Changes in renal function during acute spinal cord injury: implications for pharmacotherapy

Silver, J R

doi:10.1038/sc.2013.124

Cited by 2 publications

(1 citation statement)

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“…We collected Cr levels, BUN levels, and AIS grades. Although Cr levels increased on day 3 and BUN levels were increased on day 2, these levels were normal on most other days, suggesting that glomerular function may not be damaged after SCI; [23] thus, CysC may not be an appropriate indicator of renal function in acute SCI, or its levels at least may need to be adjusted. When samples were grouped by AIS grades, CysC levels of the AIS A group were higher than those of the AIS C and D groups.…”

Section: Discussionmentioning

confidence: 99%

Serum cystatin C is increased in acute spinal cord injury: a multicentre retrospective study

et al. 2019

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Study design A multicentre retrospective study. Objective A multicentre retrospective study was performed to observe the changes in serum cystatin C (CysC) levels in patients with acute spinal cord injury (SCI). Setting Four hospitals in China. Methods Over a 5-year study period, the CysC, creatinine (Cr), and blood urea nitrogen (BUN) levels of people who had incurred SCI in the preceding 7 days were collected and compared with those of people with limb fracture (LF) who were matched for injury time and gender. People with SCI also were grouped by injury duration, ASIA Impairment Scale (AIS) grade and the presence or absence of steroid therapy and compared each day. Results Three hundred and twenty-three samples from people with SCI were retrospectively collected; their mean serum CysC levels were significantly higher than those of people with LF (p < 0.001); No significant difference was observed in Cr or BUN levels between the two groups (p > 0.14). CysC levels increased on the second day, peaked on day 3, and returned to normal on day 5. The more severely injured individuals had higher CysC levels. Steroid therapy or not had no influence for CysC levels. Conclusion CysC levels are increased in patients with acute SCI, possibly as a direct result of injury. Serum CysC is a potential biomarker of SCI.

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Section: Discussionmentioning

confidence: 99%

Serum cystatin C is increased in acute spinal cord injury: a multicentre retrospective study

et al. 2019

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Response to ‘Changes in renal function during acute spinal cord injury: implications for pharmacotherapy’

et al. 2013

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We have read with the greatest interest the letter submitted by Dr Silver 1 in relation to our recent publication in Spinal Cord. 2 Being a pioneer in the study of renal disorders associated with spinal cord injury (SCI), we greatly appreciate his comments. Dr Silver is correct. There are studies performed nearly 60 years ago that provide information on renal function in SCI that we failed to mention in our paper. We deeply regret having omitted references to the classical work of Silver and his team on the early stages of renal function after spinal cord transection. 3 We had no intention of belittling such relevant work. Unfortunately, Medline searches performed using search terms such as 'spinal cord injury glomerular filtration' do not lead to these articles.Our results in an experimental model of SCI are not consistent with the clinical observations of Silver and colleagues on creatinine clearance. This can be due to methodological differences and certainly warrant further investigation. Nonetheless, there is evidence pointing to the fact that there are pharmacokinetic alterations during acute SCI that are likely associated with changes in renal function, which can modify drug response. 4,5 Such alterations have not yet been sufficiently characterized, as there has not been enough interest on these issues. We now intend to end with such inertia. Experimental models have proven to be useful to describe pharmacokinetic alterations due to SCI and can also be used for the characterization of the pathophysiological mechanisms underlying such alterations. 5,6 Evidently, clinical pharmacology studies are absolutely required to establish if dosing regimens need adjustment in patients with SCI compared to able-bodied individuals, and how adjustments should be performed depending on the localization, intensity and time elapsed after SCI. Needless to say that patients can significantly benefit from this information, as pharmacotherapy for this patient group is still far from being optimal. 7 We hope that our recent results 2 will bolster the interest of researchers in this field to study renal alterations, as well as other pathophysiological changes, and their impact on drug therapy in patients with SCI. Indeed, the investigations carried out by Silver and co-workers in the sixties are of paramount importance for these purposes. CONFLICT OF INTEREST

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Changes in renal function during acute spinal cord injury: implications for pharmacotherapy

Cited by 2 publications

References 6 publications

Serum cystatin C is increased in acute spinal cord injury: a multicentre retrospective study

Serum cystatin C is increased in acute spinal cord injury: a multicentre retrospective study

Response to ‘Changes in renal function during acute spinal cord injury: implications for pharmacotherapy’

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