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Liu L, Chang DY, Lewandrowski KB, Dighe AS. Discrepancy between estimated glomerular filtration rate by creatinine versus cystatin C in different patient care settings. Clin Biochem 2024; 131-132:110801. [PMID: 39029611 DOI: 10.1016/j.clinbiochem.2024.110801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE Estimated glomerular filtration rate (eGFR) calculated by cystatin C (cysC) has been recommended for broader adoption. This study assessed the discrepancy between eGFR calculated by cysC (eGFRcys) and creatinine (eGFRcr) in different patient care settings and explored potential contributing factors to such discrepancies. METHODS This retrospective study included 2072 patients with paired cysC and creatinine results in different patient care settings. Delta eGFRcr-cys (eGFRcr - eGFRcys) was analyzed in relationship to patient care settings and the Elixhauser Comorbidity index. The 90-day survival in patients with different delta eGFR was assessed by Kaplan-Meier analysis, univariate and multivariate Cox proportional hazard models. In addition, discrepancy between eGFRcys and eGFRcr was analyzed in 50 ambulatory patients with systemic inflammation but normal kidney function. RESULTS Inpatients had higher cysC (median 1.91 mg/L), lower eGFRcys (median 31 mL/min/1.73 m2), and larger delta eGFRcr-cys (median 18 mL/min/1.73 m2) than outpatients (cysC median 1.53 mg/L, p < 0.0001, eGFRcys median 41 mL/min/1.73 m2, p < 0.0001, delta eGFRcr-cys median 4 mL/min/1.73 m2, p < 0.0001). Higher Elixhauser Comorbidity index correlated with lower eGFRcys and larger delta eGFRcr-cys, with median delta eGFRcr-cys 11 and 6 mL/min/1.73 m2 in patients with a Comorbidity index > 15 and ≤ 15, respectively (p < 0.0001). Increased delta eGFRcr-cys was associated with worse 90-day survival. Patients with systemic inflammation but normal kidney function had lower eGFRcys (median 77.5 mL/min/1.73 m2) than eGFRcr (median 97 mL/min/1.73 m2, p < 0.001), with red blood cell abnormalities as associated factors. CONCLUSION Inflammation and comorbidities are associated with decreased eGFRcys and large discrepancies between eGFRcr and eGFRcys independent of kidney function and are most apparent in inpatients. Creatinine-cysC combined eGFR reduces this discrepancy and should be broadly adopted.
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Affiliation(s)
- Li Liu
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States.
| | - Daniel Y Chang
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
| | - Kent B Lewandrowski
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
| | - Anand S Dighe
- Department of Pathology, Massachusetts General Hospital, United States; Harvard Medical School, Boston, MA, United States
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Pediatric onco-nephrology: time to spread the word : Part I: early kidney involvement in children with malignancy. Pediatr Nephrol 2021; 36:2227-2255. [PMID: 33245421 DOI: 10.1007/s00467-020-04800-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/28/2020] [Accepted: 09/25/2020] [Indexed: 12/29/2022]
Abstract
Onco-nephrology has been a growing field within the adult nephrology scope of practice. Even though pediatric nephrologists have been increasingly involved in the care of children with different forms of malignancy, there has not been an emphasis on developing special expertise in this area. The fast pace of discovery in this field, including the development of new therapy protocols with their own kidney side effects and the introduction of the CD19-targeted chimeric antigen receptor T cell (CAR-T) therapy, has introduced new challenges for general pediatric nephrologists because of the unique effects of these treatments on the kidney. Moreover, with the improved outcomes in children receiving cancer therapy come an increased number of survivors at risk for chronic kidney disease related to both their cancer diagnosis and therapy. Therefore, it is time for pediatric onco-nephrology to take its spot on the expanding subspecialties map in pediatric nephrology.
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Yamazoe T, Akagawa S, Matsuno R, Akagawa Y, Yamanouchi S, Omachi T, Kimata T, Tsuji S, Kaneko K. Superiority of Cystatin C over Creatinine for Early Diagnosis of Acute Kidney Injury in Pediatric Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma. TOHOKU J EXP MED 2021; 254:163-170. [PMID: 34248109 DOI: 10.1620/tjem.254.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The exact incidence of acute kidney injury (AKI) during chemotherapy for acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LBL) is unknown. Furthermore, childhood cancer survivors are at risk of AKI-chronic kidney disease transition. Thus, early diagnosis of AKI is crucial. This study aimed to elucidate the incidence of AKI in patients undergoing chemotherapy for pediatric ALL/LBL and to compare the usefulness of serum cystatin C (CysC)- and creatinine (Cr)-based estimated glomerular filtration rate (eGFR) as diagnostic measures. Data of 16 patients with ALL/LBL treated with a total of 75 courses of chemotherapy were retrospectively analyzed. CysC- and Cr-based eGFR were measured before and three times per week during therapy. To calculate the eGFR, an equation for Japanese children was used. AKI was diagnosed when eGFR dropped by ≥ 25% from the highest eGFR value obtained during the latest 2 weeks since the start of chemotherapy. AKI was graded based on the pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease scale. All patients developed AKI during chemotherapy; however, more than 90% of the cases were mild and eventually recovered. No significant differences were found in the incidence of AKI between CysC- and Cr-based eGFR (p = 0.104). The median time to AKI diagnosis was significantly shorter in the CysC-based eGFR than in the Cr-based eGFR (8 vs. 17 days, p < 0.001). In this study, all patients with pediatric ALL/LBL could develop mild AKI during treatment. CysC-based eGFR is a more effective measure than Cr-based eGFR for the early diagnosis of AKI.
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Affiliation(s)
| | | | | | - Yuko Akagawa
- Department of Pediatrics, Kansai Medical University
| | | | | | | | - Shoji Tsuji
- Department of Pediatrics, Kansai Medical University
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4
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Liang S, Shi M, Bai Y, Deng Y, Fang M, Li J, Wu Y, Peng W, Hou Y, Fang H, Zhang H, Chen C. The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study. BMC Nephrol 2020; 21:519. [PMID: 33246435 PMCID: PMC7694927 DOI: 10.1186/s12882-020-02165-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/09/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Glucocorticoids may impact the accuracy of serum cystatin C (sCysC) in reflecting renal function. We aimed to assess the effect of glucocorticoids on the performance of sCysC in detecting acute kidney injury (AKI) in critically ill patients. METHODS A prospective observational cohort study was performed in a general intensive care unit (ICU). Using propensity score matching, we successfully matched 240 glucocorticoid users with 960 non-users among 2716 patients. Serum creatinine (SCr) and sCysC were measured for all patients at ICU admission. Patients were divided into four groups based on cumulative doses of glucocorticoids within 5 days before ICU admission (Group I: non-users; Group II: 0 mg < prednisone ≤50 mg; Group III: 50 mg < prednisone ≤150 mg; Group IV: prednisone > 150 mg). We compared the performance of sCysC for diagnosing and predicting AKI in different groups using the area under the receiver operator characteristic curve (AUC). RESULTS A total of 240 patients received glucocorticoid medication within 5 days before ICU admission. Before and after matching, the differences of sCysC levels between glucocorticoid users and non-users were both significant (P < 0.001). The multiple linear regression analysis revealed that glucocorticoids were independently associated with sCysC (P < 0.001). After matching, the group I had significantly lower sCysC levels than the group III and group IV (P < 0.05), but there were no significant differences in sCysC levels within different glucocorticoids recipient groups (P > 0.05). Simultaneously, we did not find significant differences in the AUC between any two groups in the matched cohort (P > 0.05). CONCLUSIONS Glucocorticoids did not impact the performance of sCysC in identifying AKI in critically ill patients.
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Affiliation(s)
- Silin Liang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Mai Shi
- Department of Critical Medicine, Peking University Third Hospital, No.49, Huayuan Rd., Haidian District, Beijing, 100191, People's Republic of China
| | - Yunpeng Bai
- Center of Scientific Research, Maoming People's Hospital, 101 Weimin Road, Maoming, 525000, Guangdong Province, People's Republic of China.,Department of Critical Care Medicine, Maoming People's Hospital, 101 Weimin Road, Maoming, 525000, Guangdong Province, People's Republic of China
| | - Yujun Deng
- Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Miaoxian Fang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Jiaxin Li
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yijin Wu
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Wenying Peng
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Yating Hou
- Department of Oncology, Maoming People's Hospital, 101 Weimin Road, Maoming, 525000, Guangdong Province, People's Republic of China
| | - Heng Fang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Huidan Zhang
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China.,Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China
| | - Chunbo Chen
- Department of Intensive Care Unit of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 96 Dongchuan Road, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,Department of Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, 510080, Guangdong Province, People's Republic of China. .,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
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5
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Schönermarck U, Dengler C, Lean I, Waldmann E. Comment on: "Overestimation of glomerular filtration rate calculated from serum creatinine as compared with cystatin C in patients with subclinical hypercortisolism: Hyogo Adrenal Metabolic Registry" by Naka et al. Endocr J 2020; 67:889-890. [PMID: 32641620 DOI: 10.1507/endocrj.ej20-0321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Ulf Schönermarck
- Department of Medicine IV, University Hospital, LMU Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Christina Dengler
- Department of Medicine IV, University Hospital, LMU Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Isaac Lean
- Department of Medicine IV, University Hospital, LMU Munich, Marchioninistr. 15, D-81377 Munich, Germany
| | - Elisa Waldmann
- Department of Medicine IV, University Hospital, LMU Munich, Marchioninistr. 15, D-81377 Munich, Germany
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6
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Koyama H, Kadoya M. Serum cystatin C level in chronic hypercortisolism. Endocr J 2020; 67:891-892. [PMID: 32641621 DOI: 10.1507/endocrj.ej20-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Hidenori Koyama
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Hyogo 663-8501, Japan
| | - Manabu Kadoya
- Department of Diabetes, Endocrinology and Clinical Immunology, Hyogo College of Medicine, Hyogo 663-8501, Japan
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7
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Teaford HR, Barreto JN, Vollmer KJ, Rule AD, Barreto EF. Cystatin C: A Primer for Pharmacists. PHARMACY 2020; 8:E35. [PMID: 32182861 PMCID: PMC7151673 DOI: 10.3390/pharmacy8010035] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/22/2020] [Accepted: 03/05/2020] [Indexed: 12/20/2022] Open
Abstract
Pharmacists are at the forefront of dosing and monitoring medications eliminated by or toxic to the kidney. To evaluate the effectiveness and safety of these medications, accurate measurement of kidney function is paramount. The mainstay of kidney assessment for drug dosing and monitoring is serum creatinine (SCr)-based estimation equations. Yet, SCr has known limitations including its insensitivity to underlying changes in kidney function and the numerous non-kidney factors that are incompletely accounted for in equations to estimate glomerular filtration rate (eGFR). Serum cystatin C (cysC) is a biomarker that can serve as an adjunct or alternative to SCr to evaluate kidney function for drug dosing. Pharmacists must be educated about the strengths and limitations of cysC prior to applying it to medication management. Not all patient populations have been studied and some evaluations demonstrated large variations in the relationship between cysC and GFR. Use of eGFR equations incorporating cysC should be reserved for drug management in scenarios with demonstrated outcomes, including to improve pharmacodynamic target attainment for antibiotics or reduce drug toxicity. This article provides an overview of cysC, discusses evidence around its use in medication dosing and in special populations, and describes practical considerations for application and implementation.
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Affiliation(s)
- Hilary R. Teaford
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, USA; (H.R.T.); (J.N.B.)
| | - Jason N. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, USA; (H.R.T.); (J.N.B.)
| | - Kathryn J. Vollmer
- College of Pharmacy and Health Sciences, Drake University, Des Moines, IA 50311, USA;
| | - Andrew D. Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN 55905, USA;
- Division of Epidemiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Erin F. Barreto
- Department of Pharmacy, Mayo Clinic, Rochester, MN 55905, USA; (H.R.T.); (J.N.B.)
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
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8
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Muñoz J, Soblechero P, Duque FJ, Macías-García B, Ruiz P, Zaragoza C, Barrera R. Effects of Oral Prednisone Administration on Serum Cystatin C in Dogs. J Vet Intern Med 2017; 31:1765-1770. [PMID: 28921665 PMCID: PMC5697201 DOI: 10.1111/jvim.14820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/20/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background Oral administration of glucocorticoid alters serum cystatin C (sCysC) concentration in humans. Objective To determine if oral administration of prednisone alters sCysC in dogs without pre‐existing renal disease. Animals Forty six dogs were included: 10 dogs diagnosed with steroid responsive meningitis arteritis (SRMA; group A), 20 dogs diagnosed of pituitary‐dependent hyperadrenocorticism (PDH; group B), and 16 healthy control dogs (group C). Methods Retrospective observational study. SRMA diagnosed dogs were administered prednisone 4 mg/kg/24 h PO 7 days, reducing the dose to 2 mg/kg/24 h 7 days before medication withdrawal. In group A, sampling was performed at days 0, 7, 14 and a final control at day 21. Blood and urine samples were collected in the 3 groups, and in group A, sampling was performed at all time points (days 1, 7, 14, and 21). Results In group A, sCysC was significantly higher at day 7 compared to the control group (0.4 ± 0.04 mg/L vs. 0.18 ± 0.03 mg/L mean ± SEM respectively P < 0.01); sCysC values decreased to basal at day 14 when the dose was decreased and after 1 week of withdrawal of prednisone (0.27 ± 0.03 mg/L for group A at day 14 and 0.15 ± 0.02 mg/L at day 21; P > 0.05). Dogs with PDH included in group B did not have significant differences in sCysC (0.22 ± 0.03 mg/L) compared to control (P > 0.05). Conclusions and Clinical Importance Oral administration of prednisone unlike altered endogenous glucocorticoid production, increases sCysC in dogs in a dose‐dependent fashion.
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Affiliation(s)
- J Muñoz
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - P Soblechero
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - F J Duque
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - B Macías-García
- Assisted Reproduction Unit, Minimally Invasive Surgery Centre JesúsUsón, Cáceres, Spain
| | - P Ruiz
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - C Zaragoza
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - R Barrera
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
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9
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Pianta TJ, Pickering JW, Succar L, Chin M, Davidson T, Buckley NA, Mohamed F, Endre ZH. Dexamethasone Modifies Cystatin C-Based Diagnosis of Acute Kidney Injury During Cisplatin-Based Chemotherapy. Kidney Blood Press Res 2017; 42:62-75. [PMID: 28315878 DOI: 10.1159/000469715] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/21/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Plasma cystatin C (pCysC) may be superior to serum creatinine (sCr) as a surrogate of GFR. However, the performance of pCysC for diagnosing acute kidney injury (AKI) after cisplatin-based chemotherapy is potentially affected by accompanying corticosteroid anti-emetic therapy and hydration. METHODS In a prospective observational study pCysC, sCr, urinary kidney injury molecule-1 (KIM-1), and urinary clusterin were measured over 2 weeks in 27 patients given first-cycle chemotherapy. The same variables were measured over 2 weeks in Sprague-Dawley rats given a single intraperitoneal injection of dexamethasone, cisplatin, or both, and in controls. RESULTS In patients, pCysC increases were greater than sCr 41% vs. 16%, mean paired difference 25% (95% CI: 16-34%)], relative increases were ≥ 50% in 9 patients (35%) for pCysC compared with 2 (8%) for sCr (p = 0.04) and increases in sCr were accompanied by increased KIM-1 and clusterin excretion, but increases in pCysC alone were not. In rats, dexamethasone administration produced dose-dependent increases in pCysC (and augmented cisplatin-induced increases in pCysC), but did not augment histological injury, increases in sCr, or KIM-1 and clusterin excretion. CONCLUSIONS In the presence of dexamethasone, elevation of pCysC does not reliably diagnose AKI after cisplatin-based chemotherapy.
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Affiliation(s)
- Timothy J Pianta
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Northern Clinical School, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Lena Succar
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Melvin Chin
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia
| | - Trent Davidson
- Anatomical Pathology, SEALS, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Nicholas A Buckley
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Clinical Pharmacology, University of Sydney, Sydney, New South Wales, Australia
| | - Fahim Mohamed
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Clinical Pharmacology, University of Sydney, Sydney, New South Wales, Australia
| | - Zoltan H Endre
- Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Medicine, University of Otago, Christchurch, New Zealand
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10
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Renal dysfunction can be a common complication in patients with myotonic dystrophy 1. J Neurol Sci 2016; 368:266-71. [PMID: 27538647 DOI: 10.1016/j.jns.2016.07.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/20/2016] [Accepted: 07/13/2016] [Indexed: 12/14/2022]
Abstract
Although renal failure can be a life-threatening complication even in neuromuscular disorders (NMDs), renal dysfunction is easily overlooked because muscle atrophy decreases the serum creatinine level. Renal function was retrospectively assessed using cystatin C (CysC) in various NMDs to clarify the differences among diseases. As is in the general population, age was correlated to CysC, and female patients showed lower CysC levels. Although elevated CysC was frequent in myotonic dystrophy 1 (DM1: MIM 160900) and motor neuron disorders, an inter-disease comparison by sex adjusted for age showed that only DM1 had a higher CysC compared to other diseases. Multivariate linear regression with the stepwise method also suggested that the number of CTG repeats had an impact on CysC levels. In two autopsy DM1 cases, nephrosclerotic changes were observed even though they were in their forties. These facts suggested a disease-specific pathomechanism for renal dysfunction in DM1. Although further study is required, renal function should be carefully monitored in patients with DM1.
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11
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Serum cystatin C and microalbuminuria in children with immune thrombocytopenia under short course of corticosteroids. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2015. [DOI: 10.1016/j.epag.2015.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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12
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Cystatin C in acute kidney injury diagnosis: early biomarker or alternative to serum creatinine? Pediatr Nephrol 2015; 30:665-76. [PMID: 25475610 PMCID: PMC4372053 DOI: 10.1007/s00467-014-2987-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 09/29/2014] [Accepted: 10/06/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Early acute kidney injury (AKI) diagnosis is needed to pursue treatment trials. We evaluated cystatin C (CysC) as an early biomarker of serum creatinine (SCr)-AKI and an alternative to define AKI. METHODS We studied 160 non-cardiac children in the intensive care unit (ICU). We measured daily CysC and SCr. AKI was staged by KDIGO (Kidney Disease: Improving Global Outcomes) guidelines using SCr and CysC (CysC-AKI). We calculated area under the curve (AUC) for (1) neutrophil gelatinase-associated lipocalin (NGAL), interleukin-18 (IL-18), kidney injury molecule-1 (KIM-1) and urine CysC to diagnose SCr- and CysC-AKI; and (2) for CysC to diagnose SCr-AKI. We evaluated AKI associations with length of stay and ventilation duration. RESULTS We found that 44 % of patients developed SCr-AKI; 32 % developed CysC-AKI. Early ICU NGAL was most diagnostic of CysC-AKI (AUC 0.69, 95% CI 0.54-0.84); IL-18 was most diagnostic for SCr-AKI (AUC 0.69 95% CI 0.55-0.82). Combining SCr and CysC-AKI definition led to higher biomarker diagnostic AUC's. CysC-AKI was not more strongly associated with clinical outcomes. Early ICU CysC predicted SCr-AKI development (AUC 0.70, 95 % CI 0.53-0.89). CONCLUSIONS Our findings do not support replacing SCr by CysC to define AKI. Early ICU CysC predicts SCr-AKI development and combined SCr-CysC-AKI definition leads to stronger AKI biomarker associations.
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13
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Beta-2 microglobulin-based equation for estimating glomerular filtration rates in Japanese children and adolescents. Clin Exp Nephrol 2014; 19:450-7. [DOI: 10.1007/s10157-014-1015-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022]
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14
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Factors other than the glomerular filtration rate that determine the serum beta-2-microglobulin level. PLoS One 2013; 8:e72073. [PMID: 23991042 PMCID: PMC3750024 DOI: 10.1371/journal.pone.0072073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Accepted: 07/09/2013] [Indexed: 11/22/2022] Open
Abstract
Background β2-microglobulin has been increasingly investigated as a diagnostic marker of kidney function and a prognostic marker of adverse outcomes. To date, non-renal determinants of β2-microglobulin levels have not been well described. Non-renal determinants are important for the interpretation and appraisal of the diagnostic and prognostic value of any endogenous kidney function marker. Methods This cross-sectional analysis was performed within the framework of the www.seniorlabor.ch study, which includes subjectively healthy individuals aged ≥60 years. Factors known or suspected to have a non-renal association with kidney function markers were investigated for a non-renal association with serum β2-microglobulin. As a marker of kidney function, the Berlin Initiative Study equation 2 for the estimation of the estimated glomerular filtration rate (eGFRBIS2) in the elderly was employed. Results A total of 1302 participants (714 females and 588 males) were enrolled in the study. The use of a multivariate regression model adjusting for age, gender and kidney function (eGFRBIS2) revealed age, male gender, and C-reactive protein level to be positively associated with β2-microglobulin levels. In addition, there was an inverse non-renal relationship between systolic blood pressure, total cholesterol and current smoking status. No association with markers of diabetes mellitus, body stature, nutritional risk, thyroid function or calcium and phosphate levels was observed. Conclusions Serum β2-microglobulin levels in elderly subjects are related to several non-renal factors. These non-renal factors are not congruent to those known from other markers (i.e. cystatin C and creatinine) and remind of classical cardiovascular risk factors.
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Abstract
BACKGROUND Acute kidney injury (AKI) is a common and serious problem in critically ill patients. Tests currently used to detect AKI (i.e., serum creatinine, serum urea and various urinary indices) often result in serious delays in detection of clinically relevant injury. This delayed detection translates into a potential missed opportunity for therapeutic interventions at a time when kidney damage may be limitable or reversible. This is also recognized as a potential reason for the poor clinical outcomes often associated with AKI. OBJECTIVES To appraise the recent literature characterizing several novel serum and urinary biomarkers, including neutrophil gelatinase-associated lipocalin, IL-18 and kidney injury molecule-1, which are capable of detecting AKI at an earlier phase of injury. Also to discuss the pitfalls of current conventional testing in kidney injury. METHOD Narrative literature review. CONCLUSIONS These novel biomarkers can detect injury when damage may still be reversible, allow for early risk stratification and/or prognostication, and are associated in early clinical studies with important outcomes such as severity of AKI, need for renal replacement therapy and survival. There is optimism that these novel biomarkers will discriminate the underlying pathophysiology of AKI (i.e., ischemia, sepsis, toxins or multifactorial), discriminate AKI from other renal disease (i.e., chronic kidney disease) and aid in localizing the site of acute injury in the kidney. As such, the future may entail development of an 'AKI biomarker panel' (i.e., analogous to a cardiac or liver enzyme panel) for use in clinical practice.
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Affiliation(s)
- Sean M Bagshaw
- University of Alberta Hospital, 3C1.12 Walter C. Mackenzie Centre, Division of Critical Care Medicine, 8440-112 Street, Edmonton, Alberta, T6G2B7, Canada +1 780 407 6755 ; +1 780 407 1228 ;
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de Geus HRH, Betjes MG, Bakker J. Biomarkers for the prediction of acute kidney injury: a narrative review on current status and future challenges. Clin Kidney J 2012; 5:102-108. [PMID: 22833807 PMCID: PMC3341843 DOI: 10.1093/ckj/sfs008] [Citation(s) in RCA: 128] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2011] [Accepted: 01/11/2012] [Indexed: 12/25/2022] Open
Abstract
Acute kidney injury (AKI) is strongly associated with increased morbidity and mortality in critically ill patients. Efforts to change its clinical course have failed because clinically available therapeutic measures are currently lacking, and early detection is impossible with serum creatinine (SCr). The demand for earlier markers has prompted the discovery of several candidates to serve this purpose. In this paper, we review available biomarker studies on the early predictive performance in developing AKI in adult critically ill patients. We make an effort to present the results from the perspective of possible clinical utility.
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Affiliation(s)
- Hilde R H de Geus
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
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Cruz DN, de Geus HR, Bagshaw SM. Biomarker strategies to predict need for renal replacement therapy in acute kidney injury. Semin Dial 2011; 24:124-31. [PMID: 21517976 DOI: 10.1111/j.1525-139x.2011.00830.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The early detection and diagnosis of acute kidney injury (AKI) with the standardization of novel kidney-injury-specific biomarkers is one of the highest research priorities in nephrology. Accordingly, the majority of studies of novel AKI biomarkers have focused on the early diagnosis of AKI using serum creatinine-based definitions as the gold standard. However, another potential application of kidney-injury-specific biomarkers is for guiding decisions on when to initiate renal replacement therapy (RRT). The purpose of this review is to summarize recent findings concerning some of the more promising AKI biomarkers on their capacity, either alone or integrated with traditional surrogate measures of kidney injury, for early prediction of whether patients will develop severe AKI requiring RRT. Some studies that have examined neutrophil gelatinase-associated lipocalin, cystatin-C, N-acetyl-β-d-glucosaminidase, kidney injury molecule-1, and α(1)-microglobulin, among others, have suggested that these novel biomarkers have the potential to distinguish patients in whom RRT will be needed. This would imply that these biomarkers may be integrated into clinical decision algorithms and could synergistically improve our current ability to predict worsening AKI and need for RRT. However, published studies have many recognized limitations, which preclude our ability to adapt their findings into clinical practice today. While currently available data are not sufficient to conclude that biomarkers should be used routinely for clinical decision making for RRT initiation, additional data may in the future significantly modify the clinical variability for initiation of RRT, and potentially translate into improved outcomes and cost-effectiveness. Finally, we propose a potential approach to future biomarker strategies for RRT initiation, integrating these biomarkers with "traditional" clinical factors.
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Affiliation(s)
- Dinna N Cruz
- Department of Nephrology Dialysis & Transplantation, San Bortolo Hospital, Vicenza, Italy.
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Gabriel IC, Nishida SK, Kirsztajn GM. [Serum cystatin C: a practical alternative for renal function evaluation?]. ACTA ACUST UNITED AC 2011; 33:261-7. [PMID: 21789445 DOI: 10.1590/s0101-28002011000200023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 02/14/2011] [Indexed: 11/21/2022]
Abstract
Glomerular filtration rate is the main marker of renal function in healthy individuals and patients. Despite incontestable advances in medicine, it is still difficult to define precisely this test in clinical practice. Early markers of renal lesion are important, because glomerular filtration rate usually decreases before the first chronic renal failure symptoms or signs appear. Cystatin C has been pointed as an alternative, but it was not tested in many diseases. Advantages and disadvantages of this marker are discussed. Although serum cystatin C determination is increasingly being used in clinical practice worldwide, its limitations as well as the conditions its use is in fact indicated are not adequately established; on the other hand serum creatinine (and creatinine clearance) is an easily available and low cost laboratory marker with well-known limitations that can be used routinely in the assessment of renal function.
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Keyes R, Bagshaw SM. Early diagnosis of acute kidney injury in critically ill patients. Expert Rev Mol Diagn 2008; 8:455-64. [PMID: 18598227 DOI: 10.1586/14737159.8.4.455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Acute kidney injury (AKI) is a common and serious problem in critically ill patients. Tests currently used to detect AKI (i.e., serum creatinine, serum urea and various urinary indices) often result in delayed detection of injury--becoming abnormal at 48-72 h after the initial insult. This delayed detection translates into a potential missed opportunity for therapeutic interventions at a time when kidney damage may be limitable or reversible. This may also, in particular, account for the poor clinical outcomes commonly associated with AKI. The development of novel serum and urinary biomarkers capable of detecting AKI at an earlier phase of illness is therefore vital. This article will review the pitfalls of current conventional testing in kidney injury and discuss the emergence of novel biomarkers with the potential to revolutionize the field of critical care nephrology.
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Affiliation(s)
- Robert Keyes
- Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Acute kidney injury remains a serious clinical problem for intensive care unit patients, and its incidence is rising. The detection and diagnosis of acute kidney injury in the intensive care unit currently require use of conventional markers of kidney function, specifically, serum creatinine and urea levels and, less frequently, other urinary tests. These conventional markers are familiar to clinicians and have long been used at the bedside. However, these markers are clearly not ideal, each has limitations, and none reflect real-time changes in glomerular filtration rate or a genuine acute injurious process to the kidney. More importantly, these conventional markers can contribute to delays in recognition of acute kidney injury and, hence, delays to appropriate supportive and therapeutic interventions. The early detection and diagnosis of acute kidney injury should be a clinical priority. A diagnostic test or panel of tests that are capable of evaluating aspects both of kidney function and acute injury are desperately needed in critical care nephrology. Cystatin C has been shown superior to conventional markers and may assume a greater role in intensive care unit patients for detecting both early changes in glomerular filtration rate and evidence of acute injury. Other newly characterized markers of kidney function or acute injury have the potential to revolutionized the field of critical care nephrology and greatly improve the supportive and therapeutic management of intensive care unit patients with acute kidney injury.
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Pichler J, Risch L, Hefti U, Merz TM, Turk AJ, Bloch KE, Maggiorini M, Hess T, Barthelmes D, Schoch OD, Risch G, Huber AR. Glomerular filtration rate estimates decrease during high altitude expedition but increase with Lake Louise acute mountain sickness scores. Acta Physiol (Oxf) 2008; 192:443-50. [PMID: 17970827 DOI: 10.1111/j.1748-1716.2007.01758.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Acute mountain sickness (AMS) can result in pulmonary and cerebral oedema with overperfusion of microvascular beds, elevated hydrostatic capillary pressure, capillary leakage and consequent oedema as pathogenetic mechanisms. Data on changes in glomerular filtration rate (GFR) at altitudes above 5000 m are very limited. METHODS Thirty-four healthy mountaineers, who were randomized to two acclimatization protocols, undertook an expedition on Muztagh Ata Mountain (7549 m) in China. Tests were performed at five altitudes: Zurich pre-expedition (PE, 450 m), base camp (BC, 4497 m), Camp 1 (C1, 5533 m), Camp 2 (C2, 6265 m) and Camp 3 (C3, 6865 m). Cystatin C- and creatinine-based (Mayo Clinic quadratic equation) GFR estimates (eGFR) were assessed together with Lake Louise AMS score and other tests. RESULTS eGFR significantly decreased from PE to BC (P < 0.01). However, when analysing at changes between BC and C3, only cystatin C-based estimates indicated a significant decrease in GFR (P = 0.02). There was a linear decrease in eGFR from PE to C3, with a decrease of approx. 3.1 mL min(-1) 1.73 m(-2) per 1000 m increase in altitude. No differences between eGFR of the two groups with different acclimatization protocols could be observed. There was a significant association between eGFR and haematocrit (P = 0.01), whereas no significant association between eGFR and aldosterone, renin and brain natriuretic peptide could be observed. Finally, higher AMS scores were significantly associated with higher eGFR (P = 0.01). CONCLUSIONS Renal function declines when ascending from low to high altitude. Cystatin C-based eGFR decreases during ascent in high altitude expedition but increases with AMS scores. For individuals with eGFR <40 mL min(-1) 1.73 m(-2), caution may be necessary when planning trips to high altitude above 4500 m above sea level.
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Affiliation(s)
- J Pichler
- Center of Laboratory Medicine, Kantonsspital, Aarau, Switzerland
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Abbink FCH, Laarman CARC, Braam KI, van Wijk JAE, Kors WA, Bouman AA, Spreeuwenberg MD, Stoffel-Wagner B, Bökenkamp A. Beta-trace protein is not superior to cystatin C for the estimation of GFR in patients receiving corticosteroids. Clin Biochem 2007; 41:299-305. [PMID: 18082138 DOI: 10.1016/j.clinbiochem.2007.11.012] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Revised: 11/15/2007] [Accepted: 11/17/2007] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Comparison of the effect of corticosteroid therapy on the diagnostic performance of cystatin C (Cys) and beta-trace protein (bTP), two endogenous markers of GFR. DESIGN AND METHODS Out of a total of 193 pediatric inulin clearance studies, a random sample of 85 steroid-free studies served to establish GFR prediction equations (eGFR), which were used to compare the remaining 76 steroid-free and 32 steroid-positive studies (median prednisone dose 33.0 mg m(-2) day(-1)). RESULTS We found a positive relationship between prednisone dose and eGFR(betaTP) (b=0.414, p=0.0002) and a negative relationship with eGFR(cys) (b=-0.208, p=0.0091). Only Cys independently predicted GFR below 90 mL min(-1) 1.73 m(-2), both in steroid-positives (b=6.260, p=0.010) and steroid-negatives (b=6.845, p=0.012). Glucocorticoid therapy did not affect the accuracy in estimating GFR within 30% of measured GFR for Cys, while accuracy was lower with bTP (65.6% vs. 81.6%, p=0.08). CONCLUSION Glucocorticoids have less impact on the diagnostic accuracy of Cys than bTP.
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Affiliation(s)
- Floor C H Abbink
- Department of Pediatrics, Vrije Universiteit Medical Center, De Boelelaan 1117, NL-1081 HV, Amsterdam, The Netherlands
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Zhu J, Yin R, Wu H, Yi J, Luo L, Dong G, Jing H. Cystatin C as a reliable marker of renal function following heart valve replacement surgery with cardiopulmonary bypass. Clin Chim Acta 2006; 374:116-21. [PMID: 16876777 DOI: 10.1016/j.cca.2006.06.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Revised: 04/04/2006] [Accepted: 06/02/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Little is known about serum cystatin C as a marker of renal function in cardiac surgery patients. The aim of this study was to assess its utility post cardiopulmonary bypass (CPB). METHODS 60 heart valve replacement patients were enrolled, and 26 of them had low-dose corticosteroid treatment on the first 3 days postoperatively. Serum creatinine, serum cystatin C and 24-h creatinine clearance rate (CCR) adjusted by body surface area were determined preoperation, days 1, 2, 3, 7 post operation. RESULTS Serum creatinine increased and peaked at day 3 postoperatively, while cystatin C peaked at day 2, and the adjusted CCR also reached a minimum at day 2. The inverse of cystatin C correlated better with CCR than that of creatinine (r=0.751 vs. 0.629). Using adjusted CCR as "golden standard", cystatin C was superior to creatinine in diagnosing renal dysfunction (area under the curve [AUC] for cystatin C 0.876, 95% confidence interval 81.8-93.4; AUC for creatinine 0.801, 95% confidence interval 72.5-87.7; p=0.045). Low-dose corticosteroid treatment has no significant effect on cystatin C. CONCLUSION In agreement with many other investigators, the present findings support cystatin C is a reliable marker of renal function. It is superior to creatinine in patients post CPB.
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Affiliation(s)
- Jiaquan Zhu
- Department of Cardiothoracic Surgery, Jinling Hospital, Clinical Medicine School of Nanjing University, Nanjing 210002, China.
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Huber AR, Risch L. Recent Developments in the Evaluation of Glomerular Filtration Rate: Is There a Place for β-Trace? Clin Chem 2005; 51:1329-30. [PMID: 16040837 DOI: 10.1373/clinchem.2005.053389] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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