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Morishita T, Nishizaki N, Taniguchi S, Sakai S, Kimura T, Mita M, Nakagawa M, Endo A, Ohtomo Y, Yasui M, Shimizu T, Sasabe J. Plasma D-asparagine and the D/L-serine ratio reflect chronic kidney diseases in children regardless of physique. Amino Acids 2024; 56:38. [PMID: 38844708 PMCID: PMC11156734 DOI: 10.1007/s00726-024-03400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/29/2024] [Indexed: 06/09/2024]
Abstract
Biomarkers that accurately reflect renal function are essential in management of chronic kidney diseases (CKD). However, in children, age/physique and medication often alter established renal biomarkers. We studied whether amino acid enantiomers in body fluids correlate with renal function and whether they are influenced by physique or steroid medication during development. We conducted a prospective study of children 2 to 18 years old with and without CKD. We analyzed associations of serine/asparagine enantiomers in body fluids with major biochemical parameters as well as physique. To study consequences of kidney dysfunction and steroids on serine/asparagine enantiomers, we generated juvenile mice with uninephrectomy, ischemic reperfusion injury, or dexamethasone treatment. We obtained samples from 27 children, of which 12 had CKD due to congenital (n = 7) and perinatal (n = 5) causes. Plasma D-asparagine and the D/L-serine ratio had robust, positive linear associations with serum creatinine and cystatin C, and detected CKD with high sensitivity and specificity, uninfluenced by body size or biochemical parameters. In the animal study, kidney dysfunction increased plasma D-asparagine and the D/L-serine ratio, but dexamethasone treatment did not. Thus, plasma D-asparagine and the D/L-serine ratio can be useful markers for renal function in children.
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Affiliation(s)
- Toshimasa Morishita
- Department of Pharmacology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Naoto Nishizaki
- Department of Pediatrics, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Sakiko Taniguchi
- Department of Pharmacology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shinsuke Sakai
- Department of Nephrology, Osaka University School of Medicine, Osaka, Japan
| | - Tomonori Kimura
- Department of Nephrology, Osaka University School of Medicine, Osaka, Japan
| | | | - Mayu Nakagawa
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Amane Endo
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yoshiyuki Ohtomo
- Department of Pediatrics, Juntendo University Nerima Hospital, Tokyo, Japan
| | - Masato Yasui
- Department of Pharmacology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Toshiaki Shimizu
- Department of Pediatrics and Adolescent Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jumpei Sasabe
- Department of Pharmacology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
- Human Biology-Microbiome-Quantum Research Center (WPI-Bio2Q), Keio University, Tokyo, Japan.
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2
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Garrett ME, Foster MW, Telen MJ, Ashley-Koch AE. Nontargeted Plasma Proteomic Analysis of Renal Disease and Pulmonary Hypertension in Patients with Sickle Cell Disease. J Proteome Res 2024; 23:1039-1048. [PMID: 38353026 DOI: 10.1021/acs.jproteome.3c00748] [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] [Indexed: 03/02/2024]
Abstract
Sickle cell disease (SCD) is characterized by red blood cell sickling, vaso-occlusion, hemolytic anemia, damage to multiple organ systems, and, as a result, shortened life expectancy. Sickle cell disease nephropathy (SCDN) and pulmonary hypertension (pHTN) are common and frequently co-occurring complications of SCD; both are associated with markedly accelerated mortality. To identify candidate circulating biomarkers of SCDN and pHTN, we used mass spectrometry to quantify the relative abundance of >1000 proteins in plasma samples from 189 adults with SCD from the Outcome Modifying Genes in SCD (OMG-SCD) cohort (ProteomeXchange identifier PXD048716). Forty-four proteins were differentially abundant in SCDN, most significantly cystatin-C and collagen α-1(XVIII) chain (COIA1), and 55 proteins were dysregulated in patients with SCDN and pHTN, most significantly insulin-like growth factor-binding protein 6 (IBP6). Network analysis identified a module of 133 coregulated proteins significantly associated with SCDN, that was enriched for extracellular matrix proteins, insulin-like growth factor binding proteins, cell adhesion proteins, EGF-like calcium binding proteins, and several cadherin family members. Collectively, these data provide a comprehensive understanding of plasma protein changes in SCDN and pHTN which validate numerous studies of chronic kidney disease and suggest shared profiles of protein disruption in kidney dysfunction and pHTN among SCD patients.
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Affiliation(s)
- Melanie E Garrett
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina 27701, United States
| | - Matthew W Foster
- Department of Medicine, Division of Pulmonary, Allergy and Critical Care, Duke University Medical Center, Durham, North Carolina 27701, United States
- Duke Proteomics and Metabolomics Core Facility, Duke University School of Medicine, Durham, North Carolina 27701, United States
| | - Marilyn J Telen
- Department of Medicine, Division of Hematology and Duke Comprehensive Sickle Cell Center, Duke University Medical Center, Durham, North Carolina 27701, United States
| | - Allison E Ashley-Koch
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, North Carolina 27701, United States
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3
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Cooper KM, Colletta A, Moulton K, Ralto KM, Devuni D. Kidney disease in patients with chronic liver disease: Does sex matter? World J Clin Cases 2023; 11:3980-3992. [PMID: 37388789 PMCID: PMC10303604 DOI: 10.12998/wjcc.v11.i17.3980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/30/2023] [Accepted: 05/16/2023] [Indexed: 06/12/2023] Open
Abstract
Kidney disease in patients with liver disease is serious and increases mortality. Up to 50% of patients hospitalized experience an episode of acute kidney injury. In general, men with liver disease are thought to be at increased risk of kidney disease. However, this association should be considered with caution because most studies use creatinine-based inclusion criteria, which is negatively biased against women. In this review, we synthesize data on sex differences in kidney disease in patients with chronic liver disease in the clinical setting and discuss potential physiologic underpinnings.
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Affiliation(s)
- Katherine M Cooper
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01665, United States
| | - Alessandro Colletta
- Department of Medicine, UMass Chan Medical School, Worcester, MA 01665, United States
| | - Kristen Moulton
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01665, United States
| | - Kenneth M Ralto
- Department of Medicine, Division of Renal Medicine, UMass Chan Medical School, Worcester, MA 01665, United States
| | - Deepika Devuni
- Department of Medicine, Division of Gastroenterology, UMass Chan Medical School, Worcester, MA 01665, United States
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Hu J, Li Y, Zhang X, Wang Y, Zhang J, Yan J, Li J, Zhang Z, Yin H, Wei Q, Jiang Q, Wei S, Zhang Q. Ultrasensitive Silicon Nanowire Biosensor with Modulated Threshold Voltages and Ultra-Small Diameter for Early Kidney Failure Biomarker Cystatin C. BIOSENSORS 2023; 13:645. [PMID: 37367010 DOI: 10.3390/bios13060645] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/01/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023]
Abstract
Acute kidney injury (AKI) is a frequently occurring severe disease with high mortality. Cystatin C (Cys-C), as a biomarker of early kidney failure, can be used to detect and prevent acute renal injury. In this paper, a biosensor based on a silicon nanowire field-effect transistor (SiNW FET) was studied for the quantitative detection of Cys-C. Based on the spacer image transfer (SIT) processes and channel doping optimization for higher sensitivity, a wafer-scale, highly controllable SiNW FET was designed and fabricated with a 13.5 nm SiNW. In order to improve the specificity, Cys-C antibodies were modified on the oxide layer of the SiNW surface by oxygen plasma treatment and silanization. Furthermore, a polydimethylsiloxane (PDMS) microchannel was involved in improving the effectiveness and stability of detection. The experimental results show that the SiNW FET sensors realize the lower limit of detection (LOD) of 0.25 ag/mL and have a good linear correlation in the range of Cys-C concentration from 1 ag/mL to 10 pg/mL, exhibiting its great potential in the future real-time application.
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Affiliation(s)
- Jiawei Hu
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
| | - Yinglu Li
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
| | - Xufang Zhang
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Yanrong Wang
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Jing Zhang
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Jiang Yan
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Junjie Li
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
| | - Zhaohao Zhang
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
| | - Huaxiang Yin
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
| | - Qianhui Wei
- State Key Laboratory of Advanced Materials for Smart Sensing, General Research Institute for Nonferrous Metals, Beijing 101402, China
| | - Qifeng Jiang
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Shuhua Wei
- School of Information Science and Technology, North China University of Technology, Beijing 100144, China
| | - Qingzhu Zhang
- Advanced Integrated Circuits R&D Center, Institute of Microelectronic of the Chinese Academy of Sciences, Beijing 100029, China
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Chen S, Du K, Wang S, Liang C, Shang Y, Xie X, Tang G, Li J, Wang B, Yu XA, Chang Y. A Non-Immunized and BSA-Template Aggregation-Induced Emission Sensor for Noninvasive Detection of Cystatin C in the Clinical Diagnosis of Diabetes Nephropathy. ACS Sens 2023; 8:1431-1439. [PMID: 36877474 DOI: 10.1021/acssensors.2c02122] [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: 03/07/2023]
Abstract
Diabetes nephropathy (DN) is one of the main causes of death in patients with diabetes. Cystatin C (Cys C) is a reliable indicator of glomerular filtration function. Therefore, it is urgent and meaningful to obtain early warning of DN by noninvasive measurement of Cys C. In this investigation, a novel fluorescence sensor (BSA-AIEgen sensor) was synthesized by cross-linking the aggregation-induced emission (AIE) characteristics of 2-(4-bromophenyl)-3-(4-(4-(diphenylamino) styryl) phenyl) fumaronitrile (TPABDFN) and bovine serum albumin (BSA), which exhibited the "On" state owing to the restriction of the intramolecular motions (RIM) phenomenon of TPABDFN. Intriguingly, a decrease in fluorescence of BSA-AIEgen sensors could be found owing to BSA on the surface of BSA-AIEgen sensor hydrolyzed by papain, but a reverse phenomenon emerged with the increase of Cys C content as the inhibitor of papain. Hence, Cys C was successfully detected by employing the fluorescent differential display and the linear range was from 12.5 ng/mL to 800 ng/mL (R2 = 0.994) with the limit of detection (LOD) of 7.10 ng/mL (S/N = 3). Further, the developed BSA-AIEgen sensor successfully differentiates patients with diabetes nephropathy from volunteers with the advantages of high specificity, low cost, and simple operation. Accordingly, it is expected to become a non-immunized method to monitor Cys C for the early warning, noninvasive diagnosis, and drug efficacy evaluation of diabetes nephropathy.
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Affiliation(s)
- Shujing Chen
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Kunze Du
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Shuangqi Wang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Chunxiao Liang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Ye Shang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Xiaoyuan Xie
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Ge Tang
- First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, 300193, China
| | - Jin Li
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
| | - Bing Wang
- NMPA Key Laboratory for Bioequivalence Research of Generic Drug Evaluation, Shenzhen Institute for Drug Control, Shenzhen, 518057, China
| | - Xie-An Yu
- NMPA Key Laboratory for Bioequivalence Research of Generic Drug Evaluation, Shenzhen Institute for Drug Control, Shenzhen, 518057, China
| | - Yanxu Chang
- State Key Laboratory of Component-based Chinese Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, 301617, China.,Haihe Laboratory of Modern Chinese Medicine, Tianjin 301617, China
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6
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MERT H, DURGAÇ M, ÖZCAN N, MİS L, MERT N. Hemodializ Hastalarında Sistatin C Düzeyleri, Oksidan-Antioksidan ve İnflamasyon Durumu. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2022. [DOI: 10.30934/kusbed.1056643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective: Cystatin C is considered an important marker for the detection of renal dysfunction. It was aimed to determine cystatin C levels, status of oxidant-antioxidant and inflammation in hemodialysis (HD) patients.
Methods: The study groups consisted of 20 HD patients and 20 healthy controls. Blood samples were obtained from the control group and from the HD group before hemodialysis. Serum cystatin C, total antioxidant capacity (TAC), total oxidative state (TOS), tumor necrosis factor-alpha (TNF-α), interleukin 6 (IL-6) interleukin 18 (IL-18) levels were detected by Enzyme Linked Immunosorbent Assay (ELISA), C-reactive protein (CRP) and some biochemical parameters were analyzed by autoanalyser.
Results: Cystatin C, TOS, TNF-α, IL-6, IL-18 and CRP levels of the HD group were significantly higher than the control group.
Conclusion: As a result; oxidative stress and inflammation were increased in patients with chronic renal failure undergoing hemodialysis. New strategies and new studies are needed to reduce the increase in oxidative stress and inflammation in HD patients.
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7
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Raina R, Sethi SK, Dragon-Durey MA, Khooblall A, Sharma D, Khandelwal P, Shapiro R, Boyer O, Yap HK, Bagga A, Licht C. Systematic review of atypical hemolytic uremic syndrome biomarkers. Pediatr Nephrol 2022; 37:1479-1493. [PMID: 35118546 DOI: 10.1007/s00467-022-05451-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND OBJECTIVES Observing biomarkers that affect alternative pathway dysregulation components may be effective in obtaining a new and more rapid diagnostic portrayal of atypical hemolytic uremic syndrome. We have conducted a systematic review on the aHUS biomarkers: C3, C5a, C5b-9, factor B, complement factor B, H, and I, CH50, AH50, D-dimer, as well as anti-CFH antibodies. METHODS An exhaustive literature search was conducted for aHUS patient population plasma/serum, collected/reported at the onset of diagnosis. A total of 60 studies were included with the data on 837 aHUS subjects, with at least one biomarker reported. RESULTS The biomarkers C3 [mean (SD): 72.1 (35.0), median: 70.5 vs. reference range: 75-175 mg/dl, n = 752]; CH50 [28.3 (32.1), 24.3 vs. 30-75 U/ml, n = 63]; AH50 [27.6% (30.2%), 10% vs. ≥ 46%, n = 23]; and CFB [13.1 (6.6), 12.4, vs. 15.2-42.3 mg/dl, n = 19] were lower among aHUS subjects as compared with the reference range. The biomarkers including C4 [mean (SD): 20.4 (9.5), median: 20.5 vs. reference range: 14-40 mg/dl, n = 343]; C4d [7.2 (6.5), 4.8 vs. ≤ 9.8 μg/ml, n = 108]; CFH [40.2 (132.3), 24.5 vs. 23.6-43.1 mg/dl, n = 123 subjects]; and CFI [8.05 (5.01), 6.55 mg/dl vs. 4.4-18.1 mg/dl, n = 38] were all observed to be within the reference range among aHUS subjects. The biomarkers C5a [mean (SD): 54.9 (32.9), median: 48.8 vs. reference range: 10.6-26.3 mg/dl, n = 117]; C5b-9 [466.0 (401.4), 317 (186-569.7) vs. ≤ 250 ng/ml, n = 174]; Bb [2.6 (2.1), 1.9 vs. ≤ 1.6 μg/ml, n = 77] and D-dimer [246 (65.05), 246 vs. < 2.2 ng/ml, 2, n = 2 subjects] were higher among patients with aHUS compared with the reference range. CONCLUSION If a comprehensive complement profile were built using our data, aHUS would be identified by low levels of C3, CH50, AH50, and CFB along with increased levels of C5a, C5b-9, Bb, anti-CFH autoantibodies, and D-dimer. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Affiliation(s)
- Rupesh Raina
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA. .,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA.
| | - Sidharth K Sethi
- Kidney and Renal Transplant Institute, Medanta, The Medicity Hospital, Gurgaon, Haryana, India
| | | | - Amrit Khooblall
- Akron Nephrology Associates/Cleveland Clinic Akron General Medical Center, Akron, OH, USA.,Department of Nephrology, Akron Children's Hospital, Akron, OH, USA
| | - Divya Sharma
- Department of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Priyanka Khandelwal
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | | | - Olivia Boyer
- Service de Néphrologie Pédiatrique, AP-HP, Centre de Référence de maladies rénales rares de l'enfant et de l'adulte (MARHEA), Hôpital Necker - Enfants Malades, 149 Rue de Sèvres, 75015, Paris, France.,Institut Imagine, Laboratoire des maladies rénales héréditaires, INSERM UMR 1163, Université de Paris, Paris, France
| | - Hui Kim Yap
- Shaw-NKF-NUH Children's Kidney Centre, Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, Kent Ridge, Singapore.,Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Arvind Bagga
- Division of Nephrology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Christoph Licht
- Cell Biology Program, SickKids Research Institute, Toronto, ON, Canada.,Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Division of Nephrology, The Hospital for Sick Children, Toronto, ON, Canada
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8
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Liu L, Wang H, Ning J, Han J, Yu C, Guan Q. The Predictability of Cystatin C for Peripheral Arterial Disease in Chinese Population with Type 2 Diabetes Mellitus. J Diabetes Res 2022; 2022:5064264. [PMID: 35392484 PMCID: PMC8983175 DOI: 10.1155/2022/5064264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 02/06/2022] [Accepted: 03/11/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Peripheral artery disease (PAD) in diabetic populations is a vital chronic disease all over the world due to its high morbidity and mortality. It is important to find early simple screening biomarkers and find residual risk factors that may provide a new target for prevention and treatment of PAD in diabetic patients besides traditional cardiometabolic risk factors. METHODS We performed a cross-sectional retrospective study, and a total of 1671 T2DM participants were recruited. Receiver operating characteristic analysis, stepwise logistic regression analysis, points score system, and decision curve analysis were performed to assess the risk factors for PAD. RESULTS The prevalence of PAD in the study was 7.18% (n = 120). Compared to the participants with the lowest quartile of cystatin C (CysC), the risk of developing PAD in participants with the highest quartile of CysC increased 6.339-fold. The CysC was the superior indicators to distinguish participants with PAD from those without PAD, with an AUC of 0.716. Stepwise logistic regression analysis showed that CysC was independent risk factor for PAD besides traditional risk factors. Combined exposure to these traditional risk factors and CysC was associated with a stepwise increase in the risk of developing PAD and even increased 11.976-fold in participants with the highest quintiles of combined exposure score (CES) based on traditional risk factors and CysC compared to the participants with the lowest quintiles of CES. CONCLUSIONS CysC was associated with PAD independent of potential risk factors in diabetic populations. The CysC was a reliable marker for the early screening of PAD in diabetic patients besides traditional cardiometabolic risk factors.
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Affiliation(s)
- Luna Liu
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Hai Wang
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Jing Ning
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
| | - Junming Han
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Chunxiao Yu
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
| | - Qingbo Guan
- Department of Endocrinology, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250021, China
- Shandong Provincial Key Laboratory of Endocrinology and Lipid Metabolism, Institute of Endocrinology and Metabolism, Shandong Academy of Clinical Medicine, Jinan, Shandong 250021, China
- Department of Endocrinology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, China
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9
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Hayn M, Blötz A, Rodríguez A, Vidal S, Preising N, Ständker L, Wiese S, Stürzel CM, Harms M, Gross R, Jung C, Kiene M, Jacob T, Pöhlmann S, Forssmann WG, Münch J, Sparrer KMJ, Seuwen K, Hahn BH, Kirchhoff F. Natural cystatin C fragments inhibit GPR15-mediated HIV and SIV infection without interfering with GPR15L signaling. Proc Natl Acad Sci U S A 2021; 118:e2023776118. [PMID: 33431697 PMCID: PMC7826402 DOI: 10.1073/pnas.2023776118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
GPR15 is a G protein-coupled receptor (GPCR) proposed to play a role in mucosal immunity that also serves as a major entry cofactor for HIV-2 and simian immunodeficiency virus (SIV). To discover novel endogenous GPR15 ligands, we screened a hemofiltrate (HF)-derived peptide library for inhibitors of GPR15-mediated SIV infection. Our approach identified a C-terminal fragment of cystatin C (CysC95-146) that specifically inhibits GPR15-dependent HIV-1, HIV-2, and SIV infection. In contrast, GPR15L, the chemokine ligand of GPR15, failed to inhibit virus infection. We found that cystatin C fragments preventing GPR15-mediated viral entry do not interfere with GPR15L signaling and are generated by proteases activated at sites of inflammation. The antiretroviral activity of CysC95-146 was confirmed in primary CD4+ T cells and is conserved in simian hosts of SIV infection. Thus, we identified a potent endogenous inhibitor of GPR15-mediated HIV and SIV infection that does not interfere with the physiological function of this GPCR.
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Affiliation(s)
- Manuel Hayn
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Andrea Blötz
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Armando Rodríguez
- Core Facility Functional Peptidomics, Ulm University Medical Center, 89081 Ulm, Germany
- Core Unit Mass Spectrometry and Proteomics, Ulm University Medical Center, 89081 Ulm, Germany
- PHARIS Biotec GmbH, 30625 Hannover, Germany
| | - Solange Vidal
- Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Nico Preising
- Core Facility Functional Peptidomics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Ludger Ständker
- Core Facility Functional Peptidomics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Sebastian Wiese
- Core Unit Mass Spectrometry and Proteomics, Ulm University Medical Center, 89081 Ulm, Germany
| | - Christina M Stürzel
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Mirja Harms
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Rüdiger Gross
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | - Christoph Jung
- Institute of Electrochemistry, Ulm University, 89081 Ulm, Germany
| | - Miriam Kiene
- Infection Biology Unit, German Primate Center-Leibniz Institute for Primate Research, 37077 Göttingen, Germany
| | - Timo Jacob
- Institute of Electrochemistry, Ulm University, 89081 Ulm, Germany
| | - Stefan Pöhlmann
- Infection Biology Unit, German Primate Center-Leibniz Institute for Primate Research, 37077 Göttingen, Germany
- Faculty of Biology and Psychology, University Göttingen, 37073 Göttingen, Germany
| | | | - Jan Münch
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany
| | | | - Klaus Seuwen
- Novartis Institutes for Biomedical Research, 4056 Basel, Switzerland
| | - Beatrice H Hahn
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6076;
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-6076
| | - Frank Kirchhoff
- Institute of Molecular Virology, Ulm University Medical Center, 89081 Ulm, Germany;
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Wołyniec W, Ratkowski W, Renke J, Renke M. Changes in Novel AKI Biomarkers after Exercise. A Systematic Review. Int J Mol Sci 2020; 21:E5673. [PMID: 32784748 PMCID: PMC7461060 DOI: 10.3390/ijms21165673] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/26/2020] [Accepted: 08/04/2020] [Indexed: 12/13/2022] Open
Abstract
More than 100 substances have been identified as biomarkers of acute kidney injury. These markers can help to diagnose acute kidney injury (AKI) in its early phase, when the creatinine level is not increased. The two markers most frequently studied in plasma and serum are cystatin C and neutrophil gelatinase-associated lipocalin (NGAL). The former is a marker of kidney function and the latter is a marker of kidney damage. Some other promising serum markers, such as osteopontin and netrin-1, have also been proposed and studied. The list of promising urinary markers is much longer and includes cystatin C, NGAL, kidney injury molecule-1 (KIM-1), liver-type fatty-acid-binding protein (L-FABP), interleukin 18, insulin-like growth factor binding protein 7 (IGFBP-7), tissue inhibitor of metalloproteinases-2 (TIMP-2) and many others. Although these markers are increased in urine for no longer than a few hours after nephrotoxic agent action, they are not widely used in clinical practice. Only combined IGFBP-7/TIMP-2 measurement was approved in some countries as a marker of AKI. Several studies have shown that the levels of urinary AKI biomarkers are increased after physical exercise. This systematic review focuses on studies concerning changes in new AKI biomarkers in healthy adults after single exercise. Twenty-seven papers were identified and analyzed in this review. The interpretation of results from different studies was difficult because of the variety of study groups, designs and methodology. The most convincing data concern cystatin C. There is evidence that cystatin C is a better indicator of glomerular filtration rate (GFR) in athletes after exercise than creatinine and also at rest in athletes with a lean mass lower or higher than average. Serum and plasma NGAL are increased after prolonged exercise, but the level also depends on inflammation and hypoxia; therefore, it seems that in physical exercise, it is too sensitive for AKI diagnosis. It may, however, help to diagnose subclinical kidney injury, e.g., in rhabdomyolysis. Urinary biomarkers are increased after many types of exercise. Increases in NGAL, KIM-1, cystatin-C, L-FABP and interleukin 18 are common, but the levels of most urinary AKI biomarkers decrease rapidly after exercise. The importance of this short-term increase in AKI biomarkers after exercise is doubtful. It is not clear if it is a sign of mild kidney injury or physiological metabolic adaptation to exercise.
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Affiliation(s)
- Wojciech Wołyniec
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9b Powstania Styczniowego Street, 81-519 Gdynia, Poland;
| | - Wojciech Ratkowski
- Department of Athletics, Gdańsk University of Physical Education and Sport, 1 Górskiego Street, 80-336 Gdańsk, Poland;
| | - Joanna Renke
- Department of General and Medical Biochemistry, University of Gdansk, 59 Wita Stwosza Street, 80-308 Gdańsk, Poland;
| | - Marcin Renke
- Department of Occupational, Metabolic and Internal Diseases, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, 9b Powstania Styczniowego Street, 81-519 Gdynia, Poland;
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11
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Funamoto M, Shimizu K, Sunagawa Y, Katanasaka Y, Miyazaki Y, Komiyama M, Yamakage H, Satoh-Asahara N, Takahashi Y, Wada H, Hasegawa K, Morimoto T. Serum Cystatin C, a Sensitive Marker of Renal Function and Cardiovascular Disease, Decreases After Smoking Cessation. Circ Rep 2019; 1:623-627. [PMID: 33693109 PMCID: PMC7897701 DOI: 10.1253/circrep.cr-19-0052] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 10/18/2019] [Accepted: 10/27/2019] [Indexed: 12/23/2022] Open
Abstract
Background: Smoking exerts detrimental effects during the progression of atherosclerotic vascular disease. Serum cystatin C is useful in the evaluation of early renal dysfunction and serves as a cardiovascular prognostic marker. This study measured changes in serum cystatin C after smoking cessation (SC). Methods and Results: In this study, patients who visited the SC clinic for the first time and succeeded in SC for 1 year were enrolled. In the entire cohort of 86 patients, body mass index (BMI, P<0.001) and waist circumference (WC, P<0.001) increased significantly at 3 months after SC compared with baseline. These values were further increased significantly (BMI, P<0.001; WC, P<0.001) from 3 months to 1 year after SC. Serum cystatin C decreased significantly at 3 months (P=0.045) after SC, and remained unchanged (P=0.482) from 3 months to 1 year after SC. Percent change from baseline to 3 months after SC in serum cystatin C was correlated with the percent change in serum monocyte chemoattractant protein 1 (P=0.047). Conclusions: Serum cystatin C, a marker of chronic kidney disease, was significantly reduced at 3 months after SC.
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Affiliation(s)
- Masafumi Funamoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Kana Shimizu
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yoichi Sunagawa
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yasufumi Katanasaka
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yusuke Miyazaki
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Maki Komiyama
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hajime Yamakage
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Noriko Satoh-Asahara
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Yuko Takahashi
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Hiromichi Wada
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Koji Hasegawa
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
| | - Tatsuya Morimoto
- Division of Molecular Medicine, School of Pharmaceutical Sciences, University of Shizuoka Shizuoka Japan
- Clinical Research Institute, National Hospital Organization Kyoto Medical Center Kyoto Japan
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12
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A new integrated and interactive tool applicable to inborn errors of metabolism: Application to alkaptonuria. Comput Biol Med 2018; 103:1-7. [DOI: 10.1016/j.compbiomed.2018.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/03/2018] [Accepted: 10/03/2018] [Indexed: 11/23/2022]
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13
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Ashrafi Jigheh Z, Ghorbani Haghjo A, Argani H, Roshangar L, Rashtchizadeh N, Sanajou D, Nazari Soltan Ahmad S, Rashedi J, Dastmalchi S, Mesgari Abbasi M. Empagliflozin Attenuates Renal and Urinary Markers of Tubular Epithelial Cell Injury in Streptozotocin-induced Diabetic Rats. Indian J Clin Biochem 2018; 35:109-114. [PMID: 32071503 DOI: 10.1007/s12291-018-0790-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Abstract
Empagliflozin, a SGLT-2 inhibitor, improves diabetic nephropathy through its pleiotropic anti-inflammatory effects. The present study aims to evaluate empagliflozin effects on renal and urinary levels of tubular epithelial cell injury markers in streptozotocin-induced diabetic rats. Empagliflozin at 10 mg/kg (p.o.) was administered for 4 weeks, beginning 8 weeks after induction of diabetes. Renal function as well as markers of renal tubular epithelial cell injury were assessed in kidney tissue homogenates and urine. Empagliflozin was able to ameliorate diabetes induced elevations in serum cystatin C levels. It also alleviated renal KIM-1/NGAL levels and urinary albumin, α-GST, and RBP excretions. In addition to decreasing urinary levels of cell cycle arrest indices i.e. TIMP-2 and IGFBP7, empagliflozin mitigated acetylated NF-κB levels in renal tissues of diabetic rats. As a whole, these findings reveal empagliflozin capability in improving diabetic nephropathy via ameliorating indices of renal inflammation, injury, and cell cycle arrest on streptozotocin-induced diabetic rats.
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Affiliation(s)
- Zahra Ashrafi Jigheh
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.,2Student Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Amir Ghorbani Haghjo
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
| | - Hassan Argani
- 4Urology and Nephrology Research Center, Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Roshangar
- 5Stem Cell Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nadereh Rashtchizadeh
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
| | - Davoud Sanajou
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saeed Nazari Soltan Ahmad
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalil Rashedi
- 1Department of Biochemistry, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Siavoush Dastmalchi
- 3Biotechnology Research Center, Tabriz University of Medical Sciences, Goshgasht Avenue, PO BOX: 14711, Tabriz, 5166614711 Iran
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14
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Pan CS, Ju TR, Lee CC, Chen YP, Hsu CY, Hung DZ, Chen WK, Wang IK. Alcohol use disorder tied to development of chronic kidney disease: A nationwide database analysis. PLoS One 2018; 13:e0203410. [PMID: 30188943 PMCID: PMC6126842 DOI: 10.1371/journal.pone.0203410] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/20/2018] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Alcohol use disorder (AUD) is a spectrum of high risk behaviors including alcohol abuse and dependence. Chronic kidney disease (CKD) is progressive loss of renal function for more or equal to 3 months or presence of any irreversible kidney damage. Common risk factors of CKD have been identified, but the impact of alcohol consumption on kidney function is controversial. The study aims to investigate the relationship between alcohol use disorder and CKD on a national scale. METHODS This retrospective cohort study was conducted using Taiwan's National Health Insurance research database. Patients aged 20 years or older, without CKD and with the diagnosis of AUD (ICD-9-CM codes 303.X; 305.0, V113) from years 2000 to 2013 were enrolled. Control cohort was selected to match the demographics of the target population. Patients were followed until the end of 2013 or earlier if they developed CKD, died, or lost follow up. Baseline characteristics and comorbidities were identified for risk stratification. RESULTS We identified 11639 patients in the AUD cohort and 46556 patients in the control cohort. Compared to patients in the control cohort, those in the AUD group were more likely to have multiple comorbidities (p < 0.001 for all comorbidities). After adjustment of age, gender, baseline comorbidities, and nonsteroidal anti-inflammatory drug use, the diagnosis of AUD was associated with an increased risk of CKD development (aHR = 1.62, 95% CI, 1.46-1.81). During the mean follow up periods of 6.47 (standard deviation (SD) = 3.80) years for the AUD cohort and 7.23 (SD = 3.75) years for the control cohort, the overall incidence density of CKD was significantly higher in patients with AUD than those in the control cohort (3.48 vs 6.51 per 1000 person-years, aHR = 1.68, 95% CI, 1.50-1.87). Kaplan-Meier analysis showed that the AUD cohort had a higher cumulative incidence of CKD than the control cohort (log-rank test, p value < 0.001). Patients with AUD had higher risks of CKD in all the stratified groups, except for the subgroup with age over 65 years old. CONCLUSION Our study suggested that AUD was associated with an increased incidence of newly diagnosed CKD by nearly two folds. Young age, in particular, had a higher association between AUD and CKD. Considering the preventable nature of AUD, establishing effective health policies is imperative to reduce high-risk alcohol behaviors and thereby prevent alcohol-related kidney disease. Further prospective studies are warranted to further elucidate the causation of AUD on kidney function.
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Affiliation(s)
- Chi-syuan Pan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | | | - Chi Chan Lee
- Department of Critical Care, Oregon Health Science University Hospital, Portland, OR, United States of America
| | - Yu-Pei Chen
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Chung-Y. Hsu
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Dong-Zong Hung
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wei-Kung Chen
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - I-Kuan Wang
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Nephrology, China Medical University Hospital, Taichung, Taiwan
- * E-mail:
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15
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Neumann U, Derwenskus F, Gille A, Louis S, Schmid-Staiger U, Briviba K, Bischoff SC. Bioavailability and Safety of Nutrients from the Microalgae Chlorella vulgaris, Nannochloropsis oceanica and Phaeodactylum tricornutum in C57BL/6 Mice. Nutrients 2018; 10:nu10080965. [PMID: 30049974 PMCID: PMC6116023 DOI: 10.3390/nu10080965] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
Microalgae are rich in macronutrients and therefore, they have been proposed as a potential future food source preserving natural resources. Here, we studied safety and bioavailability of algae nutrients in mice. Three microalgae species, Chlorella vulgaris, Nannochloropsis oceanica and Phaeodactylum tricornutum, were studied after ball mill disruption at different doses (5%, 15% and 25% dry weight) for 14 days. In response to all three algae diets, we observed a weight gain similar or superior to that in response to the control diet. No substantial differences in organ weights nor gut length occurred. Protein bioavailability from the algae diets did not differ from the control diet ranging from 58% to 77% apparent biological value. Fat absorption was lower for microalgae compared to soy oil in control diets, albeit still substantial. High liver eicosapentaenoic acid levels were measured following feeding with N. oceanica, the algae richest in omega-3 fatty acids. Neither histological nor serum analyses revealed any heart, kidney or liver toxicity induced by any of the algae diets. Algae-rich diets were thus well accepted, well tolerated and suitable for the maintenance of body weight and normal organ function. No toxicological effects were observed.
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Affiliation(s)
- Ulrike Neumann
- Institute of Clinical Nutrition, University of Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany.
| | - Felix Derwenskus
- Institute of Interfacial Process Engineering and Plasma Technology, University of Stuttgart, 70569 Stuttgart, Germany.
| | - Andrea Gille
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, 76131 Karlsruhe, Germany.
| | - Sandrine Louis
- Institute of Clinical Nutrition, University of Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany.
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, 76131 Karlsruhe, Germany.
| | - Ulrike Schmid-Staiger
- Fraunhofer Institute for Interfacial Engineering and Biotechnology, 70569 Stuttgart, Germany.
| | - Karlis Briviba
- Department of Physiology and Biochemistry of Nutrition, Max Rubner-Institut, 76131 Karlsruhe, Germany.
| | - Stephan C Bischoff
- Institute of Clinical Nutrition, University of Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany.
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16
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Estimating Renal Function in the Elderly Malaysian Patients Attending Medical Outpatient Clinic: A Comparison between Creatinine Based and Cystatin-C Based Equations. Int J Nephrol 2018; 2018:3081518. [PMID: 29862077 PMCID: PMC5971237 DOI: 10.1155/2018/3081518] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/12/2018] [Accepted: 03/28/2018] [Indexed: 11/29/2022] Open
Abstract
Background To assess the performance of different GFR estimating equations, test the diagnostic value of serum cystatin-C, and compare the applicability of cystatin-C based equation with serum creatinine based equation for estimating GFR (eGFR) in comparison with measured GFR in the elderly Malaysian patients. Methods A cross-sectional study recruiting volunteered patients 65 years and older attending medical outpatient clinic. 51 chromium EDTA (51Cr-EDTA) was used as measured GFR. The predictive capabilities of Cockcroft-Gault equation corrected for body surface area (CGBSA), four-variable Modification of Diet in Renal Disease (4-MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations using serum creatinine (CKD-EPIcr) as well as serum cystatin-C (CKD-EPIcys) were calculated. Results A total of 40 patients, 77.5% male, with mean measured GFR 41.2 ± 18.9 ml/min/1.73 m2 were enrolled. Mean bias was the smallest for 4-MDRD; meanwhile, CKD-EPIcr had the highest precision and accuracy with lower limit of agreement among other equations. CKD-EPIcys equation did not show any improvement in GFR estimation in comparison to CKD-EPIcr and MDRD. Conclusion The CKD-EPIcr formula appears to be more accurate and correlates better with measured GFR in this cohort of elderly patients.
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17
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den Bakker E, Gemke RJBJ, Bökenkamp A. Endogenous markers for kidney function in children: a review. Crit Rev Clin Lab Sci 2018; 55:163-183. [DOI: 10.1080/10408363.2018.1427041] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Emil den Bakker
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
| | | | - Arend Bökenkamp
- Department of Pediatric Nephrology, VU Medical Centre, Amsterdam, The Netherlands
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18
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Elnokeety MM, Shaker AM, Fayed AM. Creatinine, cystatin, and combined-based equations in assessment of renal functions in type 2 diabetic Egyptian patients. THE EGYPTIAN JOURNAL OF INTERNAL MEDICINE 2017. [DOI: 10.4103/ejim.ejim_26_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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19
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Spiga O, Cicaloni V, Bernini A, Zatkova A, Santucci A. ApreciseKUre: an approach of Precision Medicine in a Rare Disease. BMC Med Inform Decis Mak 2017; 17:42. [PMID: 28410607 PMCID: PMC5391600 DOI: 10.1186/s12911-017-0438-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 04/01/2017] [Indexed: 11/23/2022] Open
Abstract
Background Alkaptonuria (AKU; OMIM:203500) is a classic Mendelian genetic disorder described by Garrod already in 1902. It causes urine to turn black upon exposure to air and also leads to ochronosis as well as early osteoarthritis. Main body of the abstract Our objective is the implementation of a Precision Medicine (PM) approach to AKU. We present here a novel ApreciseKUre database facilitating the collection, integration and analysis of patient data in order to create an AKU-dedicated “PM Ecosystem” in which genetic, biochemical and clinical resources can be shared among registered researchers. In order to exploit the ApreciseKUre database, we developed an analytic method based on Pearson’s correlation coefficient and P value that generates as refreshable correlation matrix. A complete statistical analysis is obtained by associating every pair of parameters to examine the dependence between multiple variables at the same time. Short conclusions Employing this analytic approach, we showed that some clinically used biomarkers are not suitable as prognostic biomarkers in AKU for a more reliable patients’ clinical monitoring. We believe this database could be a good starting point for the creation of a new clinical management tool in AKU, which will lead to the development of a deeper knowledge network on the disease and will advance its treatment. Moreover, our approach can serve as a personalization model paradigm for other inborn errors of metabolism or rare diseases in general. Electronic supplementary material The online version of this article (doi:10.1186/s12911-017-0438-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ottavia Spiga
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.
| | - Vittoria Cicaloni
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy.,Toscana Life Sciences Foundation, Siena, Italy
| | - Andrea Bernini
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
| | - Andrea Zatkova
- Institute for Clinical and Translational Research Biomedical Research Center, Slovak Academy of Sciences Bratislava, Bratislava, Slovakia
| | - Annalisa Santucci
- Department of Biotechnology, Chemistry and Pharmacy, University of Siena, Siena, Italy
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20
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Comparison of cystatin C and creatinine to determine the incidence of composite adverse outcomes in HIV-infected individuals. J Infect Chemother 2014; 21:84-9. [PMID: 25456895 DOI: 10.1016/j.jiac.2014.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 09/29/2014] [Accepted: 10/01/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Cystatin C is an overall biomarker of pathophysiologic abnormalities that accompany chronic kidney disease (CKD). The utility of cystatin C is not fully understood in an HIV-infected population. METHODS This prospective study investigated 661 HIV-infected individuals for 4 years to determine the incidence of adverse outcomes, including all-cause mortality, cardiovascular disease, and renal dysfunction. The risk of developing the outcomes was discriminated with a 4 color-coded classification in a 3 × 6 contingency table, that combined 3 grades of dipstick proteinuria with 6 grades of estimated glomerular filtration rate (eGFR) calculated using either serum creatinine (eGFRcr) or cystatin C (eGFRcy): green, low risk; yellow, moderately increased risk; orange, high risk; and red, very high risk. The cumulative incidence of the outcomes was assessed by the Kaplan-Meier method, and the association between color-coded risk and the time to outcome was evaluated using multivariate proportional hazards analysis. RESULTS Compared with eGFRcr, the use of eGFRcy reduced the prevalence of risk ≥ orange by 0.8%. The adverse outcomes were significantly more likely to occur to the patients with baseline risk category ≥orange than those with ≤ yellow, independent of risk categories based on eGFRcr or eGFRcy. However, in multivariate analysis, risk category ≥orange with eGFRcy-based classification was significantly associated with adverse outcomes, but not the one with eGFRcr. CONCLUSIONS Replacing creatinine by cystatin C in the CKD color-coded risk classification may be appropriate to discriminate HIV-infected patients at increased risk of a poor prognosis.
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21
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Ghys L, Paepe D, Smets P, Lefebvre H, Delanghe J, Daminet S. Cystatin C: a new renal marker and its potential use in small animal medicine. J Vet Intern Med 2014; 28:1152-64. [PMID: 24814357 PMCID: PMC4857948 DOI: 10.1111/jvim.12366] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/27/2014] [Accepted: 03/18/2014] [Indexed: 01/01/2023] Open
Abstract
The occurrence of chronic kidney disease is underestimated in both human and veterinary medicine. Glomerular filtration rate (GFR) is considered the gold standard for evaluating kidney function. However, GFR assessment is time-consuming and labor-intensive and therefore not routinely used in practice. The commonly used indirect GFR markers, serum creatinine (sCr) and urea, are not sufficiently sensitive or specific to detect early renal dysfunction. Serum cystatin C (sCysC), a proteinase inhibitor, has most of the properties required for an endogenous GFR marker. In human medicine, numerous studies have evaluated its potential use as a GFR marker in several populations. In veterinary medicine, this marker is gaining interest. The measurement is easy, which makes it an interesting parameter for clinical use. This review summarizes current knowledge about cystatin C (CysC) in humans, dogs, and cats, including its history, assays, relationship with GFR, and biological and clinical variations in both human and veterinary medicine.
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Affiliation(s)
- L. Ghys
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - D. Paepe
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - P. Smets
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - H. Lefebvre
- Clinical Research UnitNational Veterinary School of ToulouseToulouse Cedex 3France
| | - J. Delanghe
- Department of Clinical Chemistry, Microbiology and ImmunologyFaculty of Health Medicine and Life SciencesGhent UniversityGhentBelgium
| | - S. Daminet
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
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Joosten MM, Pai JK, Bertoia ML, Gansevoort RT, Bakker SJL, Cooke JP, Rimm EB, Mukamal KJ. β2-microglobulin, cystatin C, and creatinine and risk of symptomatic peripheral artery disease. J Am Heart Assoc 2014; 3:e000803. [PMID: 24980133 PMCID: PMC4310365 DOI: 10.1161/jaha.114.000803] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 03/24/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND β2-Microglobulin and cystatin C may have advantages over creatinine in assessing risk associated with kidney function. We therefore investigated whether emerging filtration markers, β2-microglobulin and cystatin C, are prospectively associated with risk of the development of peripheral artery disease (PAD). METHODS AND RESULTS We conducted nested case-control studies among women within the Nurses' Health Study (1990-2010) and among men within the Health Professionals Follow-up Study (1994-2008) with the use of archived blood samples collected before PAD diagnosis. During follow-up, symptomatic PAD was confirmed in 144 women and 143 men. Controls were matched 3:1 based on age, race, smoking status, fasting status, and date of blood sampling. Conditional logistic regression models were used to estimate relative risks (RRs) and were adjusted for plasma creatinine and cardiovascular risk factors. In women, the RRs (95% CI) per 1-SD) increment were 1.16 (0.85 to 1.58) for β2-microglobulin and 0.94 (0.69 to 1.28) for cystatin C. Corresponding RRs in men were 1.50 (1.08 to 2.09) for β2-microglobulin and 1.54 (1.07 to 2.22) for cystatin C. There was no association between creatinine and PAD risk in women, whereas the association in men (RR 1.41, 95% CI 1.10 to 1.81) disappeared after adjustment for either β2-microglobulin or cystatin C. In pooled analyses of men and women, only β2-microglobulin was associated with PAD risk (RR 1.31, 95% CI 1.04 to 1.64). CONCLUSIONS In pooled analyses, β2-microglobulin was associated with an increased risk of symptomatic PAD; a similar association with cystatin C was observed only in men. The findings suggest that β2-microglobulin may capture the atherosclerosis-promoting or atherosclerosis-related elements of kidney dysfunction better than creatinine.
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Affiliation(s)
- Michel M. Joosten
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.)
- Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.)
- Top Institute Food and Nutrition, Wageningen, The Netherlands (M.M.J., S.L.B.)
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - Jennifer K. Pai
- Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.K.P., E.B.R.)
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.)
| | - Monica L. Bertoia
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.)
- Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.)
| | - Ron T. Gansevoort
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - Stephan J. L. Bakker
- Top Institute Food and Nutrition, Wageningen, The Netherlands (M.M.J., S.L.B.)
- University of Groningen, University Medical Center Groningen, Department of Nephrology, Groningen, The Netherlands (M.M.J., R.T.G., S.L.B.)
| | - John P. Cooke
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.)
- Department of Cardiovascular Sciences, Center for Cardiovascular Regeneration, Houston Methodist Research Institute, TX (J.P.C.)
| | - Eric B. Rimm
- Department of Nutrition, Harvard School of Public Health, Boston, MA (M.M.J., M.L.B., E.B.R.)
- Department of Epidemiology, Harvard School of Public Health, Boston, MA (J.K.P., E.B.R.)
- Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, Harvard Medical School, Boston, MA (J.K.P., J.P.C., E.B.R.)
| | - Kenneth J. Mukamal
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA (M.M.J., M.L.B., K.J.M.)
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Delineation of concentration ranges and longitudinal changes of human plasma protein variants. PLoS One 2014; 9:e100713. [PMID: 24955979 PMCID: PMC4067327 DOI: 10.1371/journal.pone.0100713] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 05/28/2014] [Indexed: 12/14/2022] Open
Abstract
Human protein diversity arises as a result of alternative splicing, single nucleotide polymorphisms (SNPs) and posttranslational modifications. Because of these processes, each protein can exists as multiple variants in vivo. Tailored strategies are needed to study these protein variants and understand their role in health and disease. In this work we utilized quantitative mass spectrometric immunoassays to determine the protein variants concentration of beta-2-microglobulin, cystatin C, retinol binding protein, and transthyretin, in a population of 500 healthy individuals. Additionally, we determined the longitudinal concentration changes for the protein variants from four individuals over a 6 month period. Along with the native forms of the four proteins, 13 posttranslationally modified variants and 7 SNP-derived variants were detected and their concentration determined. Correlations of the variants concentration with geographical origin, gender, and age of the individuals were also examined. This work represents an important step toward building a catalog of protein variants concentrations and examining their longitudinal changes.
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Harisa GI, Attia SM, Ashour AE, Abdallah GM, Omran GA, Touliabah HE. Cigarette smoking and hyperglycemia increase renal response to low levels of cadmium in welders: cystatin C as a sensitive marker. Biol Trace Elem Res 2014; 158:289-96. [PMID: 24652630 DOI: 10.1007/s12011-014-9939-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Accepted: 03/06/2014] [Indexed: 01/15/2023]
Abstract
The present study was undertaken to investigate the utility of cystatin C (CysC) as an early biomarker of cadmium (Cd)-induced renal injury. The study was carried out on 50 adult male individuals divided into five groups of 10 individuals as follows: control, welders, smoker welders, diabetic welders, and smoker diabetic welders. The results indicated that plasma levels of CysC, creatinine, urea, and uric acid were significantly higher in welders compared to control individuals. In addition, the levels of whole blood Cd, lipid peroxidation, and protein oxidation products as well as erythrocyte osmotic fragility were significantly higher in welders compared to control individuals. In contrast, the levels of plasma albumin and whole blood glutathione were significantly decreased in welders compared to control individuals. The alterations of the measured parameters were enhanced in the presence of smoking and hyperglycemia besides exposure to welding fumes. These results suggest that CysC can be used as a sensitive biomarker of the early stages of Cd-induced renal injury.
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Affiliation(s)
- Gamaleldin I Harisa
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 2457, Riyadh, 11451, Saudi Arabia,
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Moreira e Lima R, Navarro LHC, Nakamura G, Solanki DR, Castiglia YMM, Vianna PTG, Ganem EM. Serum cystatin C is a sensitive early marker for changes in the glomerular filtration rate in patients undergoing laparoscopic surgery. Clinics (Sao Paulo) 2014; 69:378-83. [PMID: 24964300 PMCID: PMC4050320 DOI: 10.6061/clinics/2014(06)02] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Accepted: 11/21/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pneumoperitoneum during laparoscopy results in transient oliguria and decreased glomerular filtration and renal blood flow. The presence of oliguria and elevated serum creatinine is suggestive of acute renal injury. Serum cystatin C has been described as a new marker for the detection of this type of injury. In this study, our aim was to compare the glomerular filtration rate estimated using cystatin C levels with the rate estimated using serum creatinine in patients with normal renal function who were undergoing laparoscopic surgery. METHODS In total, 41 patients undergoing laparoscopic cholecystectomy or hiatoplasty were recruited for the study. Blood samples were collected at three time intervals: first, before intubation (T1); second, 30 minutes after the establishment of pneumoperitoneum (T2); and third, 30 minutes after deflation of the pneumoperitoneum (T3). These blood samples were then analyzed for serum cystatin C, creatinine, and vasopressin. The Larsson formula was used to calculate the glomerular filtration rate based on the serum cystatin C levels, and the Cockcroft-Gault formula was used to calculate the glomerular filtration rate according to the serum creatinine levels. RESULTS Serum cystatin C levels increased during the study (T1 = T2<T3; p<0.05), whereas serum creatinine levels decreased (T1 = T2>T3; p<0.05). The calculated eGlomerular filtration rate-Larsson decreased, whereas the eGlomerular filtration rate-Cockcroft-Gault increased. There was no correlation between cystatin C and serum creatinine. Additionally, Pearson's analysis showed a better correlation between serum cystatin C and the eGlomerular filtration rate than between serum creatinine and the eGlomerular filtration rate. CONCLUSION This study demonstrates that serum cystatin C is a more sensitive indicator of changes in the glomerular filtration rate than serum creatinine is in patients with normal renal function who are undergoing laparoscopic procedures.
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Affiliation(s)
- Rodrigo Moreira e Lima
- Universidade Estadual Paulista (UNESP), Botucatu Medical School, Department of Anesthesiology, Botucatu/SP, Brazi
- corresponding author: , Tel.: 55 14 3811-6222
| | - Lais Helena Camacho Navarro
- Universidade Estadual Paulista (UNESP), Botucatu Medical School, Department of Anesthesiology, Botucatu/SP, Brazi
| | - Giane Nakamura
- AC Camargo Cancer Hospital, Anesthesiology, São Paulo/SP, Brazil
| | | | | | - Pedro Tadeu Galvão Vianna
- Universidade Estadual Paulista (UNESP), Botucatu Medical School, Department of Anesthesiology, Botucatu/SP, Brazi
| | - Eliana Marisa Ganem
- Universidade Estadual Paulista (UNESP), Botucatu Medical School, Department of Anesthesiology, Botucatu/SP, Brazi
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Sagheb MM, Namazi S, Geramizadeh B, Karimzadeh A, Oghazian MB, Karimzadeh I. Serum cystatin C as a marker of renal function in critically ill patients with normal serum creatinine. Nephrourol Mon 2014; 6:e15224. [PMID: 24783172 PMCID: PMC3997954 DOI: 10.5812/numonthly.15224] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 10/24/2013] [Accepted: 12/07/2013] [Indexed: 01/18/2023] Open
Abstract
Background: Serum creatinine as a classic marker of renal function has several limitations in the detection of renal dysfunction. Objectives: This study assessed the validity of serum cystatin C as a marker of renal function in critically ill patients with normal serum creatinine. Patients and Methods: Eighty adult patients referred to intensive care units with serum creatinine levels < 1.5 mg/dL and without hemodynamic instability were chosen and their serum creatinine and cystatin C levels were measured. A 24-hour urine sample was collected to calculate creatinine clearance (Ccr). Renal dysfunction was defined as Ccr < 80 mL/min/1.73 m2. Results: There were significant correlations between measured Ccr and 1/serum creatinine (R = 0.51, P < 0.001) and 1/serum cystatin C (R = 0.25, P = 0.028). The difference between false negative rates of serum creatinine (93.33%) and cystatin C (80%) in the detection of renal dysfunction was significant (P = 0.032). Receiver operating characteristic curve analysis illustrated that area under the curve of serum creatinine and cystatin C for detecting renal dysfunction were 0.711 and 0.607, respectively; however, this difference was not significant (P = 0.222). Conclusions: Our data demonstrated that serum cystatin C is not superior to serum creatinine in the early detection of renal dysfunction in critically ill patients.
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Affiliation(s)
- Mohammad Mahdi Sagheb
- Nephrology Urology Research Center and Department of Internal Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Soha Namazi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Bita Geramizadeh
- Transplant Research Center and Department of Pathology, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Amin Karimzadeh
- Department of Dermatology, Imam Khomeini Hospital, Jundishapur University of Medical Sciences, Ahvaz, IR Iran
| | - Mohammad Bagher Oghazian
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Iman Karimzadeh, Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, IR Iran. Tel/Fax: +98-2166954709, E-mail:
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Ataei N, Bazargani B, Ameli S, Madani A, Javadilarijani F, Moghtaderi M, Abbasi A, Shams S, Ataei F. Early detection of acute kidney injury by serum cystatin C in critically ill children. Pediatr Nephrol 2014; 29:133-8. [PMID: 23989306 DOI: 10.1007/s00467-013-2586-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 07/13/2013] [Accepted: 07/16/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND We prospectively evaluated whether serum cystatin C (CysC) detected acute kidney injury (AKI) earlier than basal serum creatinine (Cr). METHODS In 107 pediatric patients at high risk of developing AKI, serum Cr and serum CysC were measured upon admission. Baseline estimated creatinine clearance (eCCl) was calculated using a CysC-based glomerular filtration rate (GFR) equation from a serum Cr measured at the pediatric intensive care unit (PICU) entrance. RESULTS The median age was 10 months (interquartile range, 3-36 months). Serum Cr, serum CysC, and eCCl (mean ± standard deviation [range]) were 0.5 ± 0.18 mg/dl (0.2-1.1 mg/dl), 0.53 ± 0.78 (0.01-3.7 mg/l), and 72.55 ± 28.72 (20.6-176.2) ml/min per 1.73 m(2), respectively. The serum CysC level in patients with AKI was significantly higher than children with normal renal function (p < 0.001). The values for the cut-off point, sensitivity, specificity, and the area under curve (AUC) were determined for CysC as 0.6 mg/l, 73.9 %, 78.9 %, and 0.92 [95 % confidence interval (0.82-1)], respectively, and for Cr the values were 0.4 mg/dl, 68 %, 46.2 %, and 0.39, [95 % confidence interval (0.24-0.54)], respectively. The receiver operating characteristics (ROC) curve analysis revealed that CysC had a significantly higher diagnostic accuracy than eCCl (p < 0.001). CONCLUSIONS Our results identify that the sensitivity of serum CysC for detecting AKI is higher than that of serum Cr in a heterogeneous pediatric intensive care unit (PICU) population.
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Affiliation(s)
- Neamatollah Ataei
- Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Dr. Gharib St. Azadi Avenue, 14197, Tehran, Iran
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Sze L, Bernays RL, Zwimpfer C, Wiesli P, Brändle M, Schmid C. Impact of Growth Hormone on Cystatin C. NEPHRON EXTRA 2013; 3:118-124. [PMID: 24348508 PMCID: PMC3861865 DOI: 10.1159/000356464] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background Cystatin C (CysC) is an alternative marker to creatinine for estimation of the glomerular filtration rate (GFR). Hormones such as thyroid hormones and glucocorticoids are known to have an impact on CysC. In this study, we examined the effect of growth hormone (GH) on CysC in patients with acromegaly undergoing transsphenoidal surgery. Methods Creatinine, CysC, GH and insulin-like growth factor-1 (IGF-1) were determined in 24 patients with acromegaly before and following transsphenoidal surgery. Estimated GFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration formula. Results In all patients, surgical debulking resulted in decreased clinical disease activity and declining GH/IGF-1 levels. Postoperatively, biochemical cure was documented in 20 out of 24 patients. Creatinine levels (mean ± SEM) increased from 72 ± 3 to 80 ± 3 µmol/l (p = 0.0004) and concurrently, estimated GFR decreased from 99 ± 3 to 91 ± 3 ml/min (p = 0.0008). In contrast to creatinine, CysC levels decreased from 0.72 ± 0.02 to 0.68 ± 0.02 mg/l (p = 0.0008). Conclusions Our study provides strong evidence for discordant effects of GH on creatinine and CysC in patients with acromegaly undergoing transsphenoidal surgery, thus identifying another hormone that influences CysC independent of renal function.
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Affiliation(s)
- Lisa Sze
- Division of Endocrinology and Diabetes, Kantonsspital, St. Gallen, Frauenfeld, Switzerland ; Division of Endocrinology and Diabetes, Kantonsspital, St. Gallen, Frauenfeld, Switzerland
| | - René L Bernays
- Department of Neurosurgery, University Hospital, Frauenfeld, Switzerland ; Department of Neurosurgery, Clinic Hirslanden, Zurich, Frauenfeld, Switzerland
| | - Cornelia Zwimpfer
- Division of Endocrinology and Diabetes, Kantonsspital, St. Gallen, Frauenfeld, Switzerland
| | - Peter Wiesli
- Department of Internal Medicine, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | - Michael Brändle
- Division of Endocrinology and Diabetes, Kantonsspital, St. Gallen, Frauenfeld, Switzerland
| | - Christoph Schmid
- Division of Endocrinology and Diabetes, Kantonsspital, St. Gallen, Frauenfeld, Switzerland
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Murty MSN, Sharma UK, Pandey VB, Kankare SB. Serum cystatin C as a marker of renal function in detection of early acute kidney injury. Indian J Nephrol 2013; 23:180-3. [PMID: 23814415 PMCID: PMC3692142 DOI: 10.4103/0971-4065.111840] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
In patients with acute kidney injury (AKI), serum creatinine level does not increase until moderate to severe reduction in glomerular filtration rate (GFR) occurs. Thus its use for estimating GFR in early AKI delays detection of kidney damage and making important therapeutic decisions. Moreover, serum cystatin C is not affected by gender, age, race, and muscle mass and also does not suffer from lag period for its rise in early AKI. We studied 200 healthy subjects and 130 AKI patients over a period of 2 years at a tertiary care hospital. Serum creatinine and serum cystatin C were studied and analyzed in relevance to early AKI. We found that 56.2% of patients of AKI group had normal levels of serum creatinine in early phase, while all patients had elevated serum cystatin C at same time. Multiple logistic regression analysis revealed cystatin C-based GFR reflecting decline in GFR with worsening AKI in better than creatinine-based GFR. Serum cystatin C is a better marker of renal function in early stages of AKI and is less affected by age, gender, muscle mass, and ethnicity. Its use helps in early therapeutic intervention and possibly favorable outcome.
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Affiliation(s)
- M S N Murty
- Department of Medicine and Nephrology, INHS Asvini, Colaba, Mumbai, India
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Khorgami Z, Abdollahi A, Soleimani S, Ahamadi F, Mahdavi-Mazdeh M. Relationship between serum cystatin C and creatinine or dialysis adequacy in patients on chronic maintenance hemodialysis. Nephrourol Mon 2013; 5:733-5. [PMID: 23841035 PMCID: PMC3703130 DOI: 10.5812/numonthly.4934] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 04/05/2012] [Accepted: 06/23/2012] [Indexed: 11/30/2022] Open
Abstract
Background Glomerular filtration rate (GFR) is widely estimated by serum creatinine based equations such as Cockcroft-Gault (CG) standardized for body surface, and an abbreviated formula derived from MDRD (modification of diet in renal disease) study. However, some studies suggested that creatinine based estimation of GFR formula can be replaced by cystatin C based formula. Objectives The aim of this study was to determine whether cystatin C based equation could be used as an indicator for renal function in hemodialysis patients compared to MDRD equation; and whether cystatin C, a dialyzable molecule, was related to Kt/V, the marker for dialysis adequacy. Patients and Methods In this cross-sectional study, 98 patients on chronic hemodialysis were included. Plasma levels of urea and creatinine were measured before and after dialysis, and cystatin C was measured before dialysis. GFR was calculated and compared. Results The mean age of patients was 55.50 ± 16.10 (24-86) years and 66 cases were male (67.3%). The GFR was estimated at 6.05 ± 2.36 and 5.83 ± 2.19 cc/min by MDRD and cystatin C based formulas, respectively, with a significant correlation (r = 0.51; P < 0.001). Serum cystatin C level was 9.74 ± 2.47 mg/L which showed significant reverse correlation with both MDRD (r = -0.46; P < 0.001) and cystatin C based formulas (r = -0.87; P < 0.001). Neither creatinine nor serum cystatin C showed correlation with Kt/V, as the marker of dialysis adequacy. Conclusions Serum cystatin C may be considered as an indicator of renal function in patients under maintenance hemodialysis.
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Affiliation(s)
- Zhinoos Khorgami
- Iranian Tissue Bank Research and Preparation Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Alireza Abdollahi
- Iranian Tissue Bank Research and Preparation Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Samaneh Soleimani
- Department of Pathology, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Farrokhlagha Ahamadi
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Mitra Mahdavi-Mazdeh
- Iranian Tissue Bank Research and Preparation Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Nephrology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Mitra Mahdavi-Mazdeh, 1) Iranian Tissue Bank Research and Preparation Center, 2) Nephrology Research Center, Tehran University of Medical Sciences, Tehran, IR Iran, Tel.: +98-9121200436, Fax: +98-2166581568, E-mail:
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Kirwan CJ, Philips BJ, MacPhee IAM. Estimated glomerular filtration rate correlates poorly with four-hour creatinine clearance in critically ill patients with acute kidney injury. Crit Care Res Pract 2013; 2013:406075. [PMID: 23476756 PMCID: PMC3576793 DOI: 10.1155/2013/406075] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Accepted: 01/02/2013] [Indexed: 01/22/2023] Open
Abstract
Introduction. RIFLE and AKIN provide a standardised classification of acute kidney injury (AKI), but their categorical rather than continuous nature restricts their use to a research tool. A more accurate real-time description of renal function in AKI is needed, and some published data suggest that equations based on serum creatinine that estimate glomerular filtration rate (eGFR) can provide this. In addition, incorporating serum cystatin C concentration into estimates of GFR may improve their accuracy, but no eGFR equations are validated in critically ill patients with AKI. Aim. This study tests whether creatinine or cystatin-C-based eGFR equations, used in patients with CKD, offer an accurate representation of 4-hour creatinine clearance (4CrCl) in critically ill patients with AKI. Methods. Fifty-one critically ill patients with AKI were recruited. Thirty-seven met inclusion criteria, and the performance of eGFR equations was compared to 4CrCl. Results. eGFR equations were better than creatinine alone at predicting 4CrCl. Adding cystatin C to estimates did not improve the bias or add accuracy. The MDRD 7 eGFR had the best combination of correlation, bias, percentage error and accuracy. None were near acceptable standards quoted in patients with chronic kidney disease (CKD). Conclusions. eGFR equations are not sufficiently accurate for use in critically ill patients with AKI. Incorporating serum cystatin C does not improve estimates. eGFR should not be used to describe renal function in patients with AKI. Standards of accuracy for validating eGFR need to be set.
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Affiliation(s)
- Christopher J. Kirwan
- Department of Intensive Care, The Royal London Hospital, Barts Health NHS Trust, Whitechapel E1 1BB, UK
| | - Barbara J. Philips
- Department of Intensive Care, St. George's Healthcare NHS Trust, Tooting, London SW17 0QT, UK
| | - Iain A. M. MacPhee
- Department of Renal and Transplant Medicine, St. George's Healthcare NHS Trust, Tooting, London SW17 0QT, UK
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Chen YW, Chang CW, Chang CW, Wang TE, Wu CJ, Chen HH. Is an estimated glomerular filtration rate better than creatinine to be incorporated into the end-stage liver disease score? World J Hepatol 2012; 4:291-8. [PMID: 23293714 PMCID: PMC3536835 DOI: 10.4254/wjh.v4.i11.291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 08/17/2012] [Accepted: 10/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To incorporate estimated glomerular filtration rate (eGFR) into the model for end-stage liver disease (MELD) score to evaluate the predictive value. METHODS From January 2004 to October 2008, the records of 4127 admitted cirrhotic patients were reviewed. Patients who survived and were followed up as outpatients were defined as survivors and their most recent available laboratory data were collected. Patients whose records indicated death at any time during the hospital stay were defined as non-survivors (in-hospital mortality). Patients with incomplete data or with cirrhosis due to a congenital abnormality such as primary biliary cirrhosis were excluded; thus, a total of 3857 patients were enrolled in the present study. The eGFR, which was calculated by using either the modification of diet in renal disease (MDRD) equation or the chronic kidney disease epidemiology collaboration (CKD-EPI) equation, was incorporated into the MELD score after adjustment with the original MELD equation by logistic regression analysis [bilirubin and international normalized ratio (INR) were set at 1.0 for values less than 1.0]. RESULTS Patients defined as survivors were significantly younger, had a lower incidence of hepatoma, lower Child-Pugh and MELD scores, and better renal function. The underlying causes of cirrhosis were very different from those in Western countries. In Taiwan, most cirrhotic patients were associated with the hepatitis virus, especially hepatitis B. There were 16 parameters included in univariate logistic regression analysis to predict in-hospital mortality and those with significant predicting values were included in further multivariate analysis. Both 4-variable MDRD eGFR and 6-variable MDRD eGFR, rather than creatinine, were significant predictors of in-hospital mortality. Three new equations were constructed (MELD-MDRD-4, MELD-MDRD-6, MELD-CKD-EPI). As expected, original MELD score was a significant predictor of in-hospital mortality (odds ratio = 1.25, P < 0.001). MELD-MDRD-4 excluded serum creatinine, with the coefficients refit among the remaining 3 variables, i.e., total bilirubin, INR and 4-variable MDRD eGFR. This model represented an exacerbated outcome over MELD score, as suggested by a decrease in chi-square (2161.45 vs 2198.32) and an increase in -2 log (likelihood) (2810.77 vs 2773.90). MELD-MDRD-6 included 6-variable MDRD eGFR as one of the variables and showed an improvement over MELD score, as suggested by an increase in chi-square (2293.82 vs 2198.32) and a decrease in -2 log (likelihood) (2810.77 vs 2664.79). Finally, when serum creatinine was replaced by CKD-EPI eGFR, it showed a slight improvement compared to the original MELD score (chi-square: 2199.16, -2 log (likelihood): 2773.07). In the receiver-operating characteristic curve, the MELD-MDRD-6 score showed a marginal improvement in area under the curve (0.909 vs 0.902), sensitivity (0.854 vs 0.819) and specificity (0.818 vs 0.839) compared to the original MELD equation. In patients with a different eGFR, the MELD-MDRD-6 equation showed a better predictive value in patients with eGFR ≥ 90, 60-89, 30-59 and 15-29. CONCLUSION Incorporating eGFR obtained by the 6-variable MDRD equation into the MELD score showed an equal predictive performance in in-hospital mortality compared to a creatinine-based MELD score.
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Affiliation(s)
- Yu-Wei Chen
- Yu-Wei Chen, Chih-Jen Wu, Han-Hsiang Chen, Department of Nephrology, Mackay Memorial Hospital, Taipei 10449, Taiwan
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Kumaresan R, Giri P. A comparison of serum cystatin C and creatinine with glomerular filtration rate in Indian patients with chronic kidney disease. Oman Med J 2012; 26:421-5. [PMID: 22253951 DOI: 10.5001/omj.2011.107] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Accepted: 09/10/2011] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES There is no literature available on the performance of cystatin C in Chronic Kidney Disease (CKD) patients of Indian population based on age group. Hence, this study is aimed to compare the diagnostic performance of serum cystatin C and creatinine with measured glomerular filtration rate (GFR) and estimated GFR (eGFR) in subjects of Indian origin. METHODS The study was carried out at Tiruchirappalli, South India during the period of September 2010 to march 2011. One hundred and six CKD patients (82 males, 24 females) were enrolled and categorized into three groups based on age. The eGFR was calculated using Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulae. Serum cystatin C was measured with a particle-enhanced nephelometric immunoassay (PENIA) method. GFR was measured using (99m)T(C) - diethylene triamine penta aceticacid (DTPA) renal scan method. RESULTS Serum cystatin C showed significant correlation with measured GFR in all the three groups (r=-0.9735, r=-0.8975 and r=-0.7994 respectively) than serum creatinine (r=-0.7380, r=-0.6852 and r=-0.5127 respectively). CONCLUSION Serum cystatin C showed a high correlation with measured GFR in young and older patients with CKD than creatinine. Thus, cystatin C is a good alternative marker to creatinine in CKD patients.
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Affiliation(s)
- Ramanathan Kumaresan
- Clinical Research Department, Periyar Maniammai University, Vallam, Thanjavur, 613 403 India
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Finkenstedt A, Dorn L, Edlinger M, Prokop W, Risch L, Griesmacher A, Graziadei I, Vogel W, Zoller H. Cystatin C is a strong predictor of survival in patients with cirrhosis: is a cystatin C-based MELD better? Liver Int 2012; 32:1211-6. [PMID: 22380485 DOI: 10.1111/j.1478-3231.2012.02766.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2011] [Accepted: 01/16/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND/AIMS The model of end stage liver disease (MELD) includes serum creatinine, which is a poor surrogate marker of renal function in patients with cirrhosis. Especially in women and patients with advanced disease creatinine underestimates true renal function. Our objective was to assess whether or not the substitution of creatinine by cystatin C improves the prognostic performance of the model. METHODS The association between MELD parameters and cystatin C with survival was investigated using a Cox proportional hazards model. A cystatin C-based MELD score was calculated from the results and compared with creatinine-based MELD in terms of discrimination and calibration. RESULTS Four hundred and twenty-nine patients were included in the study; 19% died and 12% underwent liver transplantation during a median follow-up of 602 days. In multivariate Cox regression, cystatin C was an independent predictor of 90-day mortality with a hazard ratio of 8.0 (95% CI: 2.2-29.6). The median cystatin C-based MELD was 15, the median creatinine-based MELD was 12. Calibration and discrimination for 3 month and 1 year mortality was similar between the scores (AUC > 0.85 for both scores). Gender differences in cystatin C-based MELD were less pronounced than those in the creatinine-based model, because creatinine but not cystatin C was affected by gender. CONCLUSION Substitution of creatinine by cystatin C does not improve the predictive power of MELD.
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Affiliation(s)
- Armin Finkenstedt
- Department of Medicine II-Gastroenterology and Hepatology, Medical University of Innsbruck, Innsbruck, Austria
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Nedelkov D. Mass spectrometry-based protein assays for in vitro diagnostic testing. Expert Rev Mol Diagn 2012; 12:235-9. [PMID: 22468814 DOI: 10.1586/erm.12.15] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Mass spectrometry-based protein assays hold great promise for in vitro diagnostic testing. Technological advances in mass spectrometry have given rise to instruments and methods that are fully capable of automated and high-throughput protein assaying. Yet, the numerous steps involved in such assays can lead to difficulties in assay characterization and validation, and can also make them unnecessarily complex and prohibitively expensive for everyday use. Simplification of both approaches and instrumentation seems to be the solution to the fast introduction of the mass spectrometry-based assays into the clinical laboratories. One such simplified approach is the mass spectrometric immunoassay, which couples targeted immunoaffinity protein separation with the power of mass spectrometry detection. Several mass spectrometric immunoassays have been extensively characterized and have found their way into clinical laboratory improvement amendments-certified laboratories in the form of laboratory developed tests. Reviewed in this special report is the development and validation of one of those assays - a Cystatin mass spectrometric immunoassay. With the added advantage of protein variant detection and quantification, these assays can redefine our view of protein diversity, with clear implications in biomarker discovery, validation, and ultimately, in vitro diagnostic testing.
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Interpreting different measures of glomerular filtration rate in obesity and weight loss: pitfalls for the clinician. Int J Obes (Lond) 2011; 36:1421-7. [PMID: 22184061 DOI: 10.1038/ijo.2011.242] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To combat the increasing incidence of obesity, much research has been devoted to devising successful strategies for weight loss, including manipulation of diet and gastric surgery. Obesity itself can be associated with renal dysfunction, and the degree of reversibility of this with weight loss has being studied. However, there are significant limitations and flaws in the methods we have available to measure glomerular filtration rate (GFR) in overweight and obese subjects. Obesity is associated with changes in body composition including lean and fat mass. This has implications for assumptions that underpin creatinine-based measures such as creatinine clearance, estimated GFR and other equations devised for obesity including the Salazar-Corcoran equation. These changes in body composition also affect measures of glomerular filtration such as cystatin C and nuclear medicine isotope scans. This article will review the accuracy of these current measures of renal function in the obese and consider the evidence for adjusting for body surface area or adjusting for lean body mass. Finally, the effect of weight loss itself on serial measurements of renal function in a given individual, independent of a true change in renal function, will be reviewed. Ultimately using the Cockcroft-Gault equation with an adjustment for lean body mass seems to be the best measure for renal function in obesity. No method for measuring renal function in situations of weight loss has been shown to be unequivocally superior.
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Rigalleau V, Beauvieux MC, Gonzalez C, Raffaitin C, Lasseur C, Combe C, Chauveau P, De la Faille R, Rigothier C, Barthe N, Gin H. Estimation of renal function in patients with diabetes. DIABETES & METABOLISM 2011; 37:359-66. [PMID: 21680218 DOI: 10.1016/j.diabet.2011.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/07/2011] [Indexed: 01/02/2023]
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), which makes estimation of renal function crucial. Serum creatinine is not an ideal marker of glomerular filtration rate (GFR), which also depends on digestive absorption, and the production of creatinine in muscle and its tubular secretion. Formulas have been devised to estimate GFR from serum creatinine but, given the wide range of GFR, proteinuria, body mass index and specific influence of glycaemia on GFR, the uncertainty of these estimations is a particular concern for patients with diabetes. The most popular recommended formulas are the simple Cockcroft-Gault equation, which is inaccurate and biased, as it calculates clearance of creatinine in proportion to body weight, and the MDRD equation, which is more accurate, but systematically underestimates normal and high GFR, being established by a statistical analysis of results from renal-insufficient patients. This underestimation explains why the MDRD equation is repeatedly found to give a poor estimation of GFR in patients with recently diagnosed diabetes and is a poor tool for reflecting GFR decline when started from normal, as well as the source of unexpected results when applied to epidemiological studies with a 60mL/min/1.73m(2) threshold as the definition of CKD. The more recent creatinine-based formula, the Mayo Clinic Quadratic (MCQ) equation, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) improve such underestimation, as both were derived from populations that included subjects with normal renal function. Determination of cystatin C is also promising, but needs standardisation.
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Affiliation(s)
- V Rigalleau
- Service de Nutrition-Diabétologie, Hôpital Haut-Lévêque, avenue de Magellan, 33600 Pessac, France.
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Trenchevska O, Nedelkov D. Targeted quantitative mass spectrometric immunoassay for human protein variants. Proteome Sci 2011; 9:19. [PMID: 21477312 PMCID: PMC3080279 DOI: 10.1186/1477-5956-9-19] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2010] [Accepted: 04/08/2011] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Post-translational modifications and genetic variations give rise to protein variants that significantly increase the complexity of the human proteome. Modified proteins also play an important role in biological processes. While sandwich immunoassays are routinely used to determine protein concentrations, they are oblivious to protein variants that may serve as biomarkers with better sensitivity and specificity than their wild-type proteins. Mass spectrometry, coupled to immunoaffinity separations, can provide an efficient mean for simultaneous detection and quantification of protein variants. RESULTS Presented here is a mass spectrometric immunoassay method for targeted quantitative proteomics analysis of protein modifications. Cystatin C, a cysteine proteinase inhibitor and a potential marker for several pathological processes, was used as a target analyte. An internal reference standard was incorporated into the assay, serving as a normalization point for cystatin C quantification. The precision, linearity, and recovery characteristics of the assay were established. The new assay was also benchmarked against existing cystatin C ELISA. In application, the assay was utilized to determine the individual concentration of several cystatin C variants across a cohort of samples, demonstrating the ability to fully quantify individual forms of post-translationally modified proteins. CONCLUSIONS The mass spectrometric immunoassays can find use in quantifying specific protein modifications, either as a part of a specific protein biomarker discovery/rediscovery effort to delineate the role of these variants in the onset of the disease, progression, and response to therapy, or in a more systematic study to delineate and understand human protein diversity.
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Affiliation(s)
- Olgica Trenchevska
- Intrinsic Bioprobes, 2155 E, Conference Dr, Suite 104, Tempe, AZ 85284, USA.
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Owens GE, King K, Gurney JG, Charpie JR. Low renal oximetry correlates with acute kidney injury after infant cardiac surgery. Pediatr Cardiol 2011; 32:183-8. [PMID: 21085945 DOI: 10.1007/s00246-010-9839-x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2010] [Accepted: 11/01/2010] [Indexed: 01/11/2023]
Abstract
Acute kidney injury (AKI) is a frequent complication after cardiopulmonary bypass surgery during infancy. Standard methods for evaluating renal function are not particularly sensitive nor are proximate indicators of renal dysfunction that allow intervention in real time. Near-infrared spectroscopy (NIRS) is a newer noninvasive technology that continuously evaluates regional oximetry and may correlate with renal injury and adverse outcomes after cardiac surgery in infants. This prospective observational study enrolled 40 infants (age, <12 months) undergoing biventricular repair. Continuous renal oximetry data were collected for the first 48 postoperative hours and correlated with postoperative course, standard laboratory data, and the occurrence of acute renal injury. Subjects with low renal oximetry (below 50% for >2 h) had significantly higher postoperative peak creatinine levels by 48 h (0.8 ± 0.4 vs. 0.52 ± 0.2; p = 0.003) and a higher incidence of AKI (50 vs. 3.1%; p = 0.003) than those with normal renal oximetry. These subjects also required more ventilator days and greater vasoactive support, and they had elevated lactate levels. Prolonged low renal near-infrared oximetry appears to correlate with renal dysfunction, decreased systemic oxygen delivery, and the overall postoperative course in infants with congenital heart disease undergoing biventricular repair.
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Affiliation(s)
- Gabe E Owens
- Division of Pediatric Cardiology, Department of Pediatrics, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5204, USA.
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Dabla PK. Renal function in diabetic nephropathy. World J Diabetes 2010; 1:48-56. [PMID: 21537427 PMCID: PMC3083882 DOI: 10.4239/wjd.v1.i2.48] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2009] [Revised: 04/25/2010] [Accepted: 05/02/2010] [Indexed: 02/05/2023] Open
Abstract
Diabetic nephropathy is the kidney disease that occurs as a result of diabetes. Cardiovascular and renal complications share common risk factors such as blood pressure, blood lipids, and glycemic control. Thus, chronic kidney disease may predict cardiovascular disease in the general population. The impact of diabetes on renal impairment changes with increasing age. Serum markers of glomerular filtration rate and microalbuminuria identify renal impairment in different segments of the diabetic population, indicating that serum markers as well as microalbuminuria tests should be used in screening for nephropathy in diabetic older people. The American Diabetes Association and the National Institutes of Health recommend Estimated glomerular filtration rate (eGFR) calculated from serum creatinine at least once a year in all people with diabetes for detection of kidney dysfunction. eGFR remains an independent and significant predictor after adjustment for conventional risk factors including age, sex, duration of diabetes, smoking, obesity, blood pressure, and glycemic and lipid control, as well as presence of diabetic retinopathy. Cystatin-C (Cys C) may in future be the preferred marker of diabetic nephropathy due differences in measurements of serum creatinine by various methods. The appropriate reference limit for Cys C in geriatric clinical practice must be defined by further research. Various studies have shown the importance of measurement of albuminuria, eGFR, serum creatinine and hemoglobin level to further enhance the prediction of end stage renal disease.
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Affiliation(s)
- Pradeep Kumar Dabla
- Pradeep Kumar Dabla, Department of Biochemistry, Lady Hardinge Medical College, New Delhi 110001, India
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Renal Function Impairment in Peripheral Arterial Disease: An Important Parameter that Should not Be Neglected. Ann Vasc Surg 2009; 23:690-9. [DOI: 10.1016/j.avsg.2009.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/15/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
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Séronie-Vivien S, Delanaye P, Piéroni L, Mariat C, Froissart M, Cristol JP. Cystatin C: current position and future prospects. Clin Chem Lab Med 2009; 46:1664-86. [PMID: 18973461 DOI: 10.1515/cclm.2008.336] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Cystatin C is a low-molecular-weight protein which has been proposed as a marker of renal function that could replace creatinine. Indeed, the concentration of cystatin C is mainly determined by glomerular filtration and is particularly of interest in clinical settings where the relationship between creatinine production and muscle mass impairs the clinical performance of creatinine. Since the last decade, numerous studies have evaluated its potential use in measuring renal function in various populations. More recently, other potential developments for its clinical use have emerged. This review summarises current knowledge about the physiology of cystatin C and about its use as a renal marker, either alone or in equations developed to estimate the glomerular filtration rate. This paper also reviews recent data about the other applications of cystatin C, particularly in cardiology, oncology and clinical pharmacology.
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Affiliation(s)
- Sophie Séronie-Vivien
- Département de Biologie Clinique, Institut Claudius Regaud, Université Paul Sabatier, Toulouse, France.
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Beringer PM, Hidayat L, Heed A, Zheng L, Owens H, Benitez D, Rao AP. GFR estimates using cystatin C are superior to serum creatinine in adult patients with cystic fibrosis. J Cyst Fibros 2009; 8:19-25. [DOI: 10.1016/j.jcf.2008.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2008] [Revised: 07/03/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
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Abstract
Low molecular-mass plasma proteins play a key role in health and disease. Cystatin C is an endogenous cysteine proteinase inhibitor belonging to the type 2 cystatin superfamily. The mature, active form of human cystatin C is a single non-glycosylated polypeptide chain consisting of 120 amino acid residues, with a molecular mass of 13,343-13,359 Da, and containing four characteristic disulfide-paired cysteine residues. Human cystatin C is encoded by the CST3 gene, ubiquitously expressed at moderate levels. Cystatin C monomer is present in all human body fluids; it is preferentially abundant in cerebrospinal fluid, seminal plasma, and milk. Cystatin C L68Q variant is an amyloid fibril-forming protein with a high tendency to dimerize. It forms self-aggregates with massive amyloid deposits in the brain arteries of young adults, leading to lethal cerebral hemorrhage. The main catabolic site of cystatin C is the kidney: more than 99% of the protein is cleared from the circulation by glomerular ultrafiltration and tubular reabsorption. The diagnostic value of cystatin C as a marker of kidney dysfunction has been extensively investigated in multiple clinical studies on adults, children, and in the elderly. In almost all the clinical studies, cystatin C demonstrated a better diagnostic accuracy than serum creatinine in discriminating normal from impaired kidney function, but controversial results have been obtained by comparing this protein with other indices of kidney disease, especially serum creatinine-based equations. In this review, we present and discuss most of the available data from the literature, critically reviewing conclusions and suggestions for the use of cystatin C in clinical practice. Despite the multitude of clinical data in the literature, cystatin C has not been widely used, perhaps because of a combination of factors, such as a general diffidence among clinicians, the absence of definitive cut-off values, conflicting results in clinical studies, no clear evidence on when and how to request the test, the poor commutability of results, and no accurate examination of costs and of its routine use in a stat laboratory.
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Affiliation(s)
- Michele Mussap
- Department of Laboratory Medicine, University-Hospital of Padua, Padua, Italy
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Keller C, Katz R, Cushman M, Fried LF, Shlipak M. Association of kidney function with inflammatory and procoagulant markers in a diverse cohort: a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA). BMC Nephrol 2008; 9:9. [PMID: 18681974 PMCID: PMC2533297 DOI: 10.1186/1471-2369-9-9] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Accepted: 08/05/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies using creatinine-based estimated glomerular filtration rate (eGFR) have found limited associations between kidney function and markers of inflammation. Using eGFR and cystatin C, a novel marker of kidney function, the authors investigated the association of kidney function with multiple biomarkers in a diverse cohort. METHODS The Multi-Ethnic Study of Atherosclerosis consists of 6,814 participants of white, African-American, Hispanic, and Chinese descent, enrolled from 2000-2002 from six U.S. communities. Measurements at the enrollment visit included serum creatinine, cystatin C, and six inflammatory and procoagulant biomarkers. Creatinine-based eGFR was estimated using the four-variable Modification of Diet in Renal Disease equation, and chronic kidney disease was defined by an eGFR < 60 mL/min/1.73 m2. RESULTS Adjusted partial correlations between cystatin C and all biomarkers were statistically significant: C-reactive protein (r = 0.08), interleukin-6 (r = 0.16), tumor necrosis factor-alpha soluble receptor 1 (TNF-alphaR1; r = 0.75), intercellular adhesion molecule-1 (r = 0.21), fibrinogen (r = 0.14), and factor VIII (r = 0.11; two-sided p < 0.01 for all). In participants without chronic kidney disease, higher creatinine-based eGFR was associated only with higher TNF-alphaR1 levels. CONCLUSION In a cohort characterized by ethnic diversity, cystatin C was directly associated with multiple procoagulant and inflammatory markers. Creatinine-based eGFR had similar associations with these biomarkers among subjects with chronic kidney disease.
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Affiliation(s)
- Christopher Keller
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
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Carbonnel C, Seux V, Pauly V, Oddoze C, Roubicek C, Larue J, Thirion X, Soubeyrand J, Retornaz F. Quelle méthode d’évaluation de la fonction rénale utiliser chez le sujet âgé hospitalisé en unité de court séjour gériatrique ? Comparaison de quatre méthodes. Rev Med Interne 2008; 29:364-9. [DOI: 10.1016/j.revmed.2007.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2007] [Accepted: 12/09/2007] [Indexed: 10/22/2022]
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Sarnak MJ, Katz R, Fried LF, Siscovick D, Kestenbaum B, Seliger S, Rifkin D, Tracy R, Newman AB, Shlipak MG. Cystatin C and aging success. ACTA ACUST UNITED AC 2008; 168:147-53. [PMID: 18227360 DOI: 10.1001/archinternmed.2007.40] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To our knowledge, the effect of kidney function on successful aging has not been examined. METHODS We evaluated the relationship between cystatin C and aging success during a 6-year follow-up in the Cardiovascular Health Study, a community-based cohort of older adults (aged >or= 65 years). Successful aging was defined as remaining free of cardiovascular disease, cancer, and chronic obstructive pulmonary disease and having intact physical and cognitive functioning. In adjusted analysis, an accelerated failure time model was used to evaluate the percentage reduction in successful years by level of cystatin C. A separate Cox proportional hazards model evaluated whether cystatin C was related to incident physical and cognitive disability. RESULTS A total of 2140 participants had cystatin C measured and were free of the previously mentioned conditions at baseline. Their mean age was 74 years. The mean cystatin C level, creatinine level, and estimated glomerular filtration rate were 1.06 mg/L, 0.93 mg/dL, and 78 mL/min/1.73 m(2), respectively (to convert cystatin C to nanomoles per liter, multiply by 75; and to convert creatinine to micromoles per liter, multiply by 88.4). A total of 873 participants reached a first event in follow-up, 138 because of cognitive disability, 238 because of physical disability, 34 because of chronic obstructive pulmonary disease, 146 because of cancer, and 317 because of cardiovascular disease. The adjusted percentage reduction in successful life years in the highest vs the lowest quartile of cystatin C was 27% (95% confidence interval, 11%-39%). The highest vs lowest quartile of cystatin C also was independently associated with incident cognitive or physical disability (hazard ratio, 1.39; 95% confidence interval, 1.00-1.98). CONCLUSION A higher cystatin C level, even within a range of relatively normal kidney function, was associated with unsuccessful aging.
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Affiliation(s)
- Mark J Sarnak
- Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
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Ledoux D, Monchi M, Chapelle JP, Damas P. Cystatin C blood level as a risk factor for death after heart surgery. Eur Heart J 2007; 28:1848-53. [PMID: 17617637 DOI: 10.1093/eurheartj/ehm270] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Pre-operative renal dysfunction is a known risk factor for mortality and morbidity after heart surgery. Despite limited accuracy, serum creatinine is widely used to estimate glomerular filtration rate (GFR). Cystatin C is more accurate for assessing GFR. The aim of the present study was to assess associations between GFR estimated from serum cystatin C levels before heart surgery and hospital mortality, hospital morbidity, and 1 year mortality. METHODS AND RESULTS In a prospective single-centre observational study, clinical risk factors for morbidity and mortality were recorded and serum creatinine and cystatin C levels were measured in patients admitted for heart surgery. Hospital mortality and morbidity and 1 year mortality were recorded. Over an 8 month period, 499 patients were screened, among whom 376 (74.5%) were included in the study. Hospital mortality was 5.6% (21 patients) and 1 year mortality was 10.2%. Hospital morbidity, defined by a length of stay above the 75th percentile, was 22.1% (83 patients). In the multivariable analysis, GFR estimated from serum cystatin C, but not GFR estimated from serum creatinine, was an independent risk factor for hospital morbidity/mortality (odds ratio per 10 mL/min of GFR decrease, 1.20 (1.07-1.34), P = 0.001) and for 1 year mortality (hazards ratio per 10 mL/min of GFR decrease, 1.26 (1.09-1.46), P = 0.002). CONCLUSION Pre-operative GFR estimation from serum cystatin C may provide a better risk assessment than pre-operative GFR estimation from serum creatinine in patients scheduled for heart surgery.
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Affiliation(s)
- Didier Ledoux
- Intensive Care Unit, Liège University Hospital, Sart Tilman Bat B35, B-4000 Liège, Belgium.
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Donahue RP, Stranges S, Rejman K, Rafalson LB, Dmochowski J, Trevisan M. Elevated cystatin C concentration and progression to pre-diabetes: the Western New York study. Diabetes Care 2007; 30:1724-9. [PMID: 17456840 DOI: 10.2337/dc07-0040] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We conducted a nested case-control investigation to examine whether elevated baseline concentrations of cystatin C predicted progression from normoglycemia to pre-diabetes over 6 years of follow-up from the Western New York Health Study. RESEARCH DESIGN AND METHODS In 2002-2004, 1,455 participants from the Western New York Health Study, who were free of type 2 diabetes and known cardiovascular disease at baseline (1996-2001), were reexamined. An incident case of pre-diabetes was defined as an individual with fasting glucose < 100 mg/dl at the baseline examination and > or = 100 and < or = 125 mg/dl at the follow-up examination, thereby eliminating individuals with prevalent pre-diabetics. All case patients (n = 91) were matched 1:3 to control participants based on sex, race/ethnicity, and year of study enrollment. All control subjects had fasting glucose levels < 100 mg/dl at both baseline and follow-up examinations. Cystatin C concentrations and the urinary albumin-to-creatinine ratio were measured from frozen (-196 degrees C) baseline blood and urine samples. Serum creatinine concentrations were available from the baseline examination only. RESULTS Multivariate conditional logistic regression analyses adjusted for age, baseline glucose level, homeostasis model assessment of insulin resistance, BMI, hypertension, estimated glomerular filtration rate, cigarette smoking, and alcohol use revealed a significantly increased risk of progression to pre-diabetes among those with elevated baseline concentrations of cystatin C (odds ratio 3.28 [95% CI 1.43-7.54]) (upper quintile versus the remainder). Results of secondary analyses that considered high-sensitivity C-reactive protein, interleukin-6, E-selectin, or soluble intercellular adhesion molecule-1 did not alter these results. CONCLUSIONS These results suggest that cystatin C was associated with a threefold excess risk of progression to pre-diabetes in this population.
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Affiliation(s)
- Richard P Donahue
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, State University of New York at Buffalo, 3435 Main St., Farber Hall, Room 268 F, Buffalo, NY 14214, USA.
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