Serum Cystatin C as an Index of Early Detection of Acute Kidney Injury in Children With Severe Malaria

Abstract

Background: Acute kidney injury (AKI) in severe malaria is a major cause of morbidity and mortality. It is often diagnosed using serum creatinine (Scr), which has several limitations. A test for early confirmation of AKI devoid of these limitations is therefore required. Serum cystatin C is therefore suggested as an early screening tool in diagnosing AKI in severe malaria. This study aimed at determining the accuracy of serum cystatin C in the early diagnosis of AKI in severe malaria.

Methods: This was a cross-sectional study. Children with World Health Organization (WHO)-defined severe malaria were recruited and AKI was defined using the Kidney Disease: Improving Global Outcomes (KDIGO) and WHO criteria as well as a serum cystatin C level of > 0.95 mg/L. The Scr and cystatin C levels were done and data were analyzed with a P-value less than 5% considered significant.

Results: A total of 126 children aged 1 - 15 years comprising 70 (55.6%) males with a male-to-female ratio of 1.25:1 were studied. The prevalence of AKI was 38.9% using serum cystatin C, 23.8% using KDIGO and 11.9% using WHO criteria with statistically significant difference (P = 0.001). The mean serum cystatin C was 0.74 (0.59) mg/L. The sensitivity, specificity, and negative predictive value of cystatin C in the diagnosis of AKI in severe malaria were 80.0%, 73.9%, and 92.2%, respectively using the KDIGO definition of AKI.

Conclusion: Serum cystatin C has a high sensitivity, specificity and negative predictive value and can be used to screen children for early detection of AKI in severe malaria.

World J Nephrol Urol. 2024;13(1):19-25
doi: https://doi.org/10.14740/wjnu445