. Its low molecular mass allows it to be freely filtered by the glomerular membrane in the kidney, is used as alternative to creatinine and creatinine clearance for screening kidney function in those with known or suspected kidney diseases.