Serum Cystatin C as a Marker of Renal Function in Critically Ill Patients With Normal Serum Creatinine

Sagheb, Mohammad Mahdi; Namazi, Soha; Geramizadeh, Bita; Karimzadeh, Amin; Oghazian, Mohammad Bagher; Karimzadeh, Iman

doi:10.5812/numonthly.15224

Cited by 16 publications

(17 citation statements)

References 42 publications

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“…The combination of the hybridoma technique and phage display technology for screening of paired antibodies provides a new solution, with great biological and clinical significance. The cystain C as a biochemical marker or predictor of GFR offers the greater sensitivity in detecting an abnormal GFR [ 41 , 42 ]. The present study provides the new measurement of GFR to monitor the occurrence and progress of renal diseases.…”

Section: Discussionmentioning

confidence: 99%

Detection of Cystatin C biomarker for clinical measurement of renal disease by developed ELISA diagnostic kits

Jiang

Zhou

et al. 2014

J Transl Med

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BackgroundHuman cystatin C (HCC) is a potential biomarker for tubular damage and impaired renal function. It is difficult to obtain efficient paired monoclonal antibodies against HCC with low molecular to meet the requirements for clinical application The present study was to establish a stable and repeatable measurement for HCC with self-made monoclonal antibodies (McAbs) and Variable domain of heavy chain of heavy-chain antibody (VHHs) increase the sensitivity.MethodsWith hybridoma technology and phage display technology: R-HCC as a screening antigen and N-HCC as the detector for antigens to obtain the specific antibody and established an enzyme-linked immunosorbent assay for human cystatin C using self-made McAbs and VHHs.ResultsWe have successfully obtained three McAbs; 5 F2, 4E4, 1E11 and four VHHs; 3-2, 3-24, 3-33 and 4-5 which were specific for HCC. The measurement of HCC was established with the self-made monoclonal antibodies and VHHs with a high sensitivity the lower limit of detection at 0.5 ng/ml and the detection range at 0.5 ~ 31.3 ng/ml.ConclusionOur data provides a new approach for paired antibody screening and testing of the small molecular biomarker with a single dominant epitope, with the important biological and clinical significance.

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Section: Discussionmentioning

confidence: 99%

Detection of Cystatin C biomarker for clinical measurement of renal disease by developed ELISA diagnostic kits

Jiang

Zhou

et al. 2014

J Transl Med

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“…Several studies demonstrated the superiority of serum cystatin C over creatinine in detecting minor GFR reduction. 25) In addition, estimated GFR or Ccr calculated using cystatin C predicts vancomycin trough levels better than Ccr calculated by Cockcroft-Gault formula. 26,27) In fact, the mean estimated GFR (69.1±33.1 mL/min) 26) or Ccr (46.6±24.6 mL/min) 27) calculated using cystatin C levels before DRPM administration tended to be lower than the mean Ccr calculated by Cockcroft-Gault formula (76.0±37.4 mL/min).…”

Section: Discussionmentioning

confidence: 99%

Pharmacokinetic/Pharmacodynamic Analysis for Doripenem Regimens in Intensive Care Unit Patient

Tanaka

Sato

Goto

et al. 2017

Biological & Pharmaceutical Bulletin

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Doripenem (DRPM) is a broad-spectrum antibacterial agent often used as empirical therapy for critically ill patients, although there is a lack of studies validating the recommended dosage regimen for patients admitted to intensive care unit (ICU), based on pharmacokinetic (PK)/pharmacodynamic (PD) index. In this study, we estimated the free time above minimum inhibitory concentration (fT>MIC (%)) of DRPM using population PK analysis of 12 patients in ICU, and evaluated the validity of the dosage regimen stratified by creatinine clearance. Using a 2-compartment population PK model reported previously, the mean total clearance or distribution volume of DRPM estimated by Bayesian estimation was significantly lower or higher than that of based on population PK model. The estimated fT>MIC (%) of the recommended standard (normal renal function: 0.5 g every 8 h, moderate: 0.25 g every 8 h, severe renal impairment: 0.25 g every 12 h) and higher doses (normal: 1.0 g every 8 h, moderate: 0.5 g every 8 h, severe: 0.25 g every 8 h) against MICs of 0.5, 1 and 2 µg/mL exceeded 40% in all patients. When stratified by creatinine clearance, the PK/PD breakpoints estimated by Monte Carlo simulation in three grades of renal function tended to be higher than the previously reported PK/PD breakpoints for patients with urinary tract infection, an infection of lesser severity than ICU patients. These results suggest that the dosage regimen stratified by renal function derived from Japanese package insert may be sufficient to achieve effective treatment in ICU patients.Key words doripenem; pharmacokinetic/pharmacodynamic analysis; intensive care unit; breakpoint Doripenem (DRPM) is a newer carbapenem antimicrobial agent with potent and broad spectrum activities against Grampositive, Gram-negative and anaerobic bacteria, and is more potent against Pseudomonas aeruginosa than other carbapenems.1-3) Doses of 0.5-3.0 g daily in two or three divided doses administered by 0.5 or 1 h infusion are used commonly to treat infectious diseases such as pneumonia, complicated urinary tract infection and intra-abdominal infections. In order to provide optimal antimicrobial therapy, selecting an effective and well-tolerated dosage regimen based on pharmacokinetic (PK)/ pharmacodynamic (PD) index is important. For DRPM and other β-lactams with time-dependent antimicrobial activity, an effective dosage regimen requires that the blood concentrations exceed the minimum inhibitory concentration (MIC) of the infecting bacteria for at least 40% of the dosing interval.4) Therefore, the appropriate dosage regimen based on time above MIC (%T>MIC) is of great importance when using DRPM.Critically ill patients in the intensive care unit (ICU) are often affected by infections, and are given antimicrobial agents with a broad spectrum. 5) In particular, since severe sepsis and septic shock are major causes of morbidity and mortality in the ICU, early use of carbapenems including DRPM as an empirical therapy is recommended by international guidelines for the manageme...

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“…Cystatin C exhibited better accuracy than creatinine in the identifi cation of acute kidney dysfunction in the intensive care setting [19], and it was an early marker of AKI [20,21]. However, similarity between these two markers was observed, even for the early detection of AKI [22,23].…”

Section: Introductionmentioning

confidence: 99%

Serum cystatin C as an early marker of Acute Kidney Injury in elderly patients after surgery for femur fracture. An observational study

Neto¹,

Azevedo²,

Lopes³

et al. 2019

Arch Renal Dis Manag

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Recent studies found even higher numbers when considering a more sensitive classifi cation of AKI scoring system, the Kidney Disease Improving Global Outcomes (KDIGO), which found an overall incidence of 23% in hospitalized patients [5].AKI is an independent risk factor for mortality, and it reaches rates of 70% when renal replacement therapy is needed [6,7]. AKI also increases the length of hospital stay and hospital costs [8]. Considering the increased morbimortality, AKI should be identifi ed as soon as possible during the postoperative period. Creatinine and urine output are used extensively to evaluate the glomerular fi ltration rate in clinical settings. However, creatinine fails in several aspects to diagnose AKI, and it is an insensitive marker for acute changes in glomerular fi ltration rate [9,10]. Diuresis is a nonspecifi c marker for AKI, and the inability to concentrate urine may lead to a dissociation between urine production and kidney function [11]. Patients in critical care conditions may exhibit periods of oliguria that are not followed by AKI [12], and the correct measurement of urinary output may also be a problem [13].Cystatin C was investigated because of the scarcity of early Abstract Background: Acute kidney injury (AKI) is prevalent in hospitalized patients, primarily in patients undergoing major surgical procedures. AKI is associated with increased morbimortality, and patients would benefi t from a very early diagnosis that would allow implementation of specifi c therapeutic or additional prophylactic measures. The present study evaluated serum cystatin C as an early predictor of AKI in elderly patients during the postoperative period.Methods: Fifty-nine patients, aged 60 years or older undergoing correction of femur fracture under spinal anaesthesia, were prospectively evaluated up to 48 hours after surgery. Serum cystatin C was measured immediately after surgery and four (early marker) and 24 hours after surgery. The diagnosis of AKI was based on creatinine values up to 48 hours after surgery (Kidney Disease Improving Global Outcomes, KDIGO), and the impact of serum cystatin C on the diagnosis of AKI was evaluated four hours after surgery.Results: Twenty-one patients (35.6%) were diagnosed with AKI. The values of serum cystatin C [median (1 st -3 rd quartiles)] at four hours were 1.24 (1.00 -1.49) and 0.90 (0.78 -1.15) mg.L -1 for patients with and without AKI, respectively (p = 0.003). The best serum cystatin C cut-off value at four hours was 0.92 mg.L -1 , with negative and positive predictive values equal to 95% and 50%, respectively, a sensitivity of 94%, a specifi city of 51%, and an accuracy (area under the curve) of 75% (95% confi dence interval: 61% to 86%). Conclusions:Serum cystatin C exhibited good accuracy (75%) for the diagnosis of AKI and elevated the potential identifi cation of patients with lower chances of presenting AKI at a cut-off value of 0.92 mg. L -1 four hours after femur fracture repair under spinal anaesthesia. Declarations Ethics approval and consent to part...

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Serum Cystatin C as a Marker of Renal Function in Critically Ill Patients With Normal Serum Creatinine

Cited by 16 publications

References 42 publications

Detection of Cystatin C biomarker for clinical measurement of renal disease by developed ELISA diagnostic kits

Detection of Cystatin C biomarker for clinical measurement of renal disease by developed ELISA diagnostic kits

Pharmacokinetic/Pharmacodynamic Analysis for Doripenem Regimens in Intensive Care Unit Patient

Serum cystatin C as an early marker of Acute Kidney Injury in elderly patients after surgery for femur fracture. An observational study

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