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2015, Number S1

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RCAN 2015; 25 (S1)

Local reference intervals for urinary creatinine excretion in cuban children and adolescents

Monteagudo RY, Santana PS, Salabarría GJR

Language: Spanish
References: 86
Page: S59-S90
PDF size: 764.36 Kb.


ABSTRACT

Rationale: Identification, correction and (ultimately) prevention of the disorders of growth and development in pediatric ages should oblige to the definition of indicators required for exercises of body reconstruction and nutritional assessment. Urinary creatinine has been historically recognized as a surrogate of the size of body lean tissues and skeletal muscle mass. Incorporation of creatinine urinary excretion into the aforementioned exercises would complement information offered by anthropometric indicators of tissue accretion such as linear growth rate and growth velocity. Up to this moment how creatinine urinary excretion changes as the Cuban child grows has not been documented. In addition, there are not (if not population-based, at least locally) reference intervals for the expected values of this indicator. Objectives: To describe the behavior of the creatinine urinary excretion in Cuban children and adolescents assisted at a pediatric hospital in the city of Havana (Cuba), and to provide reference intervals for this indicator locally valid and representative. Study location: Laboratory for the Study of Renal Function, Clinical Laboratory Service, “Juan Manuel Márquez” Teaching Pediatric Hospital (La Habana, Cuba). Study design: Retrospective, analytical. Study serie: Records from 1,140 Cuban children and adolescents (Boys: 45.9%) assisted at the laboratory between the years 2000–2014 were used. These children represented 11.1% of the records kept at the laboratory. Material and method: Laboratory records were queried in order to recover demographical, clinical, anthropometrical and biochemical data of the children and adolescents presented at the laboratory with values of Height and Body Mass Index (BMI) within the 10-90 percentiles of the Cuban tables for sex and age, preserved renal function (given by serum Creatinine values ‹ 97 percentile for sex and age), and adequate 24 hours urine collections. Values of urinary creatinine molar concentrations were converted into the corresponding mass quantities excreted daily, and were segregated according with the age instance for each sex. For each instance of age the median of the urinary creatinine excreted values was calculated, in order to weight the effect of outlying value. In addition, urinary creatinine excretion normalized indistinctively for the current value of body weight or body surface area (BSA) was treated in the same way. Expected values of urinary creatinine excretion for sex and age of the child | adolescent were obtained from the regression equation Creatinine_urinary_Excretion, mg.24 hours-1 = f(Age; θ). Parameters θ vector of the regression equation was estimated as a least-squares solution. Local reference intervals for expected values of creatinine urinary excretion were obtained from the 100(1-α) prediction intervals associated with the adjusted regression equation. Results: For each sex, creatinine urinary excretion incremented geometrically with each change in the child´s age. A rapid increase was observed in the expected values of creatinine excretion between the ages of 11 – 14 years, coincidently with the pubertal “spurt” moment. Expected values of urinary creatinine excretion were higher in male children and adolescents. Urinary creatinine excretion normalized according with body weight or BSA was essentially constant in the range of examined ages. Conclusions: Expected values of urinary creatinine excretion for Cuban children and adolescents assisted at a teaching pediatric hospital in the city of Havana (Cuba), along with the corresponding reference intervals, have been documented. Urinary creatinine excretion can be predicted with a 100(1-α) level of accuracy for sex, age, body weight and BSA of the Cuban child|adolescent. Behavior of the urinary creatinine excretion might reflect the rapid tissue accretion occurring during adolescence. It is hoped that inclusion of the expected values for urinary creatinine excretion (as derived in this work) in the exercises of body reconstruction and nutritional assessment should contribute to a better follow-up of growth and development of the child|adolescent assisted in different scenarios of pediatric care.


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