Cystatin C and Iris: Advances in the Evaluation of Kidney Function in Critically Ill Dog

Critically ill hospitalized dogs are subject to certain complications, being acute kidney injury (AKI) a common one. Early diagnosis is crucial, and Cystatin C (CysC) is a reliable and early biomarker. The International Society of Renal Interest (IRIS) states that AKI severity can be assessed by mild changes in creatinine serum levels or reduction of urine output that cannot be considered biomarkers of renal injury but failure or insufficiency. Twenty-eight dogs admitted to the Intensive Care Unit under risk factors for the development of AKI were evaluated. Blood samples were collected for determination of sCr and CysC at admission and after 24, 48, and 72 h. Urine output was measured by daily monitoring, measured by collection in a closed system. The results showed the incidence of AKI was 67.9% based on the IRIS criteria and 78.6% based on cystatin C in critically ill patients' dogs. The measurement of serum cystatin C immediately on admission to the ICU was superior in the early identification of patients with AKI when compared to the IRIS classification and serum creatinine in critically ill dogs.

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Serum cystatin C is a poor biomarker for diagnosing acute kidney injury in critically-ill children

Indian Journal of Critical Care Medicine ◽

10.4103/0972-5229.114829 ◽

2013 ◽

Vol 17 (2) ◽

pp. 92-98 ◽

Cited By ~ 6

Author(s):

Hanan M. Hamed ◽

Seham Awad El-Sherbini ◽

Nahla A. Barakat ◽

Tarek M. Farid ◽

Enas Abdel Rasheed

Keyword(s):

Acute Kidney Injury ◽

Critically Ill ◽

Cystatin C ◽

Kidney Injury ◽

Critically Ill Children ◽

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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Serum Cystatin C, Kidney Injury Molecule-1, Neutrophil Gelatinase-Associated Lipocalin, Klotho and Fibroblast Growth Factor-23 in The Early Prediction of Acute Kidney Injury Associated With Sepsis in a Chinese Emergency Cohort Study

10.21203/rs.3.rs-1059386/v1 ◽

2021 ◽

Author(s):

Yuanyuan Pei ◽

Guangping Zhou ◽

Pengfei Wang ◽

Fang'e Shi ◽

Xiaolu Ma ◽

...

Keyword(s):

Acute Kidney Injury ◽

Serum Creatinine ◽

Cystatin C ◽

Fibroblast Growth Factor 23 ◽

Kidney Injury ◽

Serum Levels ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Kidney Injury Molecule 1 ◽

Fgf 23

Abstract Background: Acute kidney injury (AKI) was a common and critical complication of sepsis, and is associated with unacceptable morbidity and mortality. Current diagnostic criteria for AKI was insensitive for early detection. Novel biomarkers included cystatin C, KIM-1, NGAL, klotho and FGF-23 which can predict AKI earlier may allow immediate interventions. We aimed to determine the diagnostic performance of these biomarkers for detecting AKI in sepsis patients.Methods: This prospective observational study was conducted from May 2018 and November 2020, enrolling sequential 162 sepsis patients. AKI’s definition was according to 2012 KDIGO criteria and we divided patients into non-AKI (n=102) and AKI (n=60) groups. Serum levels of several AKI biomarkers were detected by ELISA. The relationship between biomarker levels on admission of AKI were analyzed and discrimination performances comparison were performed.Results: AKI incidence was up to 37.0% (60/162) during hospitalization. Compared with non-AKI group, both serum cystatin C, KIM-1, NGAL and FGF-23 were significantly elevated at admission in septic AKI patients. The areas under the receiver operating curves demonstrated that serum cystatin C had modest discriminative powers for predicting AKI after sepsis, and cystatin C combined with serum creatinine in the prediction of septic AKI increased the diagnostic sensitivity prominently.Conclusion: Serum cystatin C, KIM-1, NGAL and FGF-23 levels are both increased in septic AKI patients. Our study provides reliable evidence that cystatin C solely and combined with serum creatinine may accurately and sensitively predict septic AKI when patients on admission.

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Early detection of acute kidney injury by serum cystatin C in critically ill children

Pediatric Nephrology ◽

10.1007/s00467-013-2586-5 ◽

2013 ◽

Vol 29 (1) ◽

pp. 133-138 ◽

Cited By ~ 19

Author(s):

Neamatollah Ataei ◽

Behnaz Bazargani ◽

Sonbol Ameli ◽

Abbas Madani ◽

Faezeh Javadilarijani ◽

...

Keyword(s):

Acute Kidney Injury ◽

Early Detection ◽

Critically Ill ◽

Cystatin C ◽

Kidney Injury ◽

Critically Ill Children ◽

Serum Cystatin C ◽

Serum Cystatin

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Evaluation of Serum Cystatin C as an Early Biomarker of Acute Kidney Injury in Patients with Acute Pancreatitis

Indian Journal of Critical Care Medicine ◽

10.5005/jp-journals-10071-23572 ◽

2020 ◽

Vol 24 (9) ◽

pp. 777-782

Author(s):

Radhey Shyam ◽

Rekha Sachan ◽

ML Patel ◽

Harish Bharti ◽

KK Gupta ◽

...

Keyword(s):

Acute Kidney Injury ◽

Acute Pancreatitis ◽

Cystatin C ◽

Kidney Injury ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Early Biomarker

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Kidney Biomarkers and Major Adverse Kidney Events in Critically Ill Patients

Kidney360 ◽

10.34067/kid.0003552020 ◽

2020 ◽

pp. 10.34067/KID.0003552020

Author(s):

Alexander H. Flannery ◽

Katherine Bosler ◽

Victor M. Ortiz-Soriano ◽

Fabiola Gianella ◽

Victor Prado ◽

...

Keyword(s):

Prediction Model ◽

Critically Ill ◽

Cystatin C ◽

Critically Ill Patients ◽

Kidney Injury ◽

Clinical Prediction ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Clinical Prediction Model ◽

Major Adverse Kidney Events

Background: Several biomarkers of acute kidney injury (AKI) have been examined for their ability to predict AKI before serum creatinine. Few studies have focused on using kidney biomarkers to better predict major adverse kidney events (MAKE), an increasingly used composite outcome in critical care nephrology research. Methods: Single-center prospective study collecting blood and urine samples from critically ill patients with AKI Kidney Disease: Improving Global Outcomes stage 2 or above, and matched controls from a single, tertiary care intensive care unit. Samples were collected at 24-48 hours after AKI diagnosis (cases) or ICU admission (controls), 5-7 days later, and 4-6 weeks following discharge for AKI patients. The primary outcome of interest was MAKE at hospital discharge (MAKE-DC), consisting of the composite endpoint of death, renal replacement therapy dependence, or a decrease in estimated glomerular filtration to <75% of baseline. Results: Serum/urinary neutrophil gelatinase-associated lipocalin (NGAL), serum/urinary cystatin C, and urinary kidney injury molecule-1 early in the AKI or ICU course were all significantly higher in patients with MAKE-DC compared to those not experiencing MAKE-DC. Additionally, serum/urinary NGAL and serum cystatin C measurements at the first time point remained significantly associated with MAKE events at 3, 6, and 12 months. Serum cystatin C, and to a lesser extent serum NGAL, significantly improved upon a logistic regression clinical prediction model of MAKE-DC (AUROC 0.94 and 0.87 vs. 0.83; p= 0.001 and 0.019, respectively). Patients without MAKE-DC experienced a greater decline in serum NGAL from first to second measurement than those patients experiencing MAKE-DC. Conclusion: Early measures of kidney biomarkers in critically ill patients are associated with MAKE-DC. This relationship appears to be greatest with serum NGAL and cystatin C, which display additive utility to a clinical prediction model. Trending serum NGAL may also have utility in predicting MAKE-DC.

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Estimated Glomerular Filtration Rate Correlates Poorly with Four-Hour Creatinine Clearance in Critically Ill Patients with Acute Kidney Injury

Critical Care Research and Practice ◽

10.1155/2013/406075 ◽

2013 ◽

Vol 2013 ◽

pp. 1-8 ◽

Cited By ~ 4

Author(s):

Christopher J. Kirwan ◽

Barbara J. Philips ◽

Iain A. M. MacPhee

Keyword(s):

Acute Kidney Injury ◽

Renal Function ◽

Glomerular Filtration Rate ◽

Critically Ill ◽

Cystatin C ◽

Critically Ill Patients ◽

Filtration Rate ◽

Kidney Injury ◽

Serum Cystatin C ◽

Serum Cystatin

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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Serum Cystatin C, Klotho, and Neutrophil Gelatinase-Associated Lipocalin in the Risk Prediction of Acute Kidney Injury after Acute Myocardial Infarction

Cardiorenal Medicine ◽

10.1159/000507387 ◽

2020 ◽

Vol 10 (6) ◽

pp. 374-381

Author(s):

Yuanyuan Pei ◽

Wen Chen ◽

Xue Mao ◽

Jihong Zhu

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Serum Creatinine ◽

Cystatin C ◽

Kidney Injury ◽

Serum Levels ◽

Serum Cystatin C ◽

Serum Cystatin ◽

Neutrophil Gelatinase Associated Lipocalin ◽

Neutrophil Gelatinase

Background: Patients with acute myocardial infarction (AMI) are at high risk for acute kidney injury (AKI). Novel biomarkers that can predict AKI after AMI may facilitate immediate interventions. Recently, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL), and klotho have been established as novel AKI biomarkers. However, their effects have not been studied in patients presenting with AMI. In this study, we will measure the serum levels of these three biomarkers to find reliable biomarkers for early diagnosis of AKI in AMI patients. Methods: This prospective observational cohort study was conducted between May 2016 and November 2017. A total of 285 consecutive patients with AMI were enrolled. The study was approved by the institutional review board of Peking University People’s Hospital (No. 2016PHB 042-01). AKI was defined according to the KDIGO criteria in 2012. At admission, the clinical data of patients was collected and serum levels of several AKI biomarkers, including cystatin C, NGAL, and klotho, were measured by ELISA. The relationship between biomarker levels of AKI were analyzed and their discrimination performances were compared. Results: AKI incidence was 17.5% (50/285) during hospitalization. Compared to patients without AKI, the AKI group had higher mortality (20.0% vs. 0.4%, p < 0.001) and tended to be older, had higher incidence of chronic kidney disease, severe cardiac function, more cardiac complications, larger doses of diuretics, and less use of angiotensin-converting enzyme inhibitors/angiotensin receptor blocker and statins. Moreover, AKI patients experienced an increase in serum cystatin C (3,709.2 ± 2,281.5 vs. 1,918.5 ± 1,140.6 ng/mL, p < 0.001), NGAL (118.0 ± 70.3 vs. 91.8 ± 52.3 ng/mL, p = 0.003), and klotho (742.2 ± 497.4 vs. 470.3 ± 257.2 pg/mL, p <0.001). Furthermore, the areas under the receiver operating curves demonstrated that serum cystatin C levels at admission had modest discriminative powers for predicting AKI after AMI compared with serum creatinine (0.899, 95% CI, 0.855–0.944 vs. 0.734, 95% CI, 0.649–0.819, p <0.001). There was no difference between the discrimination performances of serum creatinine, NGAL, and klotho. Conclusion: Elevated cystatin C levels are associated with AKI in patients with AMI. This study provides reliable evidence that cystatin C levels may be superior to serum creatinine for predicting AKI after AMI at admission.

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