Diagnostic Accuracy of Serum Cystatin C for Early Recognition of Nephropathy in Type 2 Diabetes Mellitus

Abstract

Objectives. Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods. This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results. The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001 ). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol p = 0.018 and serum cystatin C p < 0.001 was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p = 0.022 ), duration of T2DM (r = 0.326, p = 0.021 ), and UACR (r = 0.528, p < 0.001 ) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p < 0.001 ). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion. Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.

Diagnostic efficacy of serum cystatin-c in association with ACE I/D and ACE G2350A gene as predictor of renal insufficiency in T2DM patients

“…The current study found positive relation between duration of diabetes and level of serum cystatin-c in diabetic patient group (p < 0.027). Other study illustrated positive relation between serum cystatin-c and age in T2DM patients [7].…”

“…Serum creatinine was unable to detect early decline in GFR owing to the fact that levels of serum creatinine begins to rise above normal range only in case of kidney had lost approximately 50% of its function, suggesting any change in GFR can occur before serum creatinine tends to be abnormal. Other study con rmed that cystatin-C is a well-de ned marker which is advised to be assessed for early DN diagnosis and progression [7,28]. Previous study had mentioned that nutritional status, in ammatory processor and dietary factors had no impact on cystatin-c levels.…”

“…Several studies reported that cystatin-C is not only an ideal biomarker but also, in critically ill adults, it is associated with recovery prognosis of acute kidney injury [5,6,7]. In addition, Taha et al [8] deduced that, in cadmium nephrotoxicity, cystatin-C is the most applicable biomarker.…”

Blocking REDD1/TXNIP Complex Ameliorates HG-Induced Renal Tubular Epithelial Cell Apoptosis and EMT through Repressing Oxidative Stress

“…Although serum creatinine is a traditional biomarker, it is not very accurate because its values do not boost up until the GFR is lowered to less than 50% of normal [ 29 ]. Cystatin C and β 2MG, as potential markers of renal injury, have higher accuracy in diagnosing DN than serum creatinine [ 30 , 31 ]. Meanwhile, they are also a classic biomarker of renal tubulointerstitial injury [ 32 , 33 ].…”

Diagnostic efficacy of cystatin-c in association with different ACE genes predicting renal insufficiency in T2DM

“…It is found also in all biological fluids 5 . It is synthesized by all nucleated cells at a stable rate and different factors such as sex, protein ingestion, inflammation, or muscle mass had no impact on its concentration 6 . It represents an ideal marker of endogenous glomerular filtration rate.…”