Abstract 1672: Glomerular Insufficiency, An Early Marker Of Renal Dysfunction In Patients With A Fontan Circulation.

Introduction : Fontan circulations have high central venous pressures and low dynamic cardiac output, risk factors for depressed renal perfusion. Objectives : Hypothesizing subclinical renal dysfunction, we sought to characterize renal pathophysiology and cardio-renal interaction in this group. Method: 17 Fontan patients were tested for early morning urine cystatin C, alpha-1-microglobulin (A 1 M), retinol binding protein (RBP), protein:creatinine and albumin:creatinine ratio; serum cystatin C (S.Cys-C) and creatinine; echocardiography including Tissue Doppler (TDI); and renal Doppler. Results : 6 (mean age 22.8 ± 5.0years) of 17 patients (mean age 23.5 ± 4.2years) had subclinical renal dysfunction, mean S.Cys-C-derived glomerular filtration rate (GFR S.Cys-C ) 77.31 ± 7.82ml/min/1.73m 2 , vs. 114.21 ± 36.38ml/min/1.73m 2 in the remainder. Whilst GFR S.Cys-C correlated highly with 2-D visual assessment of systemic ventricular function (correlation=0.618; p=0.014) this was not the case for any TDI parameters. Tubular function indices (urine cystatin C, RBP and A 1 M) were normal. Glomerular function indices were abnormal for S.Cys-C, with mean 1.04 ± 0.06mg/L, range 0.97–1.11mg/L; (normal range:0.53–0.95mg/L). Gross morphological renal abnormalities included 3 abnormal bipolar sizes in both right (mean 9.13 ± 0.49cm) and left (mean 9.38 ± 0.66cm) kidneys (normal range>10cm), 6 and 5 abnormal renal cortical thicknesses in right (mean 11.61 ± 1.27mm) and left (mean 12.31 ± 0.92mm) kidneys respectively (normal range>13mm) and 1 mild scarring of the right kidney. Abnormal resistive indices were present in the right kidney of 3 patients (mean 0.79 ± 0.01, range 0.78–0.80), and in the left kidney of 2 patients (mean 0.83 ± 0.02, range 0.81–0.84). Patients with abnormal resistive indices (>0.77) had lower arterial saturations (mean 88.67 ± 2.08%, range 87–91% vs. mean 94.77 ± 2.46%, range 90–97% in those without) and higher haematocrit (mean 0.49 ± 0.01L/L, range 0.48–0.49L/L vs. mean 0.46 ± 0.03L/L, range 0.42–0.52L/L in those without). Conclusion : Fontan patients often have subclinical renal dysfunction mainly due to glomerular insufficiency. Ventricular function, cyanosis and polycythemia appear to be important drivers for renal dysfunction.

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73: Serum Cystatin-C and beta 2-Microglobulin as Markers of Renal Dysfunction in Japanese Heart Transplant Recipients

The Journal of Heart and Lung Transplantation ◽

10.1016/j.healun.2007.11.078 ◽

2008 ◽

Vol 27 (2) ◽

pp. S85-S86

Author(s):

S. Nunoda ◽

A. Sekikawa ◽

K. Shitakura ◽

K. Okajima ◽

S. Oinuma ◽

...

Keyword(s):

Renal Dysfunction ◽

Cystatin C ◽

Heart Transplant ◽

Transplant Recipients ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Heart Transplant Recipients ◽

Beta 2 ◽

Beta 2 Microglobulin

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Clinical utility of urinary neutrophil gelatinase-associated lipocalin and serum cystatin C in a cohort of liver cirrhosis patients with renal dysfunction

European Journal of Gastroenterology & Hepatology ◽

10.1097/meg.0000000000001347 ◽

2019 ◽

Vol 31 (6) ◽

pp. 692-702 ◽

Cited By ~ 1

Author(s):

Salwa H. Gomaa ◽

Mohammed M. Shamseya ◽

Marwa A. Madkour

Keyword(s):

Liver Cirrhosis ◽

Renal Dysfunction ◽

Cystatin C ◽

Clinical Utility ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

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P0853 : Serum cystatin C and NGAL levels at the outset of protease inhibitor antiviral therapy positively predict renal dysfunction development and anaemia severity

Journal of Hepatology ◽

10.1016/s0168-8278(15)31055-2 ◽

2015 ◽

Vol 62 ◽

pp. S659-S660

Author(s):

S. Verma ◽

I. Kraslova ◽

K. Agarwal

Keyword(s):

Protease Inhibitor ◽

Renal Dysfunction ◽

Antiviral Therapy ◽

Cystatin C ◽

Serum Cystatin C ◽

Serum Cystatin

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Serum Cystatin C and Tubular Urinary Enzymes as Biomarkers of Renal Dysfunction in Type 2 Diabetes Mellitus

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.4137/cmed.s12633 ◽

2013 ◽

Vol 6 ◽

pp. CMED.S12633 ◽

Cited By ~ 29

Author(s):

Heba S. Assal ◽

Salwa Tawfeek ◽

Enas A. Rasheed ◽

Dalia El-Lebedy ◽

Eman H. Thabet

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Renal Dysfunction ◽

Cystatin C ◽

Renal Damage ◽

Specific Marker ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Sensitive Marker

Renal tubulointerstitium plays an important role in the development and progression of diabetic nephropathy. The aim of this study was to assess serum cystatin C and 2 renal tubular enzymes, neutrophil gelatinase associated lipocalin (NGAL) and N-acetyl-beta-D-glucosaminidase (NAG), as screening markers for early renal dysfunction in patients with type 2 diabetes mellitus (T2DM). ROC curve analysis showed that urinary NAG is the most sensitive marker of microalbuminuria and early renal damage with sensitivity of 83.3%, while serum cystatin C was the most sensitive and specific marker of macroalbuminuria and damage progress with sensitivity of 70.8% and specificity of 83.3% versus 70.6% and 83.3% for uNGAL; and 64.7% and 66.7% for NAG, respectively. Our data indicate that urinary NAG is the most sensitive marker for early renal damage in diabetic patients. However, for damage progress, serum cystatin C is the most sensitive and specific marker for follow-up and monitoring renal dysfunction.

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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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Long Term Treatment with Hydroxyurea Does Not Prevent Development of Renal Dysfunction and Osteodystrophy in Patients with Sickle Cell Disease.

Blood ◽

10.1182/blood.v104.11.1675.1675 ◽

2004 ◽

Vol 104 (11) ◽

pp. 1675-1675

Author(s):

Ersi Voskaridou ◽

Evangelos Terpos ◽

Alexandra Margeli ◽

Eugenia Hantzi ◽

Eleni Stoupa ◽

...

Keyword(s):

Renal Function ◽

Sickle Cell Disease ◽

Renal Dysfunction ◽

Sickle Cell ◽

Cystatin C ◽

Renal Osteodystrophy ◽

Type I ◽

Cell Disease ◽

Serum Cystatin C ◽

Serum Cystatin

Abstract Hydroxyurea (HU) is presently considered as the main treatment for the reduction of sickle-cell crises; however, information regarding the potential of HU to inhibit progressive organ failure is scarce. The gradually failing renal function and renal osteodystrophy are well known complications of sickle cell disease (SCD). The pending question is whether administration of hydroxyurea over very long period of time may delay or prevent the appearance of these abnormalities. To this effect we evaluated the renal function and bone metabolism in 57 patients with HbS/β-thal (31M/26F; median age 32 years, range: 19–67 years) receiving hydroxyurea (usually 1 g/daily) continuously for 1 to 14 years (median 10.2 years). In addition to conventional renal biochemistry we measured the levels of serum and urinary β2-microglobulin (β2M), serum cystatin C (specific and sensitive index of glomerular filtration rate), and urine N-acetyl-b-D-glucosaminidase (NAG; reflecting the distal tubular cells function). The extent of renal osteodystrophy was evaluated by DEXA scans assessing bone mineral density (BMD), and by assaying various markers of (a) osteoclast function [soluble receptor activator of nuclear factor κB ligand (sRANKL), osteoprotegerin (OPG), and tartrate resistant acid phosphatase isoform 5b (TRACP-5b)], (b) bone resorption [C-telopeptide of collagen type I (CTX)], and (c) bone formation [bone-alkaline phosphatase (bALP) and osteocalcin (OC)]. The above parameters were also evaluated in 16 age- and gender-matched controls. Three patients (5.2%) had increased serum creatinine levels; 16 patients (28%) had more than 300 mg/day protein excretion in the urine, and 13 patients (22.8%) had microalbuminuria. Moreover, serum cystatin C was elevated in 16 patients (28%), NAG in 21 (36.8%), serum β2M in 34 (59.6%) and urinary β2M in one patient. In addition, 17 patients (29.8%) had osteoporosis/osteopenia in DEXA scans (comparable to HbS/β-thal patients who did not receive HU). Furthermore, all patients displayed significantly elevated levels of OPG (p=.001), sRANKL (p<.01), sRANKL/OPG ratio (p=.022), and CTX (p=.02), while significant correlations were found between serum cystatin C vs. both serum OPG and β2M levels as well as between cystatin C and the sRANKL/OPG ratio. Not only do these results suggest that HU does not prevent renal dysfunction in this cohort of patients but also highlight the role of RANKL/OPG pathway in the renal-induced bone disease of sickle cell syndromes. Furthermore, NAG, cystatin C and OPG may be useful as early biochemical markers for the assessment of renal impairment in SCD patients.

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The Value of Beta2 Microglobulin, Retinol Binding Protein, Endothelin-1, N Amino ß-d-Glucoaminodase and Cystatin C for the Evaluation Sickle Cell Nephropathy

Blood ◽

10.1182/blood.v116.21.4817.4817 ◽

2010 ◽

Vol 116 (21) ◽

pp. 4817-4817

Author(s):

Selma Unal ◽

Caglar Kotan ◽

Ali Delibas ◽

Ali Ertug Arslankoylu

Keyword(s):

Sickle Cell ◽

Cystatin C ◽

Past History ◽

Retinol Binding Protein ◽

Control Groups ◽

Serum Cystatin C ◽

Endothelin 1 ◽

Normal Ranges ◽

Sickle Cell Nephropathy ◽

And Control

Abstract Abstract 4817 Introduction: Sickle Cell Anemia (SCA) is a chronic disease characterized by broad clinical manifestations and multi-organ disease. Sickle cell nephropathy is one of the major side effects in the patients with SCA. This study was planned to determine the incidence of renal complications of the patients with SCA and to evaluate the renal complications by using new markers such as ß2 microglobulin, retinol binding protein (RBP), endothelin-1, N amino ß-d-glucoaminodase (NAG) and cystatin C. Methods: 45 children (mean age 8.4 ± 1.21, range: 1–15 years), 10 adult patients with SCA (mean age:31.4 ± 10.11, range: 16–45 years) and 20 healthy children (mean age:8.45 ± 4.05, range: 1–15 years), 10 healthy adults (mean age: 26.6 ± 8.62, range: 16–45 years) as control groups were included in the study. A detailed history was taken from each child, and a full physical examination was performed. Serum and urine electrolytes, urine analysis, urine culture and renal ultrasonography were performed for all patients. 24 hour urine was collected both in patient and control groups, and GFR was measured. Tubular phosphate reabsorbtion, 24 hour urine protein and calcium excretion, fractional excretion of Na, K, Urea and Cl were calculated from 24 hour urine samples. ß2 microglobulin, endothelin-1 RBP and NAG levels were measured in spot urine samples of patients and controls. Serum cystatin C level was measured in both patient and control groups. ß2 microglobulin, endothelin-1, RBP and cystatin C were measured with micro-elisa method. On the other hand colorimetric assay was used to measure NAG. Results: 35 patients (63%) had enuresis nocturna, 34 patients (61%) had moderate proteinuria and 9 patient (16%) had poliuria. 26 patients (47%) had past history of urinary tract infection and 3 patients had past history of hematuria. Although all the markers to evaluate tubular functions were in normal ranges, ß2 microglobulin/creatinine ratio was found to be high in 10 patients (18%). GFR measured with creatinine was in normal ranges in all of the patients. Hovewer GFR measured with cystatin-C was low in 3 patients (0.5%). Urine ß2 microglobulin, endothelin-1, RBP, NAG, and serum cystatin-C levels were all in normal ranges both in patient and control groups. Conclusions: The commonly observed renal side effects in the patients with SCA are enuresis nocturna, proteinuria and increased tendency to urinary tract infections. It could be suspected that ß2 microglobulin/creatinin ratio and GFR that is calculated by the use of cystatin C could be use in order to evaluate the tubular and glomerular functions in those patients with SCA during the early stages of sickle cell nephropathy. Besides, urine endothelin-1, RBP and NAG levels could not be considered as good markers for determining the sickle cell nephropathy. Disclosures: No relevant conflicts of interest to declare.

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