A tale of two markers

Leung, Nelson

doi:10.1053/jlts.2002.34152

Cited by 9 publications

(6 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The gene encoding for cystatin C was cloned by a Swedish group in 1990 and Northern blot experiments have revealed that it is expressed in all human tissues examined, including kidney, liver, pancreas, intestine, stomach antrum, lung, and placenta 27. Cystatin C is produced at a constant rate and its levels are not influenced by inflammation or malignancy,28 being almost exclusively determined by glomerular filtration7 and being identical to those detected in adult subjects from the first year of life 11, 13, 14. Height, gender, and body composition do not influence serum cystatin C levels 11, 15.…”

Section: Discussionmentioning

confidence: 83%

Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation

et al. 2005

View full text Add to dashboard Cite

Renal dysfunction of variable severity is being increasingly recognized as a major complication of calcineurin inhibitors (CI), in some patients even necessitating renal transplantation. Close and effective monitoring of the renal function is indicated. Current methods for this monitoring are calculation of the glomerular filtration rate (GFR) based on creatinine or exogenous substances like 51 Cr-EDTA. The first method is unreliable in children and the second is expensive and cumbersome. Cystatin C has been shown to be an accurate marker of glomerular filtration but has not been evaluated in a large cohort of pediatric patients before and after liver transplantation (LT). We evaluated the accuracy of cystatin C in 62 children ( C alcineurin inhibitors (CI), cyclosporin, and tacrolimus have significantly contributed toward improved long-term survival of children after solid organ transplantation. 1 The current 5-year survival of children after liver transplantation (LT) is above 85% in most centers. Nephrotoxicity of variable severity is one of the most serious side effects of CI treatment, at times necessitating renal transplantation. 2 The incidence of nephrotoxicity in non-renal allograft patients is between 20% and 70%. 3 Although newer immunosuppressive drugs, like mycophenolate mofetil (MMF) and rapamicin, are not nephrotoxic, their use is still limited to rescue therapy for renal dysfunction or resistant cellular rejection. A large cohort of children worldwide is maintained on CI as anti-rejection drugs. In order to avoid irreversible renal damage, close and effective monitoring of their renal function is necessary. The gold standard for measuring glomerular function is inulin clearance or 51 Cr-EDTA estimation. Both methods are cumbersome and expensive, and 51 Cr-EDTA estimation requires administration of a radioactive substance. Serum creatinine is the endogenous substance most commonly used for estimation of glomerular filtration rate (GFR), but it is influenced by muscle mass, age, and gender, thus affecting its value in children. 4 A simple test to evaluate renal function in pediatric patients is highly desirable. Cystatin C, a low molecular weight protein, has recently been proposed as a reliable marker of renal function both in adults and children. 5 -15 After clearance from the plasma via glomerular filtration, cystatin C is completely reabsorbed and catabolized in the renal tubules. 7 Adult ranges are reached by the age of 1 year and are not influenced by gender, height, or body composition. 11 Reference ranges for both adults and children are available. 9 -14,16 Cystatin C has been assessed in adult and pediatric renal transplant recipients 9,16 -18 and in adults after liver transplantation, 19,20 but information is lacking in pediatric liver transplant recipients. The aim of this study was to evaluate cystatin C as a marker of renal function in a large cohort of pediatric patients with chronic liver disease and after liver transplantation.

show abstract

Section: Discussionmentioning

confidence: 83%

Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation

et al. 2005

View full text Add to dashboard Cite

show abstract

“…56 In a recent study, Gerbes et al evaluated 97 patients and concluded that cystatin C is a useful tool for renal function assessment, especially in patients with endstage liver disease, in women and for earlier diagnosis of renal impairment, compared to enzymatic Cr and C-G formula. 57 Renal dysfunction after renal or LT, mainly because of long-term exposure to calcineurin inhibitors, may also be best monitored by cystatin C. 58,59 Cystatin C is a reliable index of GFR after renal or LT, superior to Cr and C-G or Schwartz formulae. [60][61][62][63] In addition, several equations for GFR calculation from serum cystatin C have been developed.…”

Section: Alternative Serum Markers For Assessment Of Renal Functionmentioning

confidence: 99%

“…63 More studies are required to elucidate the usefulness of cystatin C as a marker of GFR in cirrhotics, particularly pre-LT and post-LT and to confirm its potential significant advantages over Cr. 59 These would obviate the increased cost of its measurement, and may reduce the need for isotope measurement of GFR. It could also replace Cr in prognostic formulae.…”

Section: Alternative Serum Markers For Assessment Of Renal Functionmentioning

confidence: 99%

Review article: renal function assessment in cirrhosis – difficulties and alternative measurements

Cholongitas

Shusang

Marelli

et al. 2007

Aliment Pharmacol Ther

136

123

View full text Add to dashboard Cite

Summary Background Renal function in patients with cirrhosis is important prognostically, both before and following liver transplantation. Its prognostic impact is reflected by the inclusion of serum creatinine in the model for end‐stage liver disease score, which is now used for recipient prioritization on liver transplantation waiting lists in the USA. Aim To review the accuracy of the surrogate markers for the assessment of renal function, i.e. glomerular filtration rate, particularly in patients with cirrhosis. Method We reviewed the available literature in PubMed regarding the markers for GFR evaluation and the factors which affect their accuracy in cirrhosis. Results Although creatinine is widely available, it is an unreliable marker of glomerular filtration rate, particularly in patients with cirrhosis. Clearance of exogenous markers is considered the ‘gold standard’, but this methodology has many drawbacks, particularly poor applicability. Several mathematical formulae for estimated glomerular filtration rate are used to overcome some of these limitations: Cockcroft‐Gault and Modification of Diet in Renal Disease formulae are the most frequently applied, but they are based on serum creatinine. Conclusions Due to the inaccuracy of serum creatinine and its derived formulae in estimating glomerular filtration rate, alternative serum markers, such as cystatin C, and new formulae are desirable. These need formal evaluation in patients with cirrhosis so as to have a reliable surrogate of glomerular filtration rate, and to obviate many problems that are associated with using creatinine and estimated glomerular filtration rate.

show abstract

“…Since the 1980s, cystatin C has been under investigation as a marker of renal function. 33 Cystatin C participates in immune defense through the inhibition of human polymononuclear cell chemotaxis. 34 The serum concentration of cystatin C is inversely correlated with GFR due to the fact that it is freely filtered in the kidney.…”

Section: Cystatin Cmentioning

confidence: 99%

Renal Function Tests: A Clinical Laboratory Perspective

Ogedegbe

2007

Lab Med

View full text Add to dashboard Cite

Worldwide, chronic kidney disease has become a public health problem with increasing prevalence and high cost for treatment and prevention. It is projected that by 2030 there will be about 2 million patients needing dialysis and transplantation. Kidneys perform vital functions in the homeostatic processes of the human body including the filtration of blood, maintenance of acid base, water and electrolyte balance, regulation of hormone levels, and removal of waste products and unwanted substances from plasma. Various hormones that have metabolic and physiological functions such as erythropoietin, the prostaglandins, and so forth, are produced by the kidneys. Several diseases, such as acute nephrotic syndrome, acute glomerulonephritis, and others, can singly or in combination precipitate renal diseases. Various clinical laboratory tests are useful in the investigation and evaluation of kidney function. Different treatment options available for the management and prevention of renal disease complications include dialysis and transplantation.

show abstract

A tale of two markers

Cited by 9 publications

References 32 publications

Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation

Cystatin C, an easy and reliable marker for assessment of renal dysfunction in children with liver disease and after liver transplantation

Review article: renal function assessment in cirrhosis – difficulties and alternative measurements

Renal Function Tests: A Clinical Laboratory Perspective

Contact Info

Product

Resources

About