Cystatin C as a marker of GFR—history, indications, and future research

Filler, Guido; Bökenkamp, Arend; Hofmann, Walter; Bricon, Thierry Le; Martínez-Brú, Cecilia; Grubb, Anders

doi:10.1016/j.clinbiochem.2004.09.025

Cited by 659 publications

(556 citation statements)

References 77 publications

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“…In contrast, CysC might be a promising marker to be used for this purpose as it is independent of muscle mass [33][34][35]. CysC is a 13.3 Da non-glycosylated basic protein produced by all nucleated cells.…”

Section: Discussionmentioning

confidence: 99%

Renal function in children and adolescents with Duchenne muscular dystrophy

Braat

Hoste

Waele

et al. 2015

Neuromuscular Disorders

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Improved life expectancy and the need for robust tools to monitor renal safety of emerging new therapies have fueled the interest in renal function in Duchenne muscular dystrophy (DMD) patients. We aimed to establish a methodology to accurately assess their renal function. Twenty DMD patients (5-22 years) were included in this prospective study. After obtaining medical history, all patients underwent a clinical examination, 24-hour ambulatory blood pressure monitoring, ultrasound of the kidneys, direct GFR measurement ( 51 Cr-EDTA, mGFR), complete blood and urine analysis. Seventeen of 20 patients were treated with corticosteroids and 5/20 with angiotensin converting enzyme inhibitor (lisinopril). No patient suffered from urinary tract infections or other renal diseases. Hypertension (systolic or diastolic blood pressure >P95) was found in 9/20 patients (8/9 patients were on steroid treatment) and a non-dipping blood pressure profile in 13/20 subjects (10/13 patients were on steroid treatment). Urinary protein to creatinine ratio was elevated in 17/18 patients, whereas 24-hour urine protein excretion was normal in all subjects. Median interquartile range (IQR) mGFR was 130.4 (29.1) mL/min/1.73 m 2 . Hyperfiltration (mGFR >150 mL/min/1.73 m 2 ) was found in 5/20 patients. Inverse correlation between mGFR and age was observed (R 2 = 0.45, p = 0.001). Serum creatinine based estimated GFR (eGFR) equations overestimated mGFR up to 300%. eGFR based on cystatin C Filler equation was closest to the mGFR (median eGFR (IQR) of 129.5 (39.7) mL/min/1.73 m 2 ). Our study demonstrates a high prevalence of hyperfiltration and hypertension in children and adolescents with DMD. Because the majority of hypertensive patients were under corticosteroid treatment, the iatrogenic cause of hypertension cannot be excluded. Serum or urine creatinine measurements are of no value to evaluate renal function in DMD patients due to the reduced skeletal muscle mass.

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Section: Discussionmentioning

confidence: 99%

Renal function in children and adolescents with Duchenne muscular dystrophy

Braat

Hoste

Waele

et al. 2015

Neuromuscular Disorders

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“…The Hoek study [10] did not address the contribution of dialytic clearance whether by hemodialysis (HD) or PD to the plasma cystatin C levels. Dialytic clearance must have an effect on cystatin C concentrations: cystatin C is a cysteine protease inhibitor and a lowmolecular-weight protein (13.2 kDa) produced at a constant rate by all nucleated cells [11]. Cystatin C would be affected by dialytic clearance just like the low-molecularweight protein beta-2 microglobulin, albeit less in PD patients than in high-flux hemodialysis patients [12].…”

Section: Introductionmentioning

confidence: 99%

Residual renal function assessment with cystatin C

2010

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Su Jin Kim and coworkers from Korea published an important study on the relationship of residual renal function (RRF) and cystatin in pediatric peritoneal dialysis (PD) patients in this issue of Pediatric Nephrology, both in anuric patients and patients with RRF. Based on a lack of correlation between cystatin C and standard small solutebased dialysis adequacy parameters such as Kt/V urea but a significant correlation with RRF, the authors concluded that cystatin C may be a good tool to monitor RRF. The editorial reviews the available literature in adults, the different handing between urea and cystatin C, and the determinants of cystatin C clearance in dialysis patients. In adults, cystatin C levels are determined predominantly by RRF, but not exclusively. In anephric hemodialysis and PD patients, there is a correlation with standard weekly Kt/V urea . Cystatin C levels will also depend on ultrafiltration. Despite these factors that affect cystatin C levels beyond RRF, cystatin C is a useful parameter for monitoring PD patients that may be more closely related to long-term outcomes than small solute adequacy parameters.

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“…The measurement of serum cystatin C, a low molecular weight protein (13 kDa) that is freely filtered through the glomerulus and almost completely reabsorbed and catabolised by tubular cells, has been proposed as a simple, reliable and accurate marker of GFR [1]. It has recently been shown that GFR derived from a simple regression equation based on the relationship between the reciprocal of serum cystatin C levels and GFR measured by 125 I iothalamate clearance was a more accurate estimate of renal function than the Cockcroft-Gault (C-G) formulas in subjects with and without diabetes [2].…”

Section: Introductionmentioning

confidence: 99%