Correlation Between Serum Albumin And Creatinine Levels In Children With Nephrotic Syndrome.
Paediatrica Indonesiana
November
VOLUME 48
NUMBER 6
Original Article
Correlation between serum albumin and creatinine
levels in children with nephrotic syndrome
Gartika Sapartini, Dedi Rachmadi, Herry Garna
Abstract
Background Nephrotic syndrome is a glomerular disorder
FKDUDFWHUL]HGE\PDVVLYHSURWHLQXULDK\SRDOEXPLQHPLDHGHPD
and hyperlipidemia. Hypoalbuminemia in nephrotic syndrome
OHDGVWRK\SRYROHPLDDGHFUHDVHLQUHQDOSHUIXVLRQDQGJORPHUXODU
filtration rate. Serum creatinine level reflects the glomerular
filtration rate.
Objective The aim of this study was to determine the correlation
between serum albumin and creatinine levels in children with
nephrotic syndrome.
Methods A cross-sectional study was carried out on children with
LGLRSDWKLFQHSKURWLFV\QGURPHDJHGEHWZHHQWR\HDUVROG
DGPLWWHG WR 3HGLDWULF 'HSDUWPHQW LQ +DVDQ 6DGLNLQ +RVSLWDO
IURP -DQXDU\ WR 6HSWHPEHU :H XVHG GDWD IURP
patients’ medical records to obtain serum albumin and creatinine
OHYHOVGXULQJQHSKURWLFVWDJH6WDWLVWLFDODQDO\VLVXVLQJ3HDUVRQ
correlation test was performed to establish the correlation between
serum albumin and creatinine levels. The type of correlation was
determined by regression analysis.
Results 6XEMHFWVZHUHFKLOGUHQFRQVLVWHGRIER\V
with mean of age 6.8 (SD 3.3) years. Mean of serum albumin and
FUHDWLQLQHOHYHOVZHUH 6' JG/DQG 6' PJ
G/UHVSHFWLYHO\$QDO\VLVXVLQJ3HDUVRQFRUUHODWLRQWHVWVKRZHG
DPRGHUDWH U VLJQLILFDQWFRUUHODWLRQ 3 EHWZHHQ
serum albumin and creatinine levels in children with nephrotic
syndrome. Regression analysis suggested a negative linear
relationship between serum albumin level as the independent
variable (X) and serum creatinine level as the dependent variable
< E\XVLQJHTXDWLRQ< ;
Conclusion In patients with nephrotic syndrome there is a
moderate negative correlation between serum albumin and
creatinine levels.[Paediatr Indones. 2008;48:354-7].
Keywords: idiopathic nephrotic syndrome, hypoalbuminemia,serum creatinine, glomerular filtration
rate
354Paediatr Indones, Vol. 48, No. 6, November 2008
N
ephrotic syndrome (NS) remains a major
cause for referral to pediatric nephrologists
because of the chronicity of the disorder
and the complexities of it evaluation and
management.1 The characteristic features of NS are
KHDY\SURWHLQXULD !PJPKU K\SRDOEXPLQHPLD
JG/ HGHPD DQG K\SHUOLSLGHPLD 7KH
underlying abnormality in NS is an increase in
SHUPHDELOLW\RIWKHJORPHUXODUFDSLOODU\ZDOOZKLFK
leads to massive proteinuria and hypoalbuminemia.
Hypoalbuminemia leads to a decrease in the plasma
oncotic pressure and transudation of fluid from the
intravascular compartment to the interstitial space.
The reduction in intravascular volume decreases renal
SHUIXVLRQOHDGLQJWRDGHFUHDVHGJORPHUXODUILOWUDWLRQ
rate (GFR). A decreased GFR is one of the etiology of
acute renal failure (ARF) in children with NS.
Berg and Bohlin found a decreased GFR
which was directly correlated with serum albumin
concentration during nephrotic stage in children
with minimal change NS (MCNS). Lowenberg and
)URP WKH 'HSDUWPHQW RI &KLOG +HDOWK 0HGLFDO 6FKRRO 3DGMDGMDUDQ
8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO+RVSLWDO%DQGXQJ,QGRQHVLD
Request reprint to *DUWLND 6DSDUWLQL 0' 'HSDUWPHQW RI &KLOG
+HDOWK0HGLFDO6FKRRO3DGMDGMDUDQ8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO
+RVSLWDO -O 3DVWHXU 1R %DQGXQJ ,QGRQHVLD 7HO
)D[
Gartika Sapartini et al: Serum albumin and creatinine levels in nephrotic syndrome
Berg also found a positive correlation between serum
DOEXPLQFRQFHQWUDWLRQDQG*)5LQ0&16FKLOGUHQ
lower serum albumin level in MCNS children was
UHODWHGWRORZHU*)5WKXVWKHRSSRVLWHUHPDLQHGWKH
same.6 Guasch and Myers reported that hypofiltration
ZDVDVVRFLDWHGZLWKKLJKHUVHUXPFUHDWLQLQHOHYHO but
there hasn’t been studied yet in children.
Estimation of GFR provides an indication of
RYHUDOOOHYHORIUHQDOIXQFWLRQZKLFKLVLPSRUWDQWWR
be done in children with NS due to its progression
to ARF.8 Inulin clearance is a gold standard for
*)5HVWLPDWLRQEXWLW·VLQYDVLYHDQGQRWDSUDFWLFDO
method. The alternative method which is more simple
and economical is serum creatinine level. Serum
creatinine level examination reflects the GFR. The
purpose of this study was to determine the correlation
between serum albumin and creatinine levels in
children with NS.
between serum albumin and creatinine levels. The
type of correlation was determined by regression
analysis.13 'DWD ZHUH DQDO\]HG XVLQJ 6366 YHUVLRQ
IRU:LQGRZV
Results
'XULQJ -DQXDU\ XQWLO 6HSWHPEHU WKHUH
ZHUH FKLOGUHQ ZKR PHW WKH LQFOXVLRQ FULWHULD
FRQVLVWHGRI ER\VDQG JLUOV7KH
\RXQJHVWVXEMHFWVZDVPRQWKVROGDQGWKHROGHVW
one was 13 years old with mean of age 6.8 (SD 3.3)
\HDUVDQGDYHUDJHRQVHWZDV 6' \HDUV0HDQ
RIZHLJKWZDV 6' NJDQGPHDQRIKHLJKW
ZDV FP2WKHUFKDUDFWHULVWLFVDUHVKRZQ
in Table 1.
Table 1. Characteristics of subjects
Methods
A cross-sectional study was carried out on children
ZLWK ,GLRSDWKLF 1HSKURWLF 6\QGURPH ,16 DJHG
EHWZHHQ DQG \HDUV ROG DGPLWWHG WR 3HGLDWULF
'HSDUWPHQWLQ+DVDQ6DGLNLQ+RVSLWDOIURP-DQXDU\
WR6HSWHPEHU7KHLQFOXVLRQFULWHULDZHUH
children with INS during nephrotic stage (initial
DWWDFNRUUHODSVH DQGDJHGEHWZHHQDQG\HDUV
ROG:HH[FOXGHGSDWLHQWVZLWKVHYHUHPDOQXWULWLRQ
and liver cirrhosis.
'DWDRIWKHVXEMHFWVLQFOXGLQJQDPHDJHELUWK
GDWH VH[ KLVWRU\ RI FXUUHQW DQG SUHYLRXV LOOQHVV
body weight, GU\ZHLJKWKHLJKWQXWULWLRQDQGVWDWXV
serum albumin and creatinine levels during nephrotic
stage were collected from patient’s medical record. To
GHWHUPLQHVHUXPDOEXPLQOHYHOZHXVHGEURPFUHVRO
JUHHQ %&* PHWKRGDQG-DIIHPHWKRGZDVXVHGWR
determine serum creatinine level.
If the significance level was A RQH
WDLOHGWHVWDQGSRZHURIWKHWHVWZDVWKHQWKH
PLQLPDOVL]HRIWKHVDPSOHQHHGHGZDV VXEMHFWV
INS was defined as NS with unknown etiology.
Hypoalbuminemia was defined as serum albumin level
JG/ Normal serum creatinine levels based
RQDJHZHUHXVHGDFFRUGLQJWR.KHU
6WDWLVWLFDODQDO\VLVXVLQJ3HDUVRQFRUUHODWLRQWHVW
was performed to establish the intensity of correlation
Variables
Age (years old)
Body weight (kg)
Height (cm)
Sex
Male
Female
Onset (years old)
n
Mean (SD)
Median
113
113
113
6.8 (3.3)
19.4 (7.7)
110.1 (19.4)
7
17.9
110
81 (72%)
32 (28%)
113
5.8 (3.3)
5
Table 2 shows the distribution of serum albumin
and creatinine levels of the subjects. Mean of serum
DOEXPLQOHYHOZDV 6' JG/ZLWKWKHORZHVW
OHYHOZDVJG/DQGWKHKLJKHVWOHYHOZDVJG/
0HDQRIVHUXPFUHDWLQLQHOHYHOZDV 6' G/
ZLWK WKH ORZHVW OHYHO RI PJG/ DQG WKH KLJKHVW
OHYHORIPJG/
Table 2. Distribution of serum albumin and creatinine levels
Variables
n
Mean (SD)
Median
Serum albumin (g/dL)
113
1.4 (0.4)
1.4
Serum creatinine (mg/dL)
113
0.7 (0.4)
0.6
)URPVXEMHFWVWKHUHZHUHVXEMHFWVZKR
had elevation in serum creatinine level above upper
normal limit based on age (Table 3).
Table 3 shows that mean of serum creatinine
OHYHOHOHYDWLRQZDV 6' RU 6'
times above upper normal limit based on age. The
lowest percentage of serum creatinine level elevation
Paediatr Indones, Vol. 48, No. 6, November 2008355
Gartika Sapartini et al: Serum albumin and creatinine levels in nephrotic syndrome
Table 3. Elevated serum creatinine level during nephrotic stage
Variables
n
Mean (SD)
Median
Percentage of serum creatinine
level elevation (%)
Multiplication rate of serum
creatinine level elevation (times)
34
58.4 (52.8)
50
34
1.6 (0.5)
1.5
was 1.4% and the highest was 188%. The lowest
multiplication rate of serum creatinine level elevation
was 1.01 times and the highest was 2.9 times above
upper normal limit of the serum creatinine level based
on age. These elevations of serum creatinine level
occurred in the range of serum albumin level between
0.25 g/dL and 1.8 g/ dL.
Figure 1 shows the correlation between serum
albumin and creatinine levels in children with NS.
Figure 1 describes a negative linear relationship
between serum albumin and creatinine levels in children
with NS. Pearson correlation test was used to determine
the intensity of this correlation. Based on that analysis,
there was a significant negative correlation between
serum albumin and creatinine levels (P
November
VOLUME 48
NUMBER 6
Original Article
Correlation between serum albumin and creatinine
levels in children with nephrotic syndrome
Gartika Sapartini, Dedi Rachmadi, Herry Garna
Abstract
Background Nephrotic syndrome is a glomerular disorder
FKDUDFWHUL]HGE\PDVVLYHSURWHLQXULDK\SRDOEXPLQHPLDHGHPD
and hyperlipidemia. Hypoalbuminemia in nephrotic syndrome
OHDGVWRK\SRYROHPLDDGHFUHDVHLQUHQDOSHUIXVLRQDQGJORPHUXODU
filtration rate. Serum creatinine level reflects the glomerular
filtration rate.
Objective The aim of this study was to determine the correlation
between serum albumin and creatinine levels in children with
nephrotic syndrome.
Methods A cross-sectional study was carried out on children with
LGLRSDWKLFQHSKURWLFV\QGURPHDJHGEHWZHHQWR\HDUVROG
DGPLWWHG WR 3HGLDWULF 'HSDUWPHQW LQ +DVDQ 6DGLNLQ +RVSLWDO
IURP -DQXDU\ WR 6HSWHPEHU :H XVHG GDWD IURP
patients’ medical records to obtain serum albumin and creatinine
OHYHOVGXULQJQHSKURWLFVWDJH6WDWLVWLFDODQDO\VLVXVLQJ3HDUVRQ
correlation test was performed to establish the correlation between
serum albumin and creatinine levels. The type of correlation was
determined by regression analysis.
Results 6XEMHFWVZHUHFKLOGUHQFRQVLVWHGRIER\V
with mean of age 6.8 (SD 3.3) years. Mean of serum albumin and
FUHDWLQLQHOHYHOVZHUH 6' JG/DQG 6' PJ
G/UHVSHFWLYHO\$QDO\VLVXVLQJ3HDUVRQFRUUHODWLRQWHVWVKRZHG
DPRGHUDWH U VLJQLILFDQWFRUUHODWLRQ 3 EHWZHHQ
serum albumin and creatinine levels in children with nephrotic
syndrome. Regression analysis suggested a negative linear
relationship between serum albumin level as the independent
variable (X) and serum creatinine level as the dependent variable
< E\XVLQJHTXDWLRQ< ;
Conclusion In patients with nephrotic syndrome there is a
moderate negative correlation between serum albumin and
creatinine levels.[Paediatr Indones. 2008;48:354-7].
Keywords: idiopathic nephrotic syndrome, hypoalbuminemia,serum creatinine, glomerular filtration
rate
354Paediatr Indones, Vol. 48, No. 6, November 2008
N
ephrotic syndrome (NS) remains a major
cause for referral to pediatric nephrologists
because of the chronicity of the disorder
and the complexities of it evaluation and
management.1 The characteristic features of NS are
KHDY\SURWHLQXULD !PJPKU K\SRDOEXPLQHPLD
JG/ HGHPD DQG K\SHUOLSLGHPLD 7KH
underlying abnormality in NS is an increase in
SHUPHDELOLW\RIWKHJORPHUXODUFDSLOODU\ZDOOZKLFK
leads to massive proteinuria and hypoalbuminemia.
Hypoalbuminemia leads to a decrease in the plasma
oncotic pressure and transudation of fluid from the
intravascular compartment to the interstitial space.
The reduction in intravascular volume decreases renal
SHUIXVLRQOHDGLQJWRDGHFUHDVHGJORPHUXODUILOWUDWLRQ
rate (GFR). A decreased GFR is one of the etiology of
acute renal failure (ARF) in children with NS.
Berg and Bohlin found a decreased GFR
which was directly correlated with serum albumin
concentration during nephrotic stage in children
with minimal change NS (MCNS). Lowenberg and
)URP WKH 'HSDUWPHQW RI &KLOG +HDOWK 0HGLFDO 6FKRRO 3DGMDGMDUDQ
8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO+RVSLWDO%DQGXQJ,QGRQHVLD
Request reprint to *DUWLND 6DSDUWLQL 0' 'HSDUWPHQW RI &KLOG
+HDOWK0HGLFDO6FKRRO3DGMDGMDUDQ8QLYHUVLW\+DVDQ6DGLNLQ*HQHUDO
+RVSLWDO -O 3DVWHXU 1R %DQGXQJ ,QGRQHVLD 7HO
)D[
Gartika Sapartini et al: Serum albumin and creatinine levels in nephrotic syndrome
Berg also found a positive correlation between serum
DOEXPLQFRQFHQWUDWLRQDQG*)5LQ0&16FKLOGUHQ
lower serum albumin level in MCNS children was
UHODWHGWRORZHU*)5WKXVWKHRSSRVLWHUHPDLQHGWKH
same.6 Guasch and Myers reported that hypofiltration
ZDVDVVRFLDWHGZLWKKLJKHUVHUXPFUHDWLQLQHOHYHO but
there hasn’t been studied yet in children.
Estimation of GFR provides an indication of
RYHUDOOOHYHORIUHQDOIXQFWLRQZKLFKLVLPSRUWDQWWR
be done in children with NS due to its progression
to ARF.8 Inulin clearance is a gold standard for
*)5HVWLPDWLRQEXWLW·VLQYDVLYHDQGQRWDSUDFWLFDO
method. The alternative method which is more simple
and economical is serum creatinine level. Serum
creatinine level examination reflects the GFR. The
purpose of this study was to determine the correlation
between serum albumin and creatinine levels in
children with NS.
between serum albumin and creatinine levels. The
type of correlation was determined by regression
analysis.13 'DWD ZHUH DQDO\]HG XVLQJ 6366 YHUVLRQ
IRU:LQGRZV
Results
'XULQJ -DQXDU\ XQWLO 6HSWHPEHU WKHUH
ZHUH FKLOGUHQ ZKR PHW WKH LQFOXVLRQ FULWHULD
FRQVLVWHGRI ER\VDQG JLUOV7KH
\RXQJHVWVXEMHFWVZDVPRQWKVROGDQGWKHROGHVW
one was 13 years old with mean of age 6.8 (SD 3.3)
\HDUVDQGDYHUDJHRQVHWZDV 6' \HDUV0HDQ
RIZHLJKWZDV 6' NJDQGPHDQRIKHLJKW
ZDV FP2WKHUFKDUDFWHULVWLFVDUHVKRZQ
in Table 1.
Table 1. Characteristics of subjects
Methods
A cross-sectional study was carried out on children
ZLWK ,GLRSDWKLF 1HSKURWLF 6\QGURPH ,16 DJHG
EHWZHHQ DQG \HDUV ROG DGPLWWHG WR 3HGLDWULF
'HSDUWPHQWLQ+DVDQ6DGLNLQ+RVSLWDOIURP-DQXDU\
WR6HSWHPEHU7KHLQFOXVLRQFULWHULDZHUH
children with INS during nephrotic stage (initial
DWWDFNRUUHODSVH DQGDJHGEHWZHHQDQG\HDUV
ROG:HH[FOXGHGSDWLHQWVZLWKVHYHUHPDOQXWULWLRQ
and liver cirrhosis.
'DWDRIWKHVXEMHFWVLQFOXGLQJQDPHDJHELUWK
GDWH VH[ KLVWRU\ RI FXUUHQW DQG SUHYLRXV LOOQHVV
body weight, GU\ZHLJKWKHLJKWQXWULWLRQDQGVWDWXV
serum albumin and creatinine levels during nephrotic
stage were collected from patient’s medical record. To
GHWHUPLQHVHUXPDOEXPLQOHYHOZHXVHGEURPFUHVRO
JUHHQ %&* PHWKRGDQG-DIIHPHWKRGZDVXVHGWR
determine serum creatinine level.
If the significance level was A RQH
WDLOHGWHVWDQGSRZHURIWKHWHVWZDVWKHQWKH
PLQLPDOVL]HRIWKHVDPSOHQHHGHGZDV VXEMHFWV
INS was defined as NS with unknown etiology.
Hypoalbuminemia was defined as serum albumin level
JG/ Normal serum creatinine levels based
RQDJHZHUHXVHGDFFRUGLQJWR.KHU
6WDWLVWLFDODQDO\VLVXVLQJ3HDUVRQFRUUHODWLRQWHVW
was performed to establish the intensity of correlation
Variables
Age (years old)
Body weight (kg)
Height (cm)
Sex
Male
Female
Onset (years old)
n
Mean (SD)
Median
113
113
113
6.8 (3.3)
19.4 (7.7)
110.1 (19.4)
7
17.9
110
81 (72%)
32 (28%)
113
5.8 (3.3)
5
Table 2 shows the distribution of serum albumin
and creatinine levels of the subjects. Mean of serum
DOEXPLQOHYHOZDV 6' JG/ZLWKWKHORZHVW
OHYHOZDVJG/DQGWKHKLJKHVWOHYHOZDVJG/
0HDQRIVHUXPFUHDWLQLQHOHYHOZDV 6' G/
ZLWK WKH ORZHVW OHYHO RI PJG/ DQG WKH KLJKHVW
OHYHORIPJG/
Table 2. Distribution of serum albumin and creatinine levels
Variables
n
Mean (SD)
Median
Serum albumin (g/dL)
113
1.4 (0.4)
1.4
Serum creatinine (mg/dL)
113
0.7 (0.4)
0.6
)URPVXEMHFWVWKHUHZHUHVXEMHFWVZKR
had elevation in serum creatinine level above upper
normal limit based on age (Table 3).
Table 3 shows that mean of serum creatinine
OHYHOHOHYDWLRQZDV 6' RU 6'
times above upper normal limit based on age. The
lowest percentage of serum creatinine level elevation
Paediatr Indones, Vol. 48, No. 6, November 2008355
Gartika Sapartini et al: Serum albumin and creatinine levels in nephrotic syndrome
Table 3. Elevated serum creatinine level during nephrotic stage
Variables
n
Mean (SD)
Median
Percentage of serum creatinine
level elevation (%)
Multiplication rate of serum
creatinine level elevation (times)
34
58.4 (52.8)
50
34
1.6 (0.5)
1.5
was 1.4% and the highest was 188%. The lowest
multiplication rate of serum creatinine level elevation
was 1.01 times and the highest was 2.9 times above
upper normal limit of the serum creatinine level based
on age. These elevations of serum creatinine level
occurred in the range of serum albumin level between
0.25 g/dL and 1.8 g/ dL.
Figure 1 shows the correlation between serum
albumin and creatinine levels in children with NS.
Figure 1 describes a negative linear relationship
between serum albumin and creatinine levels in children
with NS. Pearson correlation test was used to determine
the intensity of this correlation. Based on that analysis,
there was a significant negative correlation between
serum albumin and creatinine levels (P