scholarly journals Role of cystatin C as a biomarker of acute kidney injury and as an independent long-term predictor of cardiovascular events, mortality and functional outcome

2012 ◽  
Author(s):  
Carolina Marrani ◽  
Teuta Zenjelaj ◽  
Daniela Bartoli ◽  
Francesco Corradi ◽  
Rinaldo Innocenti
Keyword(s):  
Acute Kidney Injury ◽  
Cystatin C ◽  
Cardiovascular Events ◽  
Cox Regression ◽  
Elevated Serum ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Long Term Mortality

Introduction Serum cystatin C measurements as an early biomarker of acute kidney injury (AKI) is gaining acceptance as studies confirm and define its usefulness. The aim of this study is to determine whether increase in serum cystatin C has an impact on long-term mortality, independently from the presence of the kidney injury itself.Materials and methods A retrospective study (20-month follow-up) was conducted in 173 not selected hospitalized patients. According to serum cystatin C concentrations, patients were stratified in risk classes by quartiles (≥0.55 and <1 mg/L; ≥1 and <1.17 mg/L; ≥1.17 and 1.57 mg/L; ≥1.57 and ≤5.29 mg/L). We compared the association of cystatin C levels with the risk for long-term mortality, after adjustment for age, sex, race and heart failure risk factors.Results A relationship with higher serum levels of cystatin C and mortality was found in patients with and without AKI, being stronger in patients without AKI. After multivariate adjustment, the highest quartile of cystatin C (>1.5 mg/L) was associated with a lower risk for long-term mortality. The statistical analysis (Cox regression) of the independent variables as far as mortality is concerned confirmed the significance of our result (RR 3.60; IC 1.73–7.48; p = 0.001).Conclusions In summary, elevated serum cystatin C level (>1.5 mg/L) was strongly and independently associated with negative clinical outcomes such as mortality and cardiovascular events, independently from the kidney injury itself. The dosage of cystatin C might play an important role in clinical practice for the assessment of cardiovascular risk stratification.

scholarly journals Acute Kidney Injuries in Children with Severe Malaria

2020 ◽  
Vol 20 (4) ◽  
pp. e312-317
Author(s):  
Folake M. Afolayan ◽  
Olanrewaju T. Adedoyin ◽  
Mohammed B. Abdulkadir ◽  
Olayinka R. Ibrahim ◽  
Sikiru A. Biliaminu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Severe Malaria ◽  
Diagnostic Criteria ◽  
Cystatin C ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin

Objectives: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria. Keywords: Biomarkers; Acute Kidney Injury; Renal Failure; Glomerular Filtration Rate; Cystatin C; Creatinine; Malaria; Nigeria.

scholarly journals The Combination of Serum Cystatin C, Urinary Kidney Injury Molecule-1 and MELD plus Score Predicts Early Acute Kidney Injury after Liver Transplantation

2018 ◽  
Vol 23 (2) ◽  
pp. 121 ◽  
Author(s):  
Marian-Irinel Tudoroiu ◽  
Georgiana Constantin ◽  
Liliana Pâslaru ◽  
Speranţa Iacob ◽  
Cristian Gheorghe ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Acute Kidney Injury ◽  
Cystatin C ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Kidney Injury Molecule 1

scholarly journals Use of Both Serum Cystatin C and Creatinine as Diagnostic Criteria for Cardiac Surgery-Associated Acute Kidney Injury and Its Correlation with Long-Term Major Adverse Events

2019 ◽  
Vol 44 (3) ◽  
pp. 415-425
Author(s):  
Miaolin Che ◽  
Xudong Wang ◽  
Bo Xie ◽  
Ritai Huang ◽  
Shang Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Adverse Events ◽  
Predictive Value ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Single Marker ◽  
Major Adverse Events

Background/Aims: Cardiac surgery-associated acute kidney injury (CSA-AKI) was traditionally defined as an increase in serum creatinine (sCr) after cardiac surgery. Recently, serum cystatin C (sCyC) has been proposed to be a better biomarker in the prediction of AKI. The clinical utility and performance of combining sCyC and sCr in patients with AKI, particularly for the prediction of long-term outcomes, remain unknown. Methods: We measured sCyC together with sCr in 628 patients undergoing cardiac surgery. sCyC and sCr were assessed at baseline and 24 and 48 h after surgery. CSA-AKI determined by sCr (CSA-AKIsCr) was defined as an sCr increase greater than 0.3 mg/dL or 50% from baseline. Major adverse events (MAEs; including death of any cause and dialysis) at 3 years were assessed. Results: CSA-AKIsCr developed in 178 patients (28.3%). Three-year follow-up was available for 621 patients; MAEs occurred in 42 patients (6.8%). An increase in sCyC concentration ≥30% within 48 h after surgery was detected in 228 patients (36.3%). This was the best sCyC cutoff for CSA-AKIsCr detection (negative predictive value = 88.8%, positive predictive value = 58.3%). To evaluate the use of both sCyC and sCr as CSA-AKI diagnostic criteria, we stratified patients into 3 groups: non-CSA-AKI, CSA-AKI detected by a single marker, and CSA-AKI detected by both markers. By multivariable logistic regression analysis, the independent predictors of MAEs at 3 years were group 2 (non-CSA-AKI group as the reference, CSA-AKI detected by a single marker: odds ratio [OR] = 3.48, 95% confidence interval [CI]: 1.27–9.58, p = 0.016), group 3 (CSA-AKI detected by both markers: OR = 5.12, 95% CI: 2.01–13.09; p = 0.001), and baseline glomerular filtration rate (OR = 2.24; 95% CI: 1.27–3.95; p = 0.005). Conclusion: Combining sCyC and sCr to diagnose CSA-AKI would be beneficial for risk stratification and prognosis in patients after cardiac surgery.

scholarly journals Early postoperative serum cystatin C predicts severe acute kidney injury following pediatric cardiac surgery

2011 ◽  
Vol 80 (6) ◽  
pp. 655-662 ◽  
Author(s):  
Michael Zappitelli ◽  
Catherine D. Krawczeski ◽  
Prasad Devarajan ◽  
Zhu Wang ◽  
Kyaw Sint ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
Cystatin C ◽  
Kidney Injury ◽  
Pediatric Cardiac Surgery ◽  
Serum Cystatin C ◽  
Serum Cystatin ◽  
Postoperative Serum

scholarly journals Comparison of serum creatinine and serum cystatin C as biomarkers to detect sepsis-induced acute kidney injury and to predict mortality in CD-1 mice

2014 ◽  
Vol 307 (8) ◽  
pp. F939-F948 ◽  
Author(s):  
Asada Leelahavanichkul ◽  
Ana Carolina P. Souza ◽  
Jonathan M. Street ◽  
Victor Hsu ◽  
Takayuki Tsuji ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Serum Creatinine ◽  
Cystatin C ◽  
Cecal Ligation ◽  
Kidney Injury ◽  
Organ Damage ◽  
Experimental Sepsis ◽  
Sepsis Mortality ◽  
Serum Cystatin C ◽  
Serum Cystatin

Acute kidney injury (AKI) dramatically increases sepsis mortality, but AKI diagnosis is delayed when based on serum creatinine (SCr) changes, due in part, to decreased creatinine production. During experimental sepsis, we compared serum cystatin C (sCysC), SCr, and blood urea nitrogen (BUN) to inulin glomerular filtration rate (iGFR) before or 3–18 h after cecal ligation and puncture (CLP)-induced sepsis in CD-1 mice. sCysC had a faster increase and reached peak levels more rapidly than SCr in both sepsis and bilateral nephrectomy (BiNx) models. sCysC was a better surrogate of iGFR than SCr during sepsis. Combining sCysC with SCr values into a composite biomarker improved correlation with iGFR better than any biomarker alone or any other combination. We determined the renal contribution to sCysC handling with BiNx. sCysC and SCr were lower post-BiNx/CLP than post-BiNx alone, despite increased inflammatory and nonrenal organ damage biomarkers. Sepsis decreased CysC production in nephrectomized mice without changing body weight or CysC space. Sepsis decreased sCysC production and increased nonrenal clearance, similar to effects of sepsis on SCr. sCysC, SCr, and BUN were measured 6 h postsepsis to link AKI with mortality. Mice with above-median sCysC, BUN, or SCr values 6 h postsepsis died earlier than mice with below-median values, corresponding to a substantial AKI association with sepsis mortality in this model. sCysC performs similarly to SCr in classifying mice at risk for early mortality. We conclude that sCysC detects AKI early and better reflects iGFR in CLP-induced sepsis. This study shows that renal biomarkers need to be evaluated in specific contexts.

scholarly journals A comparison between two different definitions of contrast-associated acute kidney injury for long-term mortality in patients with diabetes undergoing coronary angiography: a prospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Zhubin Lun ◽  
Li Lei ◽  
Dianhua Zhou ◽  
Ming Ying ◽  
Liwei Liu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Coronary Angiography ◽  
Cox Regression ◽  
Kidney Injury ◽  
Diabetic Patients ◽  
Patients With Diabetes ◽  
Long Term Prognosis ◽  
Population Attributable Risks ◽  
Long Term Mortality

Abstract Background The definitions of contrast-associated acute kidney injury (CA-AKI) are diverse and have different predictive effects for prognosis, which are adverse for clinical practice. Few articles have discussed the relationship between these definitions and long-term prognosis in patients with diabetes. Methods A total of 1154 diabetic patients who were undergoing coronary angiography (CAG) were included in this study. Two definitions of CA-AKI were used: CA-AKIA was defined as an increase ≥ 0.3 mg/dl or > 50% in serum creatinine (SCr) from baseline within 72 h after CAG, and CA-AKIB was defined as an increase ≥ 0.5 mg/dl or > 25% in SCr from baseline within 72 h after CAG. We used Cox regression to evaluate the association of these two CA-AKI definitions with long-term mortality and calculate the population attributable risks (PARs) of different definitions for long-term prognosis. Results During the median follow-up period of 7.4 (6.2–8.2) years, the overall long-term mortality was 18.84%, and the long-term mortality in patients with CA-AKI according to both CA-AKIA and CA-AKIB criteria were 36.73% and 28.86%, respectively. We found that CA-AKIA (HR: 2.349, 95% CI 1.570–3.517, p = 0.001) and CA-AKIB (HR: 1.608, 95% CI 1.106–2.339, p = 0.013) were associated with long-term mortality. The PARs were the highest for CA-AKIA (31.14%), followed by CA-AKIB (14.93%). Conclusions CA-AKI is a common complication in diabetic patients receiving CAG. The two CA-AKI definitions are significantly associated with a poor long-term prognosis, and CA-AKIA, with the highest PAR, needs more clinical attention.

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