Can Cystatin C Be a Better Marker for the Early Detection of Renal Damage in Primary Hypertensive Patients?

Abstract

In this study, we aimed to compare Cystatin C (Cys C) with other traditional glomerular filtration rate (GFR) markers and to evaluate its superiority over them in detecting early renal involvement in patients with primary hypertension. Fifty-one primary hypertensive patients and 29 healthy control subjects, who were similar in terms of age and gender, were included in the study. In all subjects serum levels of Cys C, beta-2 microglobulin, serum creatinine (SCr), uric acid, BUN, albumin; 24 h urinary levels of protein (Upro), albumin (Ualb) and creatinine were measured. The GFR was calculated according to Creatinine Clearance (CrCl), Cockcroft-Gault (CG) and Modification of Diet in Renal Disease (MDRD) formulas. The MDRD was used as the reference method. A GFR<80 mL/min/1.73 m2 was considered as the lower cut-off limit. Mean levels of the serum parameters were found to be significantly higher in the patient group than they were in the control group (p<0.05). Mean CrCl, CG, and MDRD levels were lower in patients than they were in controls but the difference was statistically significant for CG and MDRD. The serum parameter having the best correlation with MDRD was SCr (r = -0.760) in patients and Cys C (r = -0.622) in controls. However, in ROC analysis; the area under curve (AUC) for Cys C was found to be superior (AUC = 0.900) to the other markers. The CrCl was the parameter having the worst diagnostic efficiency (AUC = 0.598). As a conclusion, compared to other traditional markers, measurement of Cys C may be a better parameter to estimate GFR, especially to detect mild reductions of GFR in primary hypertensive patients.

Relationship between serum cystatin C and hypertension among US adults without clinically recognized chronic kidney disease

“…Relatively few previous studies examined the association between cystatin C levels and hypertension 8, 20–22 . Among 906 participants in the Heart and Soul Study, Peralta et al observed that systolic blood pressure was linearly associated with cystatin C (approximately 1.2 mm of Hg increase per 0.4 mg/L of cystatin C) 21 .…”

“…Among 906 participants in the Heart and Soul Study, Peralta et al observed that systolic blood pressure was linearly associated with cystatin C (approximately 1.2 mm of Hg increase per 0.4 mg/L of cystatin C) 21 . In another case-control study involving 51 primary hypertension cases and 29 healthy control subjects, Ozer et al concluded that cystatin C was more strongly associated with hypertension than other measures related to renal function such as creatinine clearance, serum uric acud, blood urea nitrogen, beta-2-microglobulin and urinary protein excretion 22 . Finally, in the Multi-Ethnic Study of Atheroscolerosis (MESA), Kestenbaum et al reported an overall positive association between serum cystatin C levels and hypertension 8 .…”

Serum Cystatin C is a Potential Endogenous Marker for the Estimation of Renal Function in Male Gout Patients with Renal Impairment

“…In addition, more sensitive indicators of GFR or renal function have been identified in a variety of diverse systemic diseases including nephropathy in type 2 diabetes mellitus (8), hypertensive nephropathy (9), solid organ transplantation (10), and coronary angiopathy (11). Few studies have investigated serum cystatin C as an endogenous marker of renal function in rheumatic diseases other than rheumatoid arthritis (15, 16).…”

“…Recently, Herget-Rosenthal and his colleagues found that determining cystatin C levels is a more sensitive test for the early detection of renal function impairment or reduced GFR (1). It has been recognized that an increase in serum cystatin C might well reflect changes in renal function or GFR for renal injury in diverse clinical conditions or diseases, including nephropathy associated with type 2 diabetes mellitus (8), hypertensive nephropathy (9), solid organ transplantation (10), and coronary angiopathy (11). …”

Cystatin C and Uncontrolled Hypertension

“…This trial demonstrated that serum cystatin C levels in patients with uncontrolled hypertension were higher than those in patients with controlled and without hypertension, although all groups had normal serum creatinine concentrations. Relatively few previous studies reported an association between serum cystatin C and hypertension (19,(23)(24)(25). Systolic blood pressure and pulse pressure were significantly associated with serum cystatin C concentrations in a previous study, even among patients with normal creatinine clearance (24).…”