Is Serum Cystatin C a Better Marker than Serum Creatinine for Monitoring Renal Function in Pediatric Intensive Care Unit?

Background: The usefulness of serum cystatin C and serum β2-microglobulin (B2M) as markers of glomerular filtration rate (GFR) were compared in kidney donors before and after nephrectomy. Methods: Blood samples were taken from 28 donors (15 women and 13 men) for serum creatinine, urea, cystatin C and B2M estimation a median of 7 days before and 10 days after nephrectomy. Results: Estimated GFR decreased from a median of 86.2 mL/min/1.73 m2 to 60.3 mL/min/1.73 m2, a median decrease of 28.6%. Serum creatinine increased by 40% and urea by 30.4%; serum cystatin C increased by 31.2% and serum B2M increased by 65.6%. Using published data on biological variation, critical values were calculated. An increase in serum creatinine above 18 µmol/L detected the decline in renal function in 26/28 (92.9%) subjects. Increases in serum B2M greater than a critical value of 0.94 mg/L detected 24/28 (85.7%) of these subjects, but the critical value of 0.59 mg/L for cystatin C detected only 8/28 (28.6%). Conclusion: Using critical values, serial measurement of serum creatinine was better than serum B2M in detecting reduced renal function. Because of its large intraindividual variation, serial serum cystatin C estimation was very poor in detecting reduced renal function.

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Serum cystatin C, serum creatinine and the MDRD as predictors for renal function defined by the inulin clearance after orthotopic liver transplantation*

European Surgery ◽

10.1007/s10353-011-0052-9 ◽

2011 ◽

Vol 43 (6) ◽

pp. 333-337

Author(s):

D. Wagner ◽

D. Kniepeiss ◽

P. Stiegler ◽

M. Sereinigg ◽

S. Zitta ◽

...

Keyword(s):

Liver Transplantation ◽

Renal Function ◽

Serum Creatinine ◽

Orthotopic Liver Transplantation ◽

Cystatin C ◽

Inulin Clearance ◽

Serum Cystatin C ◽

Serum Cystatin

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Serum cystatin C in mouse models: a reliable and precise marker for renal function and superior to serum creatinine

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfn626 ◽

2008 ◽

Vol 24 (4) ◽

pp. 1157-1161 ◽

Cited By ~ 54

Author(s):

S. Song ◽

M. Meyer ◽

T. R. Turk ◽

B. Wilde ◽

T. Feldkamp ◽

...

Keyword(s):

Renal Function ◽

Serum Creatinine ◽

Mouse Models ◽

Cystatin C ◽

Serum Cystatin C ◽

Serum Cystatin

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Cystatin C at Admission in the Intensive Care Unit Predicts Mortality among Elderly Patients

ISRN Nephrology ◽

10.5402/2013/673795 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Maria Aparecida Dalboni ◽

Daniel de Oliveira Beraldo ◽

Beata Marie Redublo Quinto ◽

Rosângela Blaya ◽

Roberto Narciso ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Elderly Patients ◽

Cystatin C ◽

Independent Predictor ◽

Kidney Injury ◽

Roc Curves ◽

Serum Levels ◽

Serum Cystatin C ◽

Serum Cystatin

Introduction. Cystatin C has been used in the critical care setting to evaluate renal function. Nevertheless, it has also been found to correlate with mortality, but it is not clear whether this association is due to acute kidney injury (AKI) or to other mechanism. Objective. To evaluate whether serum cystatin C at intensive care unit (ICU) entry predicts AKI and mortality in elderly patients. Materials and Methods. It was a prospective study of ICU elderly patients without AKI at admission. We evaluated 400 patients based on normality for serum cystatin C at ICU entry, of whom 234 (58%) were selected and 45 (19%) developed AKI. Results. We observed that higher serum levels of cystatin C did not predict AKI ( versus mg/L; ). However, it was an independent predictor of mortality, H.R. = 6.16 (95% CI 1.46–26.00; ), in contrast with AKI, which was not associated with death. In the ROC curves, cystatin C also provided a moderate and significant area (0.67; ) compared to AKI (0.47; ) to detect death. Conclusion. We demonstrated that higher cystatin C levels are an independent predictor of mortality in ICU elderly patients and may be used as a marker of poor prognosis.

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Cystatin C is a Better Marker of Renal Dysfunction in Hypertensive Pregnancies

Indian Journal of Medical Biochemistry ◽

10.5005/jp-journals-10054-0005 ◽

2016 ◽

Vol 20 (1) ◽

pp. 21-27 ◽

Cited By ~ 1

Author(s):

Rajeev Ranjan ◽

Anjana Singh

Keyword(s):

Renal Function ◽

Uric Acid ◽

Serum Creatinine ◽

Renal Dysfunction ◽

Cystatin C ◽

Normal Pregnancy ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Function Tests ◽

Renal Function Tests

ABSTRACT Background Glomerular endotheliosis is an essential component in the pathophysiology of gestational hypertension (GH) and preeclampsia (PE) which results in renal dysfunction. This is not always detected by routine renal function tests, such as serum creatinine, urea, and uric acid. Cystatin C, an endogenous cysteine protease inhibitor, is completely absorbed by renal tubules and has been shown to be an ideal marker of glomerular filtration rate (GFR), which needs to be evaluated in assessing renal dysfunction occurring in GH and PE. Aims The present study is designed to evaluate serum cystatin C levels in normal pregnancy, GH, and PE and compare its efficacy with traditional renal function tests. Materials and methods In this prospective cross-sectional study, 75 subjects enrolled, comprised of 25 subjects each of normal pregnancy, GH, and PE. Serum cystatin C, blood urea, serum creatinine, serum uric acid, and urinary protein/creatinine ratio were estimated in all subjects prior to delivery. Results All renal parameters including cystatin C were significantly raised in GH and PE compared with control group. However, only serum cystatin C level (and no other renal parameters) was significantly higher in PE group compared with GH group. Area under the curve for cystatin C was maximum (0.917) compared with other parameters. Cystatin C had a higher sensitivity and specificity than other conventional markers. Conclusion Serum cystatin C is a better marker of renal dysfunction in hypertensive pregnancies. How to cite this article Singh A, Gupta M, Ranjan R, Saini V, Gupta SK. Cystatin C is a Better Marker of Renal Dysfunction in Hypertensive Pregnancies. Indian J Med Biochem 2016; 20(1):21-27.

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Serum Creatinine and Serum Cystatin C are Both Relevant Renal Markers to Estimate Vancomycin Clearance in Critically Ill Neonates

Frontiers in Pharmacology ◽

10.3389/fphar.2021.634686 ◽

2021 ◽

Vol 12 ◽

Author(s):

Stéphanie Leroux ◽

Valérie Biran ◽

John van den Anker ◽

Verena Gotta ◽

Wei Zhao ◽

...

Keyword(s):

Mechanical Ventilation ◽

Intensive Care ◽

Serum Creatinine ◽

Kidney Function ◽

Cystatin C ◽

Therapeutic Drug ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Final Model ◽

Model Based

Purpose: Serum creatinine (SCr) is used as a marker of kidney function to guide dosing of renally eliminated drugs. Serum Cystatin C (S-CysC) has been suggested as a more reliable kidney marker than SCr in adults and children. Purpose of this study was to investigate S-CysC as alternative renal marker to SCr for estimating vancomycin clearance in neonates undergoing intensive care.Methods: Vancomycin pharmacokinetics (PK), SCr and S-CysC data were collected in patients undergoing vancomycin treatment in the neonatal intensive care unit of Robert Debré Hospital - Paris. A population PK analysis was performed utilizing routine therapeutic drug monitoring samples. S-CysC and SCr were compared as covariates on vancomycin clearance using stepwise covariate modeling (forward inclusion [p < 0.05] and backward elimination [p < 0.01]). Model performance was evaluated by graphical and statistical criteria.Results: A total of 108 vancomycin concentrations from 66 patients (postmenstrual age [PMA] of 26–46 weeks) were modeled with an allometric one-compartment model. The median (range) values for SCr and S-CysC were 41 (12–153) µmol/l and 1.43 (0.95–2.83) mg/l, respectively. Following stepwise covariate model building, SCr was retained as single marker of kidney function (after accounting for weight and PMA) in the final model. Compared to the final model based on SCr, the alternative model based on S-CysC showed very similar performance (e.g. BIC of 578.3 vs. 576.4) but included one additional covariate: impact of mechanical ventilation on vancomycin clearance, in addition to the effects of size and maturation.Conclusion: ill neonates. However, if using S-CysC for this purpose mechanical ventilation needs to be taken into account.

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The alteration of renal function in sepsis and septic shock patients in pediatric intensive care unit

Paediatrica Indonesiana ◽

10.14238/pi51.2.2011.89-93 ◽

2011 ◽

Vol 51 (2) ◽

pp. 89

Author(s):

Feiby Julianto ◽

Adrian Umboh ◽

Suryadi Tatura

Keyword(s):

Intensive Care Unit ◽

Septic Shock ◽

Renal Function ◽

Intensive Care ◽

Mortality Rate ◽

Correlation Coefficient ◽

Pediatric Intensive Care Unit ◽

Pediatric Intensive Care ◽

Sepsis Group ◽

Sepsis And Septic Shock

Background Sepsis is a commonly seen emergency case in the pediatric intensive care unit.1 Severe sepsis mortality rate in developed country andin developing country such as Indonesia are 9% and 50-70%, respectively. Furthennore, the mortality rate in septic shock is 80%.2 Several researches documented increasing rate of acute kidney injury (AKI) incidence correlated 'With sepsis. Clinical intervention identification may decrease AKI and sepsis incidence.Objective To identify the correlation between incidence of AKI in sepsis and in septic shock patients who was treated in pediatric intensive care unit (PICU).Methods A cross sectional study was perfonned in 37 patients diagnosed as sepsis according ACCP/SCCM criteria for children aged 1 month to 13 years. The study was conducted in Pediatric Department, Prof. Dr. R.D. Kandou hospital from April 2009 to June 2009.Results From 37 sepsis patients, 27 were boys and 10 were girls. In the sepsis group (n=27) 10 had AKI, and in the septic shock group (n= 10) had AKI. Phi correlation coefficient applied to statistically analyzed sepsis in correlation with AKI (creatinin serum and GFR). Significant Phi correlation coefficient was (r=0.117; P> 0.05)Conclusions The study concludes that there is no correlation of renal function impainnent Mth sepsis and septic shock.

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Factors contributing to discrepant estimated glomerular filtration values measured by creatinine and cystatin C in patients with rheumatoid arthritis

10.21203/rs.3.rs-22338/v1 ◽

2020 ◽

Author(s):

Mitsuhiro Kawano ◽

Akikatsu Nakashima ◽

Shigeto Horita ◽

Takahiro Matsunaga ◽

Ryo Inoue ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Diabetes Mellitus ◽

Renal Function ◽

Serum Creatinine ◽

Cystatin C ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Stage 4 ◽

Group A ◽

Group B

Abstract Background This study aimed to clarify the factors underlying the discrepancy that has been noted between estimated glomerular filtration ratio (eGFR) measured using serum creatinine (Cr) and eGFR using serum cystatin C (CysC) in patients with rheumatoid arthritis (RA) and to identify those patients whose renal function should be evaluated using CysC.Methods We retrospectively evaluated clinical features, disease activity, radiological grading, and co-morbidities (diabetes mellitus, hypertension, dyslipidemia) in 238 RA patients. eGFR using serum creatinine (eGFR-Cr) and eGFR using serum cystatin C (eGFR-CysC) were calculated using the new Japanese coefficient-modified Modification of Diet in Renal Disease study equation. To clarify the cause(s) of differences of 20% or more between the two eGFRs, we divided our RA patients into Group A (eGFR-Cr/eGFR-CysC ≥ 1.2), with eGFR-Cr more than 20% higher than eGFR-CysC, and Group B (eGFR-Cr/eGFR-CysC < 1.2), and compared various clinical parameters between them.Results Forty-five patients (18.9%) were assigned to Group A, and 193 (81.1%) to Group B. Group A were older (73.8 ± 12.5 vs 63.2 ± 13.6 years), and had a longer disease duration (17.7 ± 14.0 vs 10.4 ± 9.5 years), lower body mass index (BMI) (20.0 ± 2.9 vs 22.4 ± 3.6 kg/m2), higher frequencies of hypertension and diabetes mellitus (55.6% vs 30.1% and 35.6% vs 11.0%, respectively), higher DAS28-ESR (3.1 ± 1.3 vs 2.6 ± 1.0), lower hemoglobin (Hb) (11.8 ± 1.8 vs 12.8 ± 1.4 g/dl), lower creatine kinase (CK) (63.9 ± 36.0 vs 92 ± 79 IU/L), higher frequency of Steinbrocker stage 4 (46.7% vs. 15.3%), and a lower frequency of nonsteroidal anti-inflammatory drugs (NSAID) use (13.3% vs 30.6%), all significantly (p < 0.01) by a univariate analysis. BMI (Odds Ratio [OR] 0.820, 95% confidence interval [CI] 0.675–0.996), Hb (OR 0.633, 95% CI 0.433–0.926), CK (OR 0.773 per 10 units, 95% CI 0.644–0.933), NSAID use (OR 0.099, 95% CI 0.020–0.494), diabetes mellitus (OR 6.024, 95% CI 1.508–24.390) and stage 4 Steinbrocker radiological grade (OR 10.309, 95% CI 2.994–35.714) were identified as independent relevant factors for Group A by a multifactorial analysis.Conclusion Renal function in RA patients with low BMI, diabetes, anemia and low CK may be overestimated using eGFR-Cr alone, and such patients need to be evaluated using eGFR-CysC.

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The elevated serum urea : creatinine ratio in canine babesiosis in South Africa is not of renal origin

Journal of the South African Veterinary Association ◽

10.4102/jsava.v77i4.373 ◽

2006 ◽

Vol 77 (4) ◽

Cited By ~ 10

Author(s):

M.P. De Scally ◽

A.L. Leisewitz ◽

R.G. Lobetti ◽

P.N. Thompson

Keyword(s):

Renal Failure ◽

Renal Function ◽

Serum Creatinine ◽

Cystatin C ◽

Elevated Serum ◽

Serum Urea ◽

Canine Babesiosis ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Renal Origin

Pigmented serum, usually due to free haemoglobin and/or bilirubin, is a common finding in dogs with babesiosis, resulting in interference with all biochemical tests that rely on photochemistry. This is particularly true of urea and creatinine determinations, complicating the diagnosis of acute renal failure, which is a serious complication of babesiosis. A disproportionately raised serum urea concentration of unknown origin occurs in severely anaemic canine babesiosis patients and gives rise to an increased serum urea:creatinine ratio. The assay for cystatin-C, an excellent measure of glomerular filtration rate, is unaffected by free serum haemoglobin, and due to its different intrinsic origins, is free of influence by the metabolic derangements and organ pathology, other than renal disease, encountered in canine babesiosis. Serum cystatin-C was used to compare the concentrations of serum urea and serum creatinine in dogs with the severely anaemic form of canine babesiosis as well as a canine babesiosis-free reference group. Mean serum urea and mean serum urea:creatinine ratio were significantly elevated in the babesia-infected group relative to the reference population in this study. Mean serum creatinine and mean serum cystatin-C were within the reference ranges. Therefore an elevated urea:creatinine ratio in canine babesiosis in the presence of a normal serum creatinine concentration is considered to be caused by an elevated serum urea concentration and is most likely of non-renal origin. Serum creatinine was therefore as specific a measure of renal function as serum cystatin-C in canine babesiosis in this study. The sensitivity of serum creatinine as a measure of renal function was not established by this study. Serum urea, however, proved to be of little use compared to serum cystatin-C and serum creatinine. Serum urea should therefore not be used to diagnose renal failure in canine babesiosis.

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