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Departments of
1
Pediatrics,
3 Biochemistry, and
6 Radiology, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, K1H 8L1 Canada.
5 Department of Medicine, University of Ottawa, Ottawa, Ontario, K1N 6N5 Canada.
Departments of
2
Laboratory Medicine,
4 Pediatric Nephrology, and
8 Urology, University Hospital Charité, Humboldt University, D-10117 Berlin, Germany.
7 Dade Behring GmbH, Marburg, Germany.
aAddress correspondence to this author at: Institute of Laboratory Medicine and Pathobiochemistry, University Hospital Charité, Humboldt University Berlin, Schumannstrasse 20/21, D-10117 Berlin, Germany. Fax 4930-450569912; e-mail friedrich.priem{at}charite.de.
Background: Because of the limitations of serum creatinine as a marker of glomerular filtration rate (GFR) in children, we assessed the diagnostic accuracy of the novel marker ß-trace protein (BTP) in comparison with cystatin C (Cys-C), ß2-microglobulin (ß2-MG), and creatinine as conventional indicators of reduced GFR.
Methods: We obtained serum samples from 225 children (age range, 0.2–18 years) with various renal pathologies who were referred for nuclear medicine clearance investigations (technetium-diethylenetriamine pentaacetic acid or chromium-EDTA). We measured Cys-C, BTP (nephelometric tests; Dade Behring), ß2-MG (Tinaquant; Roche), and creatinine (enzymatic assay; Creatinine-PAP; Roche).
Results: Seventy-five children had reduced GFR (<90 mL · min-1 · 1.73 m-2). One hundred fifty children (independent of gender and age) with values >90 mL · min-1 · 1.73 m-2 comprised the control group with gaussian distributions of BTP and Cys-C concentrations. The upper reference limits (97.5 percentile) were 1.01 mg/L for BTP and 1.20 mg/L for Cys-C. The correlations of nuclear medicine clearance with the reciprocals of BTP, Cys-C, and the Schwartz GFR estimate were significantly higher (r = 0.653, 0.765, and 0.706, respectively; P <0.05) than with the reciprocal of creatinine or ß2-MG (r = 0.500 and 0.557, respectively). ROC analysis showed a significantly higher diagnostic accuracy of BTP, Cys-C, and the GFR estimate for the detection of impaired GFR than serum creatinine (P <0.05). Compared to creatinine, BTP increased the diagnostic sensitivity by 
30%, but it was not more sensitive than Cys-C or the Schwartz GFR estimate.
Conclusions: BTP is superior to serum creatinine and an alternative for Cys-C to detect mildly reduced GFR in children, but it is not better than the Schwartz GFR estimate.
The following articles in journals at HighWire Press have cited this article:
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  G. J. Schwartz and D. F. Work Measurement and Estimation of GFR in Children and Adolescents Clin. J. Am. Soc. Nephrol., November 1, 2009; 4(11): 1832 - 1843. [Abstract] [Full Text] [PDF]
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 J. R. Delanghe How to estimate GFR in children Nephrol. Dial. Transplant., March 1, 2009; 24(3): 714 - 716. [Full Text] [PDF]
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 G. J. Schwartz, A. Munoz, M. F. Schneider, R. H. Mak, F. Kaskel, B. A. Warady, and S. L. Furth New Equations to Estimate GFR in Children with CKD J. Am. Soc. Nephrol., March 1, 2009; 20(3): 629 - 637. [Abstract] [Full Text] [PDF]
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A. P. Sharma, A. Kathiravelu, R. Nadarajah, A. Yasin, and G. Filler Body mass does not have a clinically relevant effect on cystatin C eGFR in children Nephrol. Dial. Transplant., February 1, 2009; 24(2): 470 - 474. [Abstract] [Full Text] [PDF]
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T. Gerhardt, U. Poge, B. Stoffel-Wagner, B. Klein, H.-U. Klehr, T. Sauerbruch, and R. P. Woitas Serum levels of beta-trace protein and its association to diuresis in haemodialysis patients Nephrol. Dial. Transplant., January 1, 2008; 23(1): 309 - 314. [Abstract] [Full Text] [PDF]
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 C. A. White, A. Akbari, S. Doucette, D. Fergusson, N. Hussain, L. Dinh, G. Filler, N. Lepage, and G. A. Knoll A Novel Equation to Estimate Glomerular Filtration Rate Using Beta-Trace Protein Clin. Chem., November 1, 2007; 53(11): 1965 - 1968. [Abstract] [Full Text] [PDF]
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 M. Zaffanello, M. Franchini, and V. Fanos Is Serum Cystatin-C a Suitable Marker of Renal Function in Children? Ann. Clin. Lab. Sci., January 1, 2007; 37(3): 233 - 240. [Abstract] [Full Text] [PDF]
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C. White, A. Akbari, N. Hussain, L. Dinh, G. Filler, N. Lepage, and G. A. Knoll Estimating Glomerular Filtration Rate in Kidney Transplantation: A Comparison between Serum Creatinine and Cystatin C-Based Methods J. Am. Soc. Nephrol., December 1, 2005; 16(12): 3763 - 3770. [Abstract] [Full Text] [PDF]
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A. S. Sambasivan, N. Lepage, and G. Filler Cystatin C Intrapatient Variability in Children with Chronic Kidney Disease Is Less than Serum Creatinine Clin. Chem., November 1, 2005; 51(11): 2215 - 2216. [Full Text] [PDF]
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A. R. Huber and L. Risch Recent Developments in the Evaluation of Glomerular Filtration Rate: Is There a Place for {beta}-Trace? Clin. Chem., August 1, 2005; 51(8): 1329 - 1330. [Full Text] [PDF]
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U. Poge, T. M. Gerhardt, B. Stoffel-Wagner, H. Palmedo, H.-U. Klehr, T. Sauerbruch, and R. P. Woitas {beta}-Trace Protein Is an Alternative Marker for Glomerular Filtration Rate in Renal Transplantation Patients Clin. Chem., August 1, 2005; 51(8): 1531 - 1533. [Full Text] [PDF]
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B. Lumbreras-Lacarra, J. M. Ramos-Rincon, and I. Hernandez-Aguado Methodology in Diagnostic Laboratory Test Research in Clinical Chemistry and Clinical Chemistry and Laboratory Medicine Clin. Chem., March 1, 2004; 50(3): 530 - 536. [Abstract] [Full Text] [PDF]
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U. Hoffmann, M. Fischereder, B. Kruger, W. Drobnik, and B. K. Kramer The Value of N-Acetylcysteine in the Prevention of Radiocontrast Agent-Induced Nephropathy Seems Questionable J. Am. Soc. Nephrol., February 1, 2004; 15(2): 407 - 410. [Abstract] [Full Text] [PDF]
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A. Lupovitch and M. G. Scott More Accurate Alternatives to Serum Creatinine for Evaluating Glomerular Filtration Rate * Dr. Mitchell G. Scott responds: Clin. Chem., December 1, 2002; 48(12): 2297 - 2298. [Full Text] [PDF]
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