Cystatin C as an Early Biomarker of Nephropathy in Patients with Type 2 Diabetes

Abstract

This study was done to evaluate clinical usefulness of cystatin C levels of serum and urine in predicting renal impairment in normoalbuminuric patients with type 2 diabetes and to evaluate the association between albuminuria and serum/urine cystatin C. Type 2 diabetic patients (n = 332) with normoalbuminuria (n = 210), microalbuminuria (n = 83) and macroalbuminuria (n = 42) were enrolled. Creatinine, urinary albumin levels, serum/urine cystatin C and estimated glomerular filtration rate (eGFR by MDRD [Modification of Diet in Renal Disease] and CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equations) were determined. The cystatin C levels of serum and urine increased with increasing degree of albuminuria, reaching higher levels in macroalbuminuric patients (P < 0.001). In multiple regression analysis, serum cystatin C was affected by C-reactive protein (CRP), sex, albumin-creatinine ratio (ACR) and eGFR. Urine cystatin C was affected by triglyceride, age, eGFR and ACR. In multivariate logistic analysis, cystatin C levels of serum and urine were identified as independent factors associated with eGFR < 60 mL/min/1.73 m2 estimated by MDRD equation in patients with normoalbuminuria. On the other hand, eGFR < 60 mL/min/1.73 m2 estimated by CKD-EPI equation was independently associated with low level of high-density lipoprotein in normoalbuminuric patients. The cystatin C levels of serum and urine could be useful markers for renal dysfunction in type 2 diabetic patients with normoalbuminuria.

Cystatin C predicts diabetic retinopathy in Chinese patients with type 2 diabetes

“…This indicates that the association between DN and DR should be close. Studies have found that cystatin C, as a superior marker of GFR, is a sensitive index to find the early phase of DN in patients with diabetes, especially in those diabetic patients with normoalbuminuria [5][6]. One study also found that lower estimated GFR was significantly associated with the severity of DR in Chinese patients with type 2 diabetes mellitus [7].…”

Decreased expression of circulating microRNA-126 in patients with type 2 diabetic nephropathy: A potential blood-based biomarker

“…Other markers of DN risk are required for optimal clinical management (9), particularly for patients with T2D who pass through a period of pre-diabetes and may experience renal impairment at the time of diagnosis. In this regard, a number of candidate markers have been proposed for the early identification of renal injury, such as creatinine, kidney enzymes, cystatin C and C-reactive protein (10,11). Genomic regulatory non-coding RNA molecules, namely microRNAs (miRNAs), have been shown to be involved in the control of key biological processes such as proliferation, differentiation, apoptosis and metabolism (12).…”

Elevated levels of renal and circulating Nop-7-associated 2 (NSA2) in rat and mouse models of diabetes, in mesangial cells in vitro and in patients with diabetic nephropathy

“…NSA2 mRNA copy numbers in patients with and without nephropathy, categorised according to their type of diabetes, are shown in ESM Fig. 1 in serum and urine alongside an increasing degree of albuminuria, being higher in macroalbuminuric patients, and correlates with other risk factors, including GFR, sex, ACR ratio, and C reactive protein [35]. Another biomarker, urinary liver-type fatty acid-binding protein (L-FABP), was found to be elevated in individuals with type 2 diabetes compared with controls, and correlated with blood pressure, HbA 1c , eGFR and cholesterol [36].…”