Acute Kidney Injury Biomarkers and Hydration Outcomes at the Boston Marathon

The purpose of our field study was to investigate the effects of running the Boston Marathon on acute kidney injury (AKI) biomarkers. We hypothesized that biomarker values would be elevated immediately post-marathon but would resolve in the 24-h post-marathon. Secondarily, we sought to identify sex differences related to renal stress. Participants were 65 runners who completed the Boston Marathon (46 ± 9 years, 65.4 ± 10.8 kg). Urine samples were collected at three different time points (pre-marathon, post-marathon, and 24-h post-marathon). Blood samples were collected post-marathon and 24-h post-marathon. Urine specific gravity (USG) and AKI biomarkers were evaluated. Pre-marathon USG (1.012 ± 0.007) was significantly less than post-marathon (1.018 ± 0.008) and 24-h post-marathon (1.020 ± 0.009; P < 0.001). Male USG (1.024 ± 0.009) was significantly greater 24-h post-marathon than females (1.017 ± 0.008; P = 0.019). Urinary neutrophil gelatinase-associated lipocalin values were significantly greater over time (P < 0.001), and there was a main effect of sex with female urinary creatinine (UCr) greater than males at all three time points (P = 0.040). Post-marathonUCr (366.24 ± 295.16 mg/dl) was significantly greater than pre-marathon (206.65 ± 145.28.56 mg/dl; p < 0.001) and 24-h post-marathon was significantly lower than other time-points (93.90 ± 125.07 mg/dl; P < 0.001). FemaleUCr values were significantly greater than males 24-h post-marathon (P < 0.001). There was no difference in serum cystatin C (SCys) values post- or 24-h post-marathon (P = 0.178). Serum creatinine (SCr) significantly decreased between post-marathon and 24-h post-marathon, (P < 0.001). We can infer that the characteristics unique to the Boston Marathon may have attributed to prolonged elevations in AKI biomarkers. Sex differences were observed during the Boston Marathon warranting further investigation.

Early Vascular Aging in Children With Tuberous Sclerosis Complex

Objectives: Experimental data indicate that activating mutations in the mTOR (mammalian target of rapamycin) pathway may lead to abnormal arterial wall structure. Vascular anomalies like arterial stenoses are reported in pediatric patients with tuberous sclerosis complex (TSC). In addition, large renal lesions (angiomyolipoma—AML and cysts) are risk factors for arterial hypertension in adult patients with TSC. This study aimed to assess blood pressure, including central blood pressure and arterial damage (early vascular aging—EVA) in children with TSC.Materials and Methods: In a group of 33 pediatric patients with TSC (11.13 ± 4.03 years, 15 boys, 18 girls), we evaluated peripheral and central office blood pressure, 24-h ambulatory blood pressure, and arterial damage: aortic pulse wave velocity (aPWV) [m/s], [Z-score], augmentation index (AIx75HR [%]), common carotid artery intima-media thickness (cIMT) [mm], [Z-score], stiffness of common carotid artery (E-tracking), renal lesions in magnetic resonance and ultrasonography, and selected biochemical parameters. The control group consisted of 33 healthy children (11.23 ± 3.28 years, 15 boys, 18 girls).Results: In TSC group 7 (21.2%) children had arterial hypertension, 27 (81.8%) children had renal angiomyolipomas, 26 (78.8%)—renal cysts, and 4 (12.1%) patients were treated with mTOR inhibitors (2 patients with everolimus and 2 patients with sirolimus) at the moment of evaluation. Children with TSC had higher central systolic blood pressure (AoSBP) (98.63 ± 9.65 vs. 90.45 ± 6.87 [mm Hg], p < 0.001), cIMT (0.42 ± 0.05 vs. 0.39 ± 0.03 [mm], p = 0.011), cIMT Z-score (0.81 ± 1.21 vs. 0.16 ± 0.57, p = 0.007), aPWV (4.78 ± 0.81 vs. 4.25 ± 0.56 [m/s], p = 0.003) and aPWV Z-score (−0.14 ± 1.15 vs. −0.96 ± 0.87, p = 0.002) compared to healthy children, without differences in AIx75HR (8.71 ± 15.90 vs. 5.24 ± 11.12 [%], p = 0.319) and stiffness of common carotid artery. In children with TSC AoSBP correlated positively with serum cystatin C concentration (r = 0.377, p = 0.030) and with maximum diameter of renal cyst (R = 0.419, p = 0.033); mean arterial pressure (MAP) 24 h Z-score correlated with serum cystatin C concentration (R = 0.433, p = 0.013); and aPWV Z-score with daily urinary albumin loss [mg/24 h] (R = 0.412, p = 0.029).Conclusions: Children with tuberous sclerosis complex are at risk of elevated central blood pressure and early vascular aging. In children with TSC, blood pressure and arterial stiffness are related to renal involvement.

Analysis Of Serum Cystatin C Levels In People With Type 2 Diabetes Mellitus As A Biomarker Of Early Detection Of Atherosclerosis

Type 2 diabetes mellitus (DMT2) is associated with atherosclerosis, which causes the disease. cardiovascular and increased mortality. It is still difficult to detect ateroskelerosis in the early stages. Arterial stenosis often develops without symptoms in patients. DMT2, then causes cardiovascular disease. Therefore, development diagnostics to easily detect early-stage atherosclerosis are needed. In this study, we focused on cystatin C serum, an inhibitor of cysteine proteinase. Some research results, it has reported a significant correlation between serum Cystatin C levels and Arterial stiffness in a group of normal individuals. Cystatin C serum has a correlation strong with a value of elasticity of the carotid artery walls that reflect the degree of atherosclerosis subclinical. This is a new sign that is quite potential as a biomarker of early detection atherosclerosis. The purpose of the study is to know the picture serum Cystatin C levels as an early marker to determine the presence of possible complications of atherosclerosis in DMT2 patients, as well as the usefulness of Cystatin-C in predicting atherosclerosis of the early stages. Research methods are analytical research with use cross-sectional design. The study was conducted by calculating the value of Cystatin C blood serum with DMT2. The study subjects were people with DMT2 in RSUD.Labuang Baji Makassarand its network. Sum the sample in this study was 20 people. Determination of the research subject is done by conducting a search on medical records of DMT2 patients who meet the criteria of inclusion and exclusion to achieve minimum number of samples. The study subjects were classified into two groups based on medical record data searches are subclinical atherosclerosis group and nonclinical group ateroskelorosis. The research sample is a serum sample. Serum sample examination is carried out in the Clinical Prodia Laboratory using PENIA method. The results of this study reported the results that Cystatin-C Serum is closely correlated with subclinical atherosclerosis (arterial stiffness. Increase in serum cystatin-C levels indicates the risk of atherosclerosis in Patients with DMT2. The results of this study reported that serum cystatin C levels in dmt2 patients in the nonclinical atherosclerosis group (n = 10) showed normal cystatin levels (0.50 - 0.96 mg/L), while serum Cystatin-C levels in dmt2 group patients showed normal cystatin levels (0.50 - 0.96 mg/L), while serum cystatin-C levels in DMT2 group patients Subclinical atherosclerosis (n = 10) has an increase in serum cystatin-C levels (> 0.90 mg/L). Level cystatin C serum is associated with SA in DMT2 patients. Cystatin C was identified as a predictor of atherosclerosis risk, after adjusting for a variety of factors associated with diabetes.

Associations of serum cystatin C with depressive symptoms and suicidal ideation in major depressive disorder

Background Individuals with major depressive disorder (MDD) have high suicidal ideation. There is evidence that serum cystatin C (Cys C) may be involved in the pathophysiology of MDD. The present study aimed to investigate Cys C concentration in patients with MDD and clarify its possible association with depressive symptoms and suicidal ideation. Methods An online cross-sectional survey of 159 patients diagnosed with MDD was conducted. Serum Cys C levels were measured using ADVIA 2400 biochemical analyzer. The 24-item Hamilton Depression Scale (HAMD-24) was administered to evaluate the depressive symptoms. Generalized linear regression, logistic regression and restricted cubic spline models were used to examine the association of serum Cys C levels with depressive symptoms and suicidal ideation. Results Serum Cys C levels were higher in MDD patients than in controls (p = 0.001) and were positively associated with scores on HAMD-24 in unadjusted (gender distribution, age, smoking, alcohol consumption, family history of depression and traumatic life events; (p = 0.003) and fully adjusted linear regression model (p = 0.005). The fully adjusted regression coefficient with 95% confidence intervals for serum Cys C levels and HAMD-24 score was 30.339 (9.602 to 51.077). The level of Cys C in the suicidal ideation (SI) group was significantly higher than that in the non-suicide ideation (non-SI) group (p = 0.001). Serum Cys C levels were positively associated with suicidal ideation in each logistic regression model (all p < 0.05). Conclusion Serum Cys C levels were elevated in MDD patients and appeared to be positively correlated with depressive symptoms and suicidal ideation. These findings suggest that the dysfunction of Cys C may be involved in the severity of depression and in the pathophysiological process of MDD. Thus, regulation of serum Cys C could potentially be an effective predictor of the severity of depression and potentially, play a role in reducing the risk of suicide in MDD patients.

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

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.

The predictive value of serum level of cystatin C for COVID-19 severity

To investigate the potential prognostic value of Serum cystatin C (sCys C) in patients with COVID-19 and determine the association of sCys C with severe COVID-19 illness. We performed a retrospective review of medical records of 162 (61.7 ± 13.5 years) patients with COVID-19. We assessed the predictive accuracy of sCys C for COVID-19 severity by the receiver operating characteristic (ROC) curve analysis. The participants were divided into two groups based on the sCys C cut-off value. We evaluated the association between high sCys C level and the development of severe COVID-19 disease, using a COX proportional hazards regression model. The area under the ROC curve was 0.708 (95% CI 0.594–0.822), the cut-off value was 1.245 (mg/L), and the sensitivity and specificity was 79.1% and 60.7%, respectively. A multivariable Cox analysis showed that a higher level of sCys C (adjusted HR 2.78 95% CI 1.25–6.18, p = 0.012) was significantly associated with an increased risk of developing a severe COVID-19 illness. Patients with a higher sCys C level have an increased risk of severe COVID-19 disease. Our findings suggest that early assessing sCys C could help to identify potential severe COVID-19 patients.

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.