The Association Between GFR Evaluated by Serum Cystatin C and Proteinuria During Pregnancy

Abstract

Introduction: Physiological changes in pregnancy result in increased cardiac output and renal blood flow, with a consequential increase in proteinuria. Data from studies of the relationship between proteinuria caused by isolated proteinuria and glomerular filtration rate (GFR) are still limited. The objective of this study was to investigate the effects of isolated proteinuria on the cystatin C-based GFR in the third trimester of pregnancy. Methods: Data were collected from pregnant women in their third trimester whose serum creatinine levels were normal. The GFR of each participant was measured using serum cystatin C levels, and proteinuria was measured using urine protein-creatinine ratios. The participants were divided into 3 groups according to their level of proteinuria: normal (<150 mg/d), physiological (150-300 mg/d), and gestational (>300 mg/ d). Changes in GFR were recorded for each group. Results: The study included 89 participants, of whom 66.3% had levels of proteinuria that did not differ from that of the normal population (<150 mg/d). The incidence of physiological and gestational proteinuria was 21.4% and 12.4%, respectively. The results demonstrate that proteinuria >101.50 mg/d was significantly associated with declined estimated glomerular filtration rate (eGFR) (r ¼-0.34, P ¼ 0.01). The analysis found that proteinuria >491.27 mg/d led to a risk of GFR <90 ml/min with an odds ratio of 12.69, P ¼ 0.02 when adjusted for systolic blood pressure (SBP), diastolic blood pressure (DBP), and body mass index. Conclusion: This study suggests that the term "physiological proteinuria" is a misnomer. When used in the traditional manner, creatinine level has inadequate sensitivity to estimate GFR in pregnant women. We found that there is a significant decline in GFR when urine protein > 101.5 mg/d, which could be an early biomarker for renal pathology rather than pregnancy physiology, suggesting that further workup and precaution is required.

The model of screening for preeclampsia in the second and third trimesters of gestation

“…Recent evidence suggests that cystatin C is a promising biomarker for detecting pe during the third trimester of pregnancy, especially pregnancies complicated by hypertension, or even for predicting high-risk pregnancies [12,13], which has better predictive value than creatinine in the diagnosis of renal damage, even in the early stages [14][15][16]. An additional advantage is the determination of FFR by cystatinin C without the requirement to include race quotient, age, sex, and muscle volume as required for creatinine [17].…”

Nồng Độ Cystatin C Huyết Thanh Trên Thai Phụ Tiền Sản Giật Tại Bệnh Viện Phụ Sản Thành Phố Cần Thơ

“…Cystatin C có thể phát hiện giảm mức lọc cầu thận ở giai đoạn sớm khi albumin niệu, creatinin huyết thanh còn trong giới hạn bình thường [9]. Cystatin C huyết thanh ở bệnh nhân tiền sản giật giúp phát hiện được những rối loạn chức năng thận ở giai đoạn sớm và ước đoán mức lọc cầu thận chính xác hơn so với creatinin, từ đó giúp phân tầng được đối tượng nguy cơ và có những can thiệp kịp thời để hạn chế tối đa xảy ra tai biến cho sản phụ [8]. Tuy nhiên vai trò của cystatin C huyết thanh trên thai phụ tiền sản giật và các yếu tố liên quan đến cystatin C chưa được nghiên cứu ở Việt Nam, đây là một vấn đề mới.…”

Lesión renal aguda en la mujer embarazada

“…Respecto a la Cistatina C, Bellos et al [31] publicaron un metaanálisis donde revisaron 27 estudios observacionales, con un total de 2.320 mujeres embarazadas, y evidenciaron que los niveles de esta proteína eran mayores en mujeres preeclámpticas, con una sensibilidad de 85 % y especi cidad de 84 %, siendo útil como biomarcador de detección de PE durante el tercer trimestre del embarazo. Por su parte, Kreepala et al [32] investigaron los efectos de la proteinuria aislada sobre la TFG basada en Cistatina C en el tercer trimestre del embarazo y encontraron que el nivel de proteína tiene una sensibilidad inadecuada para estimar la TFG en mujeres embarazadas, y que además existe una disminución signi cativa en la TFG en presencia de proteinuria, lo que propone a la Cistatina C como un marcador temprano de Emb-LRA. Finalmente, Tyagi et al [18] estudiaron la utilidad de TIMP-2 y IGFBP7 y https://revistanefrologia.org http://www.asocolnef.com encontraron que, a pesar de que estos biomarcadores predicen con éxito la LRA temprana en población general, no son aplicables a las pacientes obstétricas.…”