Early detection of acute renal failure by serum cystatin C

Herget–Rosenthal, Stefan; Marggraf, G.; Hüsing, Johannes; Göring, Frauke; Pietruck, Frank; Janßen, Onno E.; Philipp, Thomas; Kribben, Andreas

doi:10.1111/j.1523-1755.2004.00861.x

Cited by 769 publications

(546 citation statements)

References 48 publications

(59 reference statements)

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“…However, other studies have supported the utility of CysC as an early predictor of AKI. In a population of critically ill patients, serum cystatin C predated the identification of creatinine-based AKI by 1 to 2 days (22). In a recently published study of 100 patients undergoing CPB, the predictive capacity of plasma CysC on arrival in the ICU was excellent (AUC 0.83, 95% CI 0.68 to 0.98) for the subsequent development of AKI (23).…”

Section: Discussionmentioning

confidence: 99%

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

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Background and objectives:Little is known about the performance of plasma cystatin C (CysC) in patients undergoing cardiopulmonary bypass (CPB) and its utility in the early diagnosis of acute kidney injury (AKI). In this post hoc analysis, the goal was to determine whether plasma cystatin C, measured 2 hours after the conclusion of CPB, is a reliable marker of AKI.Design, setting, participants, & measurements: Plasma CysC was measured in 150 patients undergoing CPB at the following times: preoperatively, 2 hours after the conclusion of CPB, postoperative day 1, and postoperative day 2. Plasma CysC levels were related to the development of AKI as defined by an increase in serum creatinine of >50% or >0.3 mg/dl from baseline up to 3 days postoperative. Mixed linear models were used to evaluate the relationship of serial plasma CysC values with AKI. The discriminatory capacity of plasma CysC was estimated using receiver operating characteristic curves. Logistic regression was utilized to assess the adjusted relationship between plasma CysC and subsequent AKI.Results: AKI developed in 47 (31.3%) patients. Plasma CysC was higher at all times among patients who developed AKI compared with those who did not (P < 0.0001). The discriminatory capacity of plasma CysC measured preoperatively and 2 hours after the conclusion of CPB was modest.Conclusions: Serial measures of plasma CysC are highly correlated with the development of AKI. However, the discriminatory capacity of plasma CysC as an early marker of AKI remains limited.

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Section: Discussionmentioning

confidence: 99%

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Wald

Liangos

Perianayagam

et al. 2010

Clinical Journal of the American Society of Nephrology

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“…Multiple studies evaluating serum cystatin C (SCysC) as a GFR marker have shown that it performs at least as well as SCr in the population at large, and it is superior to SCr in specific patient populations (14). SCysC has also been proposed as an early biomarker of AKI in the intensive care (15,16), cardiac surgery (17), and radiocontrast administration (18) settings.…”

Section: T He Incidence Of Acute Kidney Injury (Aki) Is Increasingmentioning

confidence: 99%

Cystatin C as a Marker of Acute Kidney Injury in the Emergency Department

Soto

Coelho

Rodrigues

et al. 2010

Clinical Journal of the American Society of Nephrology

110

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Background and objectives: The diagnosis of acute kidney injury (AKI) is usually based on changes in serum creatinine, which is a poor marker of early renal dysfunction. The discriminative and predictive abilities of serum and urinary cystatin C were examined for the prediction of AKI.Design, setting, participants, & measurements: In this prospective cohort study, serum and urinary cystatin C were serially measured in a heterogeneous group of patients (n ‫؍‬ 616) presenting to a tertiary care emergency department. The primary outcome was AKI, classified according to RIFLE and AKIN criteria. The secondary outcome was an adjudication based on clinical criteria to AKI, prerenal azotemia, chronic kidney disease (CKD), and normal kidney function.Results: Patients were adjudicated to have AKI in 21.1%, prerenal azotemia in 25.8%, CKD in 2.4%, and normal kidney function in 50.7%. For the diagnosis of AKI, the discriminatory ability of urinary creatinine and cystatin C was marginal. Both serum cystatin C and serum creatinine (at presentation and 6 hours later) showed high discriminatory ability for the diagnosis of AKI. However, only serum cystatin C attained a significant early predictive power (Hosmer-Lemeshow P value > 0.05). Serum cystatin C could differentiate between AKI and prerenal azotemia, but not between AKI and CKD.Conclusions: Serum cystatin C is an early, predictive biomarker of AKI, which outperforms serum creatinine in the heterogeneous emergency department setting. However, neither biomarker discriminated between AKI and CKD. Additional biomarkers continue to be needed for improved specificity in the diagnosis of community-acquired AKI.

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“…This compound is produced at a constant rate by all nucleated cells and is filtered freely at the glomerulus and reabsorbed and catabolized but not secreted by the tubules. Cystatin C detects the development of AKI 1 to 2 d earlier than graded changes in serum creatinine as based on the ADQI/RIFLE criteria (25) and increases more rapidly than serum creatinine after administration of radiocontrast media (26). Although the accuracy of cystatin C as marker of GFR was questioned recently, particularly in inflammation (27) and patients with liver cirrhosis (28), from a pragmatic point of view, it can be supposed that if a cystatin C-based definition should be used, then physicians would be alerted 1 to 2 d earlier for the risk for AKI than by serum creatinine.…”

Section: Defining Patients At Risk For Acute Renal Injurymentioning

confidence: 99%

Defining Acute Renal Failure

Biesen

Vanholder²,

Lameire³

2006

Clinical Journal of the American Society of Nephrology

156

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The introduction of the RIFLE classification has increased the conceptual understanding of the acute kidney injury (AKI) syndrome, and this classification has been successfully tested in a number of clinical studies. This review discusses the strengths and weaknesses of the RIFLE classification and suggests additional parameters to broaden future definitions of AKI. These definitions should not only focus on kidney function alone, but also include parameters describing the origin of the patient, the most important causal factors responsible for AKI and information on the pre-existing kidney function. This more complete definition should lead to a decrease in the variability of the results of epidemiological studies and of future clinical trials in AKI populations.

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Early detection of acute renal failure by serum cystatin C

Abstract: Serum cystatin C is a useful detection marker of ARF, and may detect ARF one to two days earlier than creatinine.

Cited by 769 publications

References 48 publications

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Plasma Cystatin C and Acute Kidney Injury after Cardiopulmonary Bypass

Cystatin C as a Marker of Acute Kidney Injury in the Emergency Department

Defining Acute Renal Failure

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