Comparative evaluation of cystatin C– and creatinine-based equations for estimating glomerular filtration rate in children with cerebral palsy and healthy controls in a Nigerian tertiary hospital

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BACKGROUND AND OBJECTIVE: Children with cerebral palsy (CP) often experience various medical and functional challenges that may impact renal function over time. Despite this risk, routine renal evaluations and nephrology referrals are not commonly part of their standard care protocol. This study aimed to compare cystatin C- and creatinine-based estimated glomerular filtration rates (eGFR) between children with cerebral palsy and healthy controls. METHODOLOGY: A hospital-based, cross-sectional comparative study was conducted at the Paediatric Neurology and Nephrology Clinicsand general children’s outpatient clinic of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi. A total of 100 children aged 5–18 years comprising 50 children with cerebral palsy and 50 age- and sex-matched healthy controls, were enrolled. Relevant sociodemographic and clinical data were collected using a structured questionnaire. Blood samples were analyzed for serum creatinine and cystatin C. eGFR was calculated using the Modified Schwartz formula (for creatinine) and the univariate cystatin C formula. Data were analyzed using SPSS version 26. RESULTS: The mean serum creatinine level was significantly lower in children with CP (0.596 ± 0.117 mg/dL) compared to controls (0.702 ± 0.123 mg/dL; p < 0.001). Consequently, creatinine-based eGFR was significantly higher in the CP group (95.99 ± 18.91 mL/min/1.73 m²) than in controls (88.55 ± 15.44 mL/min/1.73 m²; p = 0.043). However, there were no significant differences in mean cystatin C levels (0.682 ± 0.096 mg/L vs. 0.686 ± 0.073 mg/L; p = 0.852) or cystatin C-based eGFR (102.12 ± 9.52 mL/min/1.73 m² vs. 101.34 ± 8.86 mL/min/1.73 m²; p = 0.671) between the groups. CONCLUSION: Most children with cerebral palsy demonstrated eGFR values within normal ranges using both creatinine and cystatin C markers. Furthermore, creatinine-based eGFR was higher in children with cerebral palsy compared to healthy controls, likely reflecting reduced muscle mass rather than superior renal function. Cystatin C may be a more reliable marker for renal function assessment in children with cerebral palsy, as it is less influenced by muscle mass variations.

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