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Arora S, Dunkley L, Waldman LM, Chin VL, Umpaichitra V. Kidney function in minority children and adolescents with metabolically healthy and unhealthy obesity. Clin Obes 2020; 10:e12345. [PMID: 31692279 DOI: 10.1111/cob.12345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/11/2019] [Accepted: 09/28/2019] [Indexed: 01/20/2023]
Abstract
Metabolic syndrome and/or body mass index (BMI) ≥40 kg/m2 are risk factors for kidney function decline in the general population. To compare creatinine (Cr), estimated glomerular filtration rate (eGFR) and blood urea nitrogen (BUN) between minority children and adolescents with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), a chart review was conducted on subjects aged 4 to 20 years with BMI ≥95th percentile from July 2014 to April 2017. They were stratified into MHO and MUO groups. Cr, eGFR and BUN were studied. Total n = 277: MHO n = 105 vs MUO n = 172. Cr was higher and BUN was lower in MUO whereas eGFR did not differ between the groups. Using general linear model, we found that metabolic status predicted BUN (P = .009) but not Cr or eGFR. When age, sex and Tanner stage matched, BUN, Cr and eGFR were similar between the groups. Higher BUN in MHO could be due to higher dietary protein intake. Subjects were divided into BMI ≥40 vs <40 kg/m2 , BUN and eGFR were not different. A trend towards higher Cr in those with BMI ≥40 kg/m2 (P = .054) was found; the group being older and taller. After age and height matching, all outcomes were not different. Higher Cr was found in those with elevated blood pressures vs the MHO (P = .047). Those with diastolic blood pressure (DBP) ≥90th percentile had higher Cr than those with systolic blood pressure ≥90th percentile (P = .017). Children and adolescents with MUO, and those with BMI ≥40 kg/m2 did not appear to have early diminished kidney function. Higher Cr, although in normal range, occurred in those with abnormal DBP.
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Affiliation(s)
- Sumeet Arora
- Pediatric Endocrinology Division, Department of Pediatrics, NYC Health + Hospitals/Kings County and SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Laura Dunkley
- Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York
| | - Lee M Waldman
- Department of Pediatrics, NYC Health + Hospitals/Kings County, Brooklyn, New York
| | - Vivian L Chin
- Pediatric Endocrinology Division, Department of Pediatrics, NYC Health + Hospitals/Kings County and SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Vatcharapan Umpaichitra
- Pediatric Endocrinology Division, Department of Pediatrics, NYC Health + Hospitals/Kings County and SUNY Downstate Health Sciences University, Brooklyn, New York
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52
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Chen S, Liu L, Zhang W, Sun L, Wang F, Zhao Y, Liu S, Zhao L, Xu Y. Suppressed dendritic cell functions by cystatin C lead to compromised immunity in vivo. Cell Immunol 2020; 349:104049. [PMID: 32057353 DOI: 10.1016/j.cellimm.2020.104049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/19/2020] [Accepted: 01/26/2020] [Indexed: 12/30/2022]
Abstract
Pathogenic microorganisms utilize multiple approaches to break down host immunity in favor of their invasion, of which, cystatin C is one of the soluble factors secreted by parasites reported to affect host immunity in vivo. The cellular targets and mechanisms of action in vivo of cystatin C, however, are far from clear. As professional antigen-presenting cells, dendritic cells (DCs) are first immune cells that contact foreign pathogenic agents or their products to initiate immune responses. We previously reported that cystatin C can regulate the functions of DCs in terms of suppressed CD4+ T cell activation but enhanced Th1/Th17 differentiation via different mechanisms. Here, we further verified these regulatory effects of cystatin C on DCs in vivo. We found that the suppressive role of DC-mediated CD4+ T cell proliferation by cystatin C was partly cell-contact independent and extended to CD8+ T cells in vivo. Although cystatin C-overexpressing DCs trafficked equally as their mock-transduced counterparts, their adoptive transfer suppressed CD8+ T cell immunity and resulted in compromised tumor rejection in both vaccination and treatment regimes. Compared with their role in promoting Th17 differentiation in vivo, cystatin C-transduced DCs had far greater ability to induce T regulatory cells (Tregs), leading to collectively a higher Treg/Th17 ratio in an adoptively transferred disease model, and thus relieved Th17-dependent autoimmunity. Collectively, these data demonstrated strong in vivo evidences for immune regulatory roles of cystatin C in DCs and provided theoretical basis for the application of cystatin C-transduced cell therapy in the treatment or remission of certain autoimmune diseases. (246).
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Affiliation(s)
- Shun Chen
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Lei Liu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Wenjie Zhang
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Li Sun
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Fengge Wang
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Yanfang Zhao
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Shan Liu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Lin Zhao
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Yuekang Xu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu 241000, China.
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53
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Tang Y, Li Y, Sun J, Pan H, Yao F, Jiao X. Selection of an Optimal Combination Panel to Better Triage COVID-19 Hospitalized Patients. J Inflamm Res 2020; 13:773-787. [PMID: 33149652 PMCID: PMC7602889 DOI: 10.2147/jir.s273193] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 09/09/2020] [Indexed: 02/05/2023] Open
Abstract
PURPOSE It is difficult to predict the prognosis of COVID-19 patients at the disease onset. This study was designed to add new biomarkers into conventional inflammatory panels to build an optimal combination panel, to better triage patients and predict their outcomes. PATIENTS AND METHODS Biochemical parameters representing multi-organ functions, cytokines, acute-phase proteins, and other inflammatory markers were measured in COVID-19 patients on hospital admission. Receiver operating characteristic (ROC) curves, logistic regression, event-free survival (EFS), and Cox analyses were performed to screen and compare the predictive capabilities of the new panel in patients with different illness severity and outcome. RESULTS This study included 120 patients with COVID-19, consisting of 32 critical, 28 severe, and 60 mild/moderate patients. Initial levels of the selected biomarkers showed a significant difference in the three groups, all of which influenced patient outcome and EFS to varying degrees. Cox proportional hazard model revealed that procalcitonin (PCT) and interleukin 10 (IL-10) were independent risk factors, while superoxide dismutase (SOD) was an independent protective factor influencing EFS. In discriminating the critical and mild patients, a panel combining PCT, IL-6, and neutrophil (NEUT) yielded the best diagnostic performance with an AUC of 0.99, the sensitivity of 90.60% and specificity of 100%. In distinguishing between severe and mild patients, SOD's AUC of 0.89 was higher than any other single biomarker. In differentiating the critical and severe patients, the combination of white blood cell count (WBC), PCT, IL-6, IL-10, and SOD achieved the highest AUC of 0.95 with a sensitivity of 75.00% and specificity of 100%. CONCLUSION The optimal combination panel has a substantial potential to better triage COVID-19 patients on admission. Better triage of patients will benefit the rational use of medical resources.
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Affiliation(s)
- Yueting Tang
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Yirong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Jiayu Sun
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Huaqin Pan
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, People’s Republic of China
| | - Fen Yao
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
| | - Xiaoyang Jiao
- Department of Cell Biology and Genetics, Shantou University Medical College, Shantou, Guangdong, People’s Republic of China
- Correspondence: Xiaoyang Jiao Shantou University Medical College, Shantou, Guangdong, People’s Republic of ChinaTel +86-754-88900459Fax +86-754-88557562 Email
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Li F, Hu L, Zhao X, Ge W, Pan H, Zhang W, Jiang Y, Xu X, Hou J, Pu J. The value of cystatin C and urinary and serum neutrophil gelatinase-associated lipocalin during the perioperative period of renal transplantation. Transl Androl Urol 2019; 8:432-441. [PMID: 31807420 DOI: 10.21037/tau.2019.08.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Background The perioperative management of renal transplantation is complex. Our research aimed to study the clinical value of cystatin-C (Cys-C) and urinary and serum neutrophil gelatinase-associated lipocalin (NGAL) during the perioperative period of renal transplantation. Methods We collected the clinical information of 47 renal transplantation patients. Urine and serum samples were collected daily until the second week and then weekly until discharge to determine serum NGAL (s-NGAL), urine NGAL (u-NGAL), serum creatinine (s-Cr), and Cys-C levels. Receiver-operating characteristic (ROC) analysis was used, and the area under the curve (AUC) was compared to evaluate the accuracy of the diagnosis of delayed graft function (DGF). Multivariable analysis was used to find the association between the markers and renal function at discharge. Results In our research, the value of Cys-C, serum NGAL, and urine NGAL were higher in DGF group. In the ROC analysis, Cys-C had the highest AUC (0.939) compared with s-NGAL (0.909), u-NGAL (0.856), and s-Cr (0.747). Multivariable analysis showed that Cys-C levels in the first week after the operation and cold ischemia time were independently associated with estimated glomerular filtration rate (eGFR) at discharge (P<0.05). Conclusions Our results showed that Cys-C, serum NGAL, and urine NGAL could reflect renal function sensitively. Cys-C had the highest sum of sensitivity and specificity at 4.77 mg/L, with a sensitivity of 0.818 and specificity of 0.889. The Cys-C level during the first week after the operation was independently associated with eGFR at discharge and could predict the short-term prognosis of renal transplantation patients.
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Affiliation(s)
- Feng Li
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Linkun Hu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xiaojun Zhao
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wenqing Ge
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Hao Pan
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Wei Zhang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Yufeng Jiang
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Xu Xu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jianquan Hou
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
| | - Jinxian Pu
- Department of Urinary Surgery, The First Affiliated Hospital, Soochow University, Suzhou 215006, China
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55
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Jadresic L, Silverwood RJ, Kinra S, Nitsch D. Can childhood obesity influence later chronic kidney disease? Pediatr Nephrol 2019; 34:2457-2477. [PMID: 30415420 DOI: 10.1007/s00467-018-4108-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/22/2018] [Accepted: 09/28/2018] [Indexed: 11/24/2022]
Abstract
Childhood overweight and obesity affects more and more children. Whilst associations of childhood overweight with later outcomes such as hypertension, diabetes and cardiovascular disease have been well documented, less is known about the association of childhood overweight and obesity with kidney disease. We review the existing evidence for the association of childhood obesity with markers of childhood and adult kidney disease. Whilst there is some evidence for an association, studies have not been able to distinguish between childhood being a sensitive time to develop later kidney problems, or whether observed associations of childhood obesity with poor outcomes are driven by greater lifelong exposure to obesity.
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Affiliation(s)
- Lyda Jadresic
- Department of Paediatrics, Gloucestershire Royal Hospital, Gloucester, GL1 3NN, UK
| | - Richard J Silverwood
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Dorothea Nitsch
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
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56
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Kooshki H, Abbaszadeh R, Heidari R, Akbariqomi M, Mazloumi M, Shafei S, Absalan M, Tavoosidana G. Developing a DNA aptamer-based approach for biosensing cystatin-c in serum: An alternative to antibody-based methods. Anal Biochem 2019; 584:113386. [DOI: 10.1016/j.ab.2019.113386] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 07/22/2019] [Accepted: 08/03/2019] [Indexed: 12/28/2022]
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57
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Wu SC, Liang CX, Zhang YL, Hu WP. Elevated serum procalcitonin level in patients with chronic kidney disease without infection: A case-control study. J Clin Lab Anal 2019; 34:e23065. [PMID: 31617251 PMCID: PMC7031592 DOI: 10.1002/jcla.23065] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 09/14/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background Inflammation is a necessary component of chronic kidney disease (CKD) that can be attributed to an accumulation of toxins and a reduced clearance of proinflammatory cytokines. Procalcitonin (PCT) is a widely applied biomarker in the diagnosis of infection, and considering the presence of pre‐existing inflammation in CKD patients, the PCT level could be high in such a population; however, no reference value for PCT in CKD patients has been available to date. Methods During the present study period, 361 CKD patients and 119 healthy controls were included. The PCT level and other biochemistry parameters were assayed by using a COBAS system. Statistical analysis was conducted to compare the differences in PCT levels and other biochemistry parameters between the two groups, and linear regression was used to assess the correlation between two variables. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the performance of PCT and the optimal cutoff value to differentiate between CKD patients and healthy controls. Results The PCT level in CKD patients was significantly higher than that in healthy controls, and among the CKD patients, the PCT level was increased with advanced clinical stage. Moreover, PCT was moderately correlated with CysC. The optimal off‐value was 0.075 with a sensitivity of 94.7% and specificity of 90.8%. Conclusion The PCT level was significantly higher in CKD patients than in healthy controls, and the reference value for CKD patients should be adjusted to avoid unnecessary antibiotic treatments which may pose a negative impact on residual renal function.
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Affiliation(s)
- Sen-Chao Wu
- Department of Nephrology, Longyan First Hospital Affiliated to Fujian Medical University, Longyan, China
| | - Cai-Xia Liang
- Department of Nephrology, Second Affiliated Hospital of Guizhou Medical University, Kaili, China
| | - Yan-Lin Zhang
- Department of Nephrology, First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Wei-Ping Hu
- Department of Nephrology, First Affiliated Hospital of Xiamen University, Xiamen, China.,School of Clinical Medicine, Fujian Medical University, Fuzhou, China
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58
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Zhang W, Zi M, Sun L, Wang F, Chen S, Zhao Y, Liang S, Hu J, Liu S, Liu L, Zhan Y, Lew AM, Xu Y. Cystatin C regulates major histocompatibility complex-II-peptide presentation and extracellular signal-regulated kinase-dependent polarizing cytokine production by bone marrow-derived dendritic cells. Immunol Cell Biol 2019; 97:916-930. [PMID: 31513306 DOI: 10.1111/imcb.12290] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Revised: 09/06/2019] [Accepted: 09/08/2019] [Indexed: 12/13/2022]
Abstract
Cystatin C is a ubiquitously expressed cysteine protease inhibitor that protects cells from either improper hydrolysis by endogenous proteases or pathogen growth/virulence by exogenous proteases. Although commonly used as a serum biomarker for evaluating renal function, cystatin C is associated with many immunological disorders under various pathophysiological conditions. How cystatin C affects immune cells, especially dendritic cells (DCs), however, is far from clear. In this study, we found that pharmacological treatment with or genetic overexpression of cystatin C in bone marrow-derived DCs (BMDCs) reduced their capacity to stimulate CD4+ T-cell proliferation, despite increased antigen uptake. This reduced capacity corresponded with reduced major histocompatibility complex-II presentation owing to diminished levels of the chaperon H2-DM in BMDCs. Instead of promoting proliferation, cystatin C promoted skewing of T cells toward proinflammatory T-helper (Th)1/Th17 differentiation. This was mediated by augmented extracellular signal-regulated kinase 1/2 mitogen-activated protein kinase phosphorylation in BMDCs, leading to secretion of polarizing cytokines, which in turn led to the Th deviation. Collectively, our study explained the cellular and molecular basis of how this protease inhibitor can regulate immune responses, namely by affecting BMDCs and their cytokine pathway. Our results might open up an avenue for the development of therapeutic agents for the treatment of cystatin C-related immunological diseases.
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Affiliation(s)
- Wenjie Zhang
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Mengting Zi
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Li Sun
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Fengge Wang
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Shun Chen
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Yanfang Zhao
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Shuangchao Liang
- Department of Vascular Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Jiqiong Hu
- Department of Vascular Surgery, Yijishan Hospital of Wannan Medical College, Wuhu, 241000, China
| | - Shan Liu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Lei Liu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
| | - Yifan Zhan
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, 3000, Australia
| | - Andrew M Lew
- The Walter & Eliza Hall Institute of Medical Research, Parkville, VIC, 3000, Australia
| | - Yuekang Xu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, College of Life Science, Anhui Normal University, Wuhu, 241000, China
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Gilarska M, Raaijmakers A, Zhang ZY, Staessen JA, Levtchenko E, Klimek M, Grudzień A, Starzec K, Allegaert K, Kwinta P. Extremely Low Birth Weight Predisposes to Impaired Renal Health: A Pooled Analysis. Kidney Blood Press Res 2019; 44:897-906. [PMID: 31536985 DOI: 10.1159/000502715] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 08/14/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A number of studies examined the association between preterm delivery and kidney size and function later in life. However, the number of cases in published cohort studies is low. This study was aimed at performing a multicenter collaboration to pool data to obtain more accurate results to quantify the extent of renal impairment in former extremely low birth weight (ELBW; <1,000 g) children. METHODOLOGY We performed a subject-level meta-analysis to pool data from Cracow (64 cases/34 controls) and Leuven (93 cases/87 controls). We assessed and analyzed cystatin C, estimated glomerular filtration rate (eGFR), ultrasound kidney length, and blood pressure (BP) in 11-year-old ELBW children compared with controls born at term. The prevalence of hypertension (HT) and prehypertension (preHT) in both groups was also analyzed. RESULTS The study group comprised 157 former ELBW children (gestational age 23-33 weeks and birth weight 430-1,000 g) and 123 children born at term. Former ELBW children had lower mean eGFR (100.62 ± 16.53 vs. 111.89 ± 15.26 mL/min/1.73 m2; p < 0.001), smaller absolute kidney length (8.56 ± 0.78 vs. 9.008 ± 0.73 cm; <0.001), and higher systolic (111.8 ± 9.8 vs. 107.2 ± 9.07 mm Hg; p = 0.01) and diastolic (68.6 ± 6.8 vs. 66.3 ± 7.7 mm Hg; p = 0.03) BP. Smaller renal size in former ELBW children was positively associated with lower birth weight, shorter gestational age, and severity of perinatal complications (intraventricular hemorrhage, length of stay, mechanical ventilation, and oxygen therapy). CONCLUSION ELBW is associated with lower eGFR and a high frequency of preHT and HT.
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Affiliation(s)
- Maja Gilarska
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Anke Raaijmakers
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Zhen-Yu Zhang
- Department of Cardiovascular Sciences, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium
| | - Jan A Staessen
- Department of Cardiovascular Sciences, Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium
| | - Elena Levtchenko
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Małgorzata Klimek
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Grudzień
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Katarzyna Starzec
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland
| | - Karel Allegaert
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium.,Intensive Care and Department of Pediatric Surgery and Department of Pediatrics, Division of Neonatology, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Przemko Kwinta
- Department of Pediatrics, Jagiellonian University Medical College, Cracow, Poland,
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60
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Tan J, Tang Y, Xu Y, Yan S, Xu Y, Tan L, Zhong Z, Tarun P, Qin W. The Clinicopathological Characteristics of Henoch-Schönlein Purpura Nephritis with Presentation of Nephrotic Syndrome. Kidney Blood Press Res 2019; 44:754-764. [PMID: 31387105 DOI: 10.1159/000501459] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 06/07/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Henoch-Schönlein purpura nephritis (HSPN) is a common vasculitis involving the kidneys, with a lower incidence in adults. Meanwhile, nephrotic syndrome (NS) can appear in HSPN. However, the clinicopathological features and renal outcome of adult-onset HSPN presenting with NS (NS-HSPN) have not been well clarified. METHODS A total of 191 HSPN patients were prospectively analyzed and comparisons were made between NS-HSPN and non-NS-HSPN. Multivariate Cox regression analysis was carried out to find the unfavorable factors of renal outcome of NS-HSPN. RESULTS Among the 191 patients, 44 (23.0%) had NS-HSPN. Apart from edema and abdominal pain, patients with NS-HSPN tended to have lower levels of erythrocytes and hemoglobulin in blood as well as a greater number of erythrocytes in urine (p < 0.05). Mesangial proliferation was the most common pathological lesion in HSPN and the rates of crescent formation were significantly different, with 54.5% in NS-HSPN and 33.3% in non-NS-HSPN (p < 0.05). Notably, 18.2 and 4.8% of patients reached the composite endpoints in the NS-HSPN and non-NS-HSPN groups, respectively (p < 0.05), demonstrating that NS-HSPN patients were more likely to progress to end-stage renal disease and had a worse outcome. We also found that hypertension, estimated glomerular filtration rate (eGFR), cystatin, and tubular atrophy/interstitial fibrosis (HR > 1, p < 0.05) at onset were correlated with adverse outcome in NS-HSPN. CONCLUSION NS-HSPN had more severe clinicopathological manifestations and poorer prognosis. The adverse predictors of NS-HSPN principally depend on clinicopathological presentation rather than on different therapies, and hypertension, eGFR, cystatin, and tubular atrophy/interstitial fibrosis can serve as independent risk factors in NS-HSPN.
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Affiliation(s)
- Jiaxing Tan
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Yi Tang
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Yicong Xu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Siyu Yan
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Yuanyuan Xu
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Li Tan
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Zhengxia Zhong
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Padamata Tarun
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Wei Qin
- Division of Nephrology, Department of Medicine, West China Hospital, Sichuan University, Chengdu, China,
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61
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Kirelik D, Fisher M, DiMaria M, Soranno DE, Gist KM. Comparison of creatinine and cystatin C for estimation of glomerular filtration rate in pediatric patients after Fontan operation. CONGENIT HEART DIS 2019; 14:760-764. [PMID: 30993817 DOI: 10.1111/chd.12776] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 03/11/2019] [Accepted: 04/03/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are several limitations when using creatinine to estimate glomerular filtration rate, especially in children with chronic medical conditions who are at high risk of kidney dysfunction. Cystatin C has been the recent focus of research as a replacement biomarker for creatinine. Our objective was to compare the 2 biomarkers in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. We hypothesized that there would be poor correlation and agreement between the 2 estimates of renal function. METHODS This was a single center retrospective chart review of 20 patients who had previously undergone Fontan operation. Demographic and clinical data were collected from medical records. Blood samples were collected as part of routine clinical care and simultaneously measured for serum creatinine and cystatin C. Glomerular filtration rate was calculated using the creatinine-based bedside Schwartz formula and cystatin C-based Zapatelli equation. Spearman correlation and Bland-Altman analysis were used to assess correlation and agreement. RESULTS The median Schwartz-derived estimated glomerular filtration rate was 98.94 mL/min/1.73 m2 while the median Zappitelli-derived estimated glomerular filtration rate was 84.76 mL/min/1.73 m2 . The mean difference was -19.27 suggesting poor agreement. There was weak to moderate correlation between the Schwartz and cystatin C estimated glomerular filtration rate. CONCLUSION The bedside Schwartz formula may be an overestimate of glomerular filtration rate in pediatric single-ventricle heart disease patients who have undergone the Fontan operation. While larger studies are necessary, cystatin C is a promising biomarker to replace creatinine and better estimate kidney function in this population.
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Affiliation(s)
- Danielle Kirelik
- George Washington University School of Medicine, Washington, DC.,Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Mark Fisher
- Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Michael DiMaria
- Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Danielle E Soranno
- Section of Pediatric Nephrology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
| | - Katja M Gist
- Section of Pediatric Cardiology, Department of Pediatrics, University of Colorado, Children's Hospital Colorado, Aurora, Colorado
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Jayasekara JMKB, Dissanayake DM, Shihana F, Sivakanesan R, Silva RN, Gunawickrama SHNP. Comparison of Serum Cystatin C and Creatinine Levels among Individuals with Persisting Proteinuria in Farming Communities of Rural Sri Lanka. Malays J Med Sci 2019; 25:67-75. [PMID: 30914880 PMCID: PMC6422570 DOI: 10.21315/mjms2018.25.6.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 10/17/2018] [Indexed: 11/17/2022] Open
Abstract
Background Chronic kidney disease of uncertain aetiology (CKDu) is one of the major health concerns among agricultural communities in Sri Lanka. Individuals involved in severe agricultural works for their livelihood are highly vulnerable for this disease and patients have been detected with persisting proteinuria at community-level screening. The current study was designed to evaluate the diagnosis of two functional markers of kidney damage using individuals with persisting proteinuria as the baseline. Methods One hundred and fifty hard-working agricultural farmers from high-prevalence area for CKDu (Madawachchiya) were screened three times for proteinuria; 66 proteinuric and 21 non-proteinuric were identified as the baseline classification. Selected individuals were analysed further for creatinine, protein and cystatin C in urine and creatinine, cystatin C in serum. Urine protein-to-creatinine ratio (UP/UC) was calculated. Results Based on creatinine and cystatin C cut-off levels in serum, individuals were classified as high or normal. Diagnosis of two functional markers (creatinine and cystatin C) were evaluated using receiver operating characteristic (ROC) curve and in terms of sensitivity and specificity using UP/UC as the baseline. Creatinine and cystatin C-based eGFR (estimated Glomerular filtration rate) levels were calculated, and Pearson’s correlation coefficient was determined between different eGFR measurements using UP/UC. Mean (SD) UP/UC ratio, serum creatinine, and serum cystatin C levels of the proteinuric subjects were 129.0 (18.4) mg/mmol, 1.35 (0.39) mg/dL, 1.69 (0.58) mg/L. For non-proteniuric individuals, the results were found to be 14.4 (2.28), 1.22 (0.40) mg/dL, 0.82 (0.25) mg/L. The ROC analysis showed excellent accuracy in using cystatin C for identifying proteinuric patients than creatinine area under the curve (AUC): 0.9675, P < 0.001). Cut-off points were identified as 1.015 mg/dL for serum creatinine and 0.930mg/L for cystatin C. Furthermore, cystatin C based Hoek formula showed the better correlation (0.635, P < 0.001) with UP/UC compared with creatinine based modification of diet in renal disease (MDRD) formula. Conclusion The study showed elevated serum cystatin C in patients with persisting proteinuria compared with non-responding serum creatinine. Moreover, cystatin C-based eGFR equations were more accurate to determine the kidney function than serum creatinine in proteinuric patients who are vulnerable for CKDu in high-prevalence areas.
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Affiliation(s)
| | | | - Fathima Shihana
- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Ramaiya Sivakanesan
- Department of Biochemistry, Faculty of Medicine, University of Peradeniya, Sri Lanka
| | - Rajith Niloshan Silva
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, Sir John Kotelawala Defence University, Sri Lanka
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Edinga-Melenge BE, Yakam AT, Nansseu JR, Bilong C, Belinga S, Minkala E, Noudjeu PA, Ondhoua M, Kokola SW, Ama Moor VJ, Ashuntantang G. Reference intervals for serum cystatin C and serum creatinine in an adult sub-Saharan African population. BMC Clin Pathol 2019; 19:4. [PMID: 30923459 PMCID: PMC6423796 DOI: 10.1186/s12907-019-0086-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 03/11/2019] [Indexed: 12/01/2022] Open
Abstract
Background Serum cystatin C (SCysC) and serum creatinine (SCr) are two biomarkers used in common practice to estimate the glomerular filtration rate (GFR). For SCysC and SCr to be used in a given population, normal values need to be determined to better assess patients. This study aimed to determine SCysC and SCr reference intervals (RIs) in a Cameroonian adult population and factors susceptible of influencing them. Methods We carried-out a cross-sectional study from November 2016 to May 2017 in Yaoundé, Cameroon. Participants were Cameroonians aged 18 years and above, residing inside the country and found in good health at study inclusion. SCysC and SCr were determined by particle-enhanced turbidimetric immunoassay standardized against the ERM-DA471/IFCC reference material and by the IDMS reference modified Jaffe kinetic method, respectively. RIs were determined using the 2.5th and 97.5th percentiles and their respective 90% confidence intervals (CIs). The quantile regression served to identify potential factors likely influencing SCysC and SCr values. Results We included 381 subjects comprising 49.1% females.. RIs for SCysC varied between 0.57 (90%CI: 0.50–0.60) and 1.03 mg/L (90%CI: 1.00–1.10) for females, and from 0.70 (90%CI: 0.60–0.70) to 1.10 mg/L (90%CI: 1.10–1.20) for males. Concerning SCr, its RIs ranged from 0.58 (90%CI: 0.54–0.61) to 1.08 mg/dL (90%CI: 1.02–1.21) for females, and from 0.74 (90%CI: 0.70–0.80) to 1.36 mg/dL (90%CI: 1.30–1.45) for males. Men had significantly higher SCysC and SCr values than women (p < 0.001). Likewise, subjects aged 50 years and above had higher SCysC values in comparison to younger age groups (p < 0.001), which was not the case for SCr values (p = 0.491). Moreover, there was a positive and significant correlation between SCysC and SCr in women (ρ = 0.55, p < 0.001), in men (ρ = 0.39, p < 0.001) and globally (ρ = 0.58; p < 0.001). Furthermore, the sex influenced both biomarkers’ values across all quantile regression models while age and body surface area (BSA) influenced them inconsistently. Conclusion This study has determined serum cystatin C and serum creatinine reference intervals in an adult Cameroonian population, whose interpretations might take into account the patient’s sex and to a certain extent, his/her age and/or BSA. Electronic supplementary material The online version of this article (10.1186/s12907-019-0086-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bertille Elodie Edinga-Melenge
- Department of Biochemistry, Centre Pasteur of Cameroon, Yaoundé, Cameroon.,2Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon
| | - Adrienne Tchapmi Yakam
- 3Ebebda District Hospital, Centre Regional Delegation, Ministry of Public Health, Ebebda, Cameroon
| | - Jobert Richie Nansseu
- 4Department for the Control of Disease, Epidemics and Pandemics, Ministry of Public Health, Yaoundé, Cameroon.,5Department of Public Health, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, PO Box 1364, Yaoundé, Cameroon
| | - Catherine Bilong
- Department of Biochemistry, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Suzanne Belinga
- Department of Biochemistry, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | - Eric Minkala
- Department of Biochemistry, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Michel Ondhoua
- Department of Biochemistry, Centre Pasteur of Cameroon, Yaoundé, Cameroon
| | | | - Vicky Joceline Ama Moor
- 2Department of Physiological Sciences and Biochemistry, Faculty of Medicine and Biomedical Sciences, University of Yaoundé I, Yaoundé, Cameroon.,6Laboratory of Biochemistry, Yaoundé University Teaching Hospital, Yaoundé, Cameroon
| | - Gloria Ashuntantang
- 7Cardiology and Nephrology Unit, Yaoundé General Hospital, Yaoundé, Cameroon.,8Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences of the University of Yaoundé I, Yaoundé, Cameroon
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Liu TT, Pang HM, Jing L, Wei WX, Qin XL, Guo Q, Lu H, Cheng DH, Jiang WZ. A population pharmacokinetic model of vancomycin for dose individualization based on serum cystatin C as a marker of renal function. ACTA ACUST UNITED AC 2019; 71:945-955. [PMID: 30873627 DOI: 10.1111/jphp.13071] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/19/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVES This study aimed to establish a vancomycin population pharmacokinetics (PPK) model based on serum cystatin C and to optimize dosing for achieving targeted steady-state trough concentrations (Css ) of 10-15 and 15-20 mg/l. METHODS Patients aged ≥18 years were prospectively enrolled. A vancomycin PPK model was built with glomerular filtration rate (GFR) as a renal covariate estimated by cystatin C. A new group of patients were used for external evaluation. PPK analysis and Monte Carlo simulations were performed using nonlinear mixed effect modelling programme. KEY FINDINGS Two hundreds of patients with 514 samples were included. The final model was CL (L/h) = (5.07 × (GFR/105.5)0.524 × (AGE/48.5)-0.309 × (WT/60)0.491 ); V (l) = 46.3. Internal and external evaluations demonstrated good stability and predictability. The average probability of target attainment (PTA) of optimal dosing regimens for targeted Css achieving 10-15 and 15-20 mg/l were 51.2% and 40.6%, respectively. An average PTA ≥71% for targeted concentration of 10-20 mg/l was obtained. CONCLUSIONS A vancomycin PPK model with cystatin C as the renal marker has good stability and predictability. The new proposed dosing regimens were predicted to achieve a good PTA.
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Affiliation(s)
- Tao-Tao Liu
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hui-Mei Pang
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jing
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wen-Xing Wei
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xiao-Ling Qin
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Qing Guo
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Hua Lu
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Dao-Hai Cheng
- Department of Pharmacy, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Wei-Zhe Jiang
- Department of Pharmacology, Guangxi Medical University, Nanning, Guangxi, China
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Kooijmans ECM, Bökenkamp A, Tjahjadi NS, Tettero JM, van Dulmen‐den Broeder E, van der Pal HJH, Veening MA. Early and late adverse renal effects after potentially nephrotoxic treatment for childhood cancer. Cochrane Database Syst Rev 2019; 3:CD008944. [PMID: 30855726 PMCID: PMC6410614 DOI: 10.1002/14651858.cd008944.pub3] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Improvements in diagnostics and treatment for paediatric malignancies resulted in a major increase in survival. However, childhood cancer survivors (CCS) are at risk of developing adverse effects caused by multimodal treatment for their malignancy. Nephrotoxicity is a known side effect of several treatments, including cisplatin, carboplatin, ifosfamide, radiotherapy and nephrectomy, and can cause glomerular filtration rate (GFR) impairment, proteinuria, tubulopathy, and hypertension. Evidence about the long-term effects of these treatments on renal function remains inconclusive. It is important to know the risk of, and risk factors for, early and late adverse renal effects, so that ultimately treatment and screening protocols can be adjusted. This review is an update of a previously published Cochrane Review. OBJECTIVES To evaluate existing evidence on the effects of potentially nephrotoxic treatment modalities on the prevalence of renal dysfunction in survivors treated for childhood cancer with a median or mean survival of at least one year after cessation of treatment, where possible in comparison with the general population or CCS treated without potentially nephrotoxic treatment. In addition, to evaluate evidence on associated risk factors, such as follow-up duration, age at time of diagnosis and treatment combinations, as well as the effect of doses. SEARCH METHODS On 31 March 2017 we searched the following electronic databases: CENTRAL, MEDLINE and Embase. In addition, we screened reference lists of relevant studies and we searched the congress proceedings of the International Society of Pediatric Oncology (SIOP) and The American Society of Pediatric Hematology/Oncology (ASPHO) from 2010 to 2016/2017. SELECTION CRITERIA Except for case reports, case series and studies including fewer than 20 participants, we included studies with all study designs that reported on renal function (one year or longer after cessation of treatment), in CCS treated before the age of 21 years with cisplatin, carboplatin, ifosfamide, radiation involving the kidney region, a nephrectomy, or a combination of two or more of these treatments. When not all treatment modalities were described or the study group of interest was unclear, a study was not eligible for the evaluation of prevalence. We still included it for the assessment of risk factors if it had performed a multivariable analysis. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, 'Risk of bias' assessment and data extraction using standardised data collection forms. We performed analyses according to the guidelines of the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS Apart from the remaining 37 studies included from the original review, the search resulted in the inclusion of 24 new studies. In total, we included 61 studies; 46 for prevalence, six for both prevalence and risk factors, and nine not meeting the inclusion criteria, but assessing risk factors. The 52 studies evaluating the prevalence of renal dysfunction included 13,327 participants of interest, of whom at least 4499 underwent renal function testing. The prevalence of adverse renal effects ranged from 0% to 84%. This variation may be due to diversity of included malignancies, received treatments, reported outcome measures, follow-up duration and the methodological quality of available evidence.Seven out of 52 studies, including 244 participants, reported the prevalence of chronic kidney disease, which ranged from 2.4% to 32%.Of these 52 studies, 36 studied a decreased (estimated) GFR, including at least 432 CCS, and found it was present in 0% to 73.7% of participants. One eligible study reported an increased risk of glomerular dysfunction after concomitant treatment with aminoglycosides and vancomycin in CCS receiving total body irradiation (TBI). Four non-eligible studies assessing a total cohort of CCS, found nephrectomy and (high-dose (HD)) ifosfamide as risk factors for decreased GFR. The majority also reported cisplatin as a risk factor. In addition, two non-eligible studies showed an association of a longer follow-up period with glomerular dysfunction.Twenty-two out of 52 studies, including 851 participants, studied proteinuria, which was present in 3.5% to 84% of participants. Risk factors, analysed by three non-eligible studies, included HD cisplatin, (HD) ifosfamide, TBI, and a combination of nephrectomy and abdominal radiotherapy. However, studies were contradictory and incomparable.Eleven out of 52 studies assessed hypophosphataemia or tubular phosphate reabsorption (TPR), or both. Prevalence ranged between 0% and 36.8% for hypophosphataemia in 287 participants, and from 0% to 62.5% for impaired TPR in 246 participants. One non-eligible study investigated risk factors for hypophosphataemia, but could not find any association.Four out of 52 studies, including 128 CCS, assessed the prevalence of hypomagnesaemia, which ranged between 13.2% and 28.6%. Both non-eligible studies investigating risk factors identified cisplatin as a risk factor. Carboplatin, nephrectomy and follow-up time were other reported risk factors.The prevalence of hypertension ranged from 0% to 50% in 2464 participants (30/52 studies). Risk factors reported by one eligible study were older age at screening and abdominal radiotherapy. A non-eligible study also found long follow-up time as risk factor. Three non-eligible studies showed that a higher body mass index increased the risk of hypertension. Treatment-related risk factors were abdominal radiotherapy and TBI, but studies were inconsistent.Because of the profound heterogeneity of the studies, it was not possible to perform meta-analyses. Risk of bias was present in all studies. AUTHORS' CONCLUSIONS The prevalence of adverse renal effects after treatment with cisplatin, carboplatin, ifosfamide, radiation therapy involving the kidney region, nephrectomy, or any combination of these, ranged from 0% to 84% depending on the study population, received treatment combination, reported outcome measure, follow-up duration and methodological quality. With currently available evidence, it was not possible to draw solid conclusions regarding the prevalence of, and treatment-related risk factors for, specific adverse renal effects. Future studies should focus on adequate study designs and reporting, including large prospective cohort studies with adequate control groups when possible. In addition, these studies should deploy multivariable risk factor analyses to correct for possible confounding. Next to research concerning known nephrotoxic therapies, exploring nephrotoxicity after new therapeutic agents is advised for future studies. Until more evidence becomes available, CCS should preferably be enrolled into long-term follow-up programmes to monitor their renal function and blood pressure.
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Affiliation(s)
- Esmee CM Kooijmans
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Arend Bökenkamp
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatric NephrologyPO Box 7057AmsterdamNetherlands1007 MB
| | - Nic S Tjahjadi
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Jesse M Tettero
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Eline van Dulmen‐den Broeder
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
| | - Helena JH van der Pal
- Princess Maxima Center for Pediatric Oncology, KE.01.129.2PO Box 85090UtrechtNetherlands3508 AB
| | - Margreet A Veening
- Amsterdam UMC, Vrije Universiteit AmsterdamDepartment of Pediatrics, Division of Oncology/HematologyDe Boelelaan 1117AmsterdamNetherlands1081 HV
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Önerli Salman D, Şıklar Z, Çullas İlarslan EN, Özçakar ZB, Kocaay P, Berberoğlu M. Evaluation of Renal Function in Obese Children and Adolescents Using Serum Cystatin C Levels, Estimated Glomerular Filtration Rate Formulae and Proteinuria: Which is most Useful? J Clin Res Pediatr Endocrinol 2019; 11:46-54. [PMID: 30145854 PMCID: PMC6398183 DOI: 10.4274/jcrpe.galenos.2018.2018.0046] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/17/2018] [Indexed: 12/11/2022] Open
Abstract
Objective There is a growing interest in the relationship between obesity and renal damage. The effect of obesity on renal function in children and adolescents has not been adequately investigated. In addition, there is no complete consensus on the reliability of various renal function parameters. The primary goal of this study was to evaluate renal function in obese children and adolescents using glomerular filtration rate (GFR), cystatin C, and creatinine (Cr)-derived formulas. We also compared classical GFR measurement methods with methods based on bioimpedance analysis-derived body cell mass (BCM). Methods We enrolled 108 obese and 46 healthy subjects aged 6-18 years. Serum cystatin C, serum Cr, 24-hour proteinuria, Cr clearance, and GFR were evaluated in both groups. Estimated GFR was measured with Cr-based, cystatin C-based, combined (cystatin C and Cr) and BCM-based formulae. Both actual and fat-free mass body surface areas (BSA) were used when required. Metabolic parameters (blood glucose, insulin, and lipids) were analyzed in the obese subjects. International Diabetes Federation criteria were used to identify metabolic syndrome (MetS). Results We did not detect statistically significant differences between the obese and control groups for mean Cr (p=0.658) and mean cystatin C (p=0.126). Mean cystatin C levels of MetS patients were significantly higher than those of non-MetS obese participants (p<0.001). Cr-based GFR measurements, BCM-based measurements and a combined Cr and cystatin C measurement showed a statistically significant increase in the GFR of obese subjects compared to controls (p=0.002 and p<0.001). This increase was negatively correlated with duration of obesity. Estimations based on actual or fat-free mass BSA did not differ either. Only the Filler equation showed a statistically significant decrease in eGFR in MetS patients. There were no statistically significant differences between the obese and control groups for proteinuria (p=0.994) and fat-free mass proteinuria (p=0.476). Conclusion We conclude that cystatin C could be used as an earlier biomarker than Cr in the detection of impaired renal function in obese children, especially those with MetS. Cr-based formulae reveal hyperfiltration as the first change in renal function. Decreasing eGFR seen in MetS patients with cystatin C-based formulae, but not Cr-based formulae, may represent the early stages of renal damage. Using fat-free mass or BCM for eGFR formulae in obese children seems to provide no additional information.
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Affiliation(s)
| | - Zeynep Şıklar
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | | | - Z. Birsin Özçakar
- Ankara University Faculty of Medicine, Department of Pediatric Nephrology, Ankara, Turkey
| | - Pınar Kocaay
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Merih Berberoğlu
- Ankara University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Chuang LP, Lin SW, Lee LA, Chang CH, Huang HY, Hu HC, Kao KC, Hsieh MJ, Yang CT, Li HY, Chen NH. Elevated Serum Markers of Acute Kidney Injury in Patients With Obstructive Sleep Apnea. J Clin Sleep Med 2019; 15:207-213. [PMID: 30736871 PMCID: PMC6374082 DOI: 10.5664/jcsm.7618] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 09/21/2018] [Accepted: 09/26/2018] [Indexed: 01/19/2023]
Abstract
STUDY OBJECTIVES Previous research revealed a positive correlation between endothelial cell injury (indicated by albuminuria) and obstructive sleep apnea (OSA). However, little else has been revealed about acute kidney injury (AKI) in patients with OSA. METHODS This prospective study recruited consecutive patients undergoing overnight polysomnography for evaluation of sleep apnea. Patients in whom any major disease or recent infection had been previously diagnosed were excluded. Ultimately, data from 75 patients with apnea-hypopnea indices of 5 or more were analyzed. Baseline values for the urinary albumin-creatinine ratio (UACR), serum levels for three markers of AKI (cystatin C, neutrophil gelatinase-associated lipocalin [NGAL], interleukin-18 [IL-18]), and polysomnography data were recorded and analyzed. Patients then were followed for 6 months of continuous positive airway pressure (CPAP) treatment. RESULTS At baseline, UACRs were greater in patients with more severe OSA (P = .005, r = .329). All three serum markers of AKI (cystatin C, NGAL, and IL-18) studied were positively correlated with OSA severity, and two (cystatin C and IL-18) were positively correlated with the frequency of oxygen desaturation during sleep. However, none of the AKI markers had positive correlations with UACR. After 6 months of CPAP treatment, UACR and IL-18 were decreased significantly in patients with good adherence. CONCLUSIONS Albuminuria and levels of three serum markers of AKI (cystatin C, NGAL, IL-18) were positively correlated with OSA severity, and good adherence with CPAP treatment decreased albuminuria and interleukin-18 levels. These results may provide additional tools for assessing early renal injury in patients with OSA.
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Affiliation(s)
- Li-Pang Chuang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Wei Lin
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Li-Ang Lee
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Hsiang Chang
- Department of Nephrology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Hung-yu Huang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Han-Chung Hu
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Kuo-Chin Kao
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Meng-Jer Hsieh
- Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Ta Yang
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsueh-Yu Li
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Otolaryngology, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Ning-Hung Chen
- Sleep Center and Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
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Utility of the Serum Cystatin C Level for Diagnosis of Osteoporosis among Middle-Aged and Elderly People. BIOMED RESEARCH INTERNATIONAL 2019; 2019:5046852. [PMID: 30775381 PMCID: PMC6354135 DOI: 10.1155/2019/5046852] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 01/10/2019] [Indexed: 11/17/2022]
Abstract
Purpose Osteoporosis is a common age-related disorder leading to increased bone fragility and risk of fracture. Early diagnosis of osteoporosis is a vital step in providing early therapeutic intervention. Serum cystatin C is a marker of early renal dysfunction, a predictor of cardiovascular and inflammatory diseases, and an inhibitor of the differentiation of osteoclast precursor cells. The purpose of this study was to evaluate the relationship between serum cystatin C and osteoporosis. Methods We enrolled 46 subjects who attended a health checkup and underwent measurement of bone status by quantitative ultrasound and determination of the level of serum cystatin C. A comparative study was conducted between those with and without osteoporosis for all subjects collectively and in two subgroups aged <65 and ≥65 years. Results Serum cystatin C levels were strongly correlated with age, creatinine, and bone status data, with significant negative correlations with stiffness, T-score, and percentage of young adult mean. Among patients with osteoporosis, serum cystatin C was significantly higher even after adjustment for age and sex, whereas no significant difference was noted in creatinine. For patients aged ≥ 65 years, serum cystatin C was significantly higher in subjects with osteoporosis, although there was no significant difference in age between normal subjects and those with osteoporosis. Conclusions To the best of our knowledge, this is the first study to demonstrate an association between serum cystatin C and osteoporosis. Serum cystatin C is significantly higher in osteoporosis and in particular may be a useful marker for osteoporosis among middle and elderly people aged ≥ 65 years. Measurement of serum cystatin C can be carried out easily and may contribute to early diagnosis and treatment of osteoporosis.
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The value of serum cystatin C in early evaluation of renal insufficiency in patients undergoing chemotherapy: a systematic review and meta-analysis. Cancer Chemother Pharmacol 2019; 83:561-571. [PMID: 30610366 DOI: 10.1007/s00280-018-3762-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 12/18/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Several studies have shown that cystatin C levels can be used to detect decline in renal function in cancer patients receiving chemotherapy, and can serve as a supplement to creatinine level measurement for early detection of renal insufficiency. Nevertheless, use of the parameter remains controversial. This study aimed to assess the value of serum cystatin C levels in evaluation of early renal insufficiency due to chemotherapy. METHODS Studies were retrieved from PubMed, Ovid Embase, the Web of Science, the Cochrane Library, Ovid, and the CNKI databases up to May 15, 2018. Serum levels of cystatin C before and after chemotherapy were evaluated for its ability to assess renal function. RESULTS A total of 12 studies, including 1775 participants, met our inclusion and exclusion criteria. Pooled analysis revealed that the levels of serum cystatin C in cancer patients after chemotherapy were significantly higher than those of patients prior to treatment [standard mean difference (SMD) = 0.54, 95% CI 0.34-0.74, P = 0.0000]. Compared to creatinine, serum cystatin C increased significantly in the early phases of glomerular filtration rate (GFR) change before and after chemotherapy (GFR ≥ 90 ml/min/1.73 m2, P < 0.05 vs. P > 0.05, 5.83%; 60 < GFR < 90 ml/min/1.73 m2, P < 0.01 vs. P > 0.01, 38.83%) and increased more substantially in the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01 vs. P < 0.01, 70.87% vs. 23.09%). However, creatinine decreased even in the early phases and did not increase in an obvious manner until the later phases (GFR < 60 ml/min/1.73 m2, P < 0.01, 23.09%). The GFR values were derived from measured methods. CONCLUSIONS Cystatin C may be superior to creatinine for the detection of minor changes in GFR in early stages of renal insufficiency secondary to chemotherapy. More studies are needed to further verify this result.
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Messova A, Dziubak R, Köglmeier J. Renal Function in Children on Long Term Home Parenteral Nutrition. Front Pediatr 2019; 7:137. [PMID: 31058118 PMCID: PMC6477075 DOI: 10.3389/fped.2019.00137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 03/25/2019] [Indexed: 11/13/2022] Open
Abstract
Objectives: To assess renal function in pediatric intestinal failure (IF) patients on long term home parenteral nutrition (HPN). Methods: Children who received HPN for a minimum of 3 years between 2007 and 2017 were identified from the IF clinic of a large tertiary referral center. Estimated glomerular filtration rate (eGFR) was calculated using the Schwartz formula at discharge on HPN, after 6 months, 1, 2, and 3 years. Results: Twenty five patients (40% male) fulfilled the inclusion criteria. The indications for HPN were due to an underlying motility disorder in 56% (14/25), enteropathy in 24% (6/25), and short bowel syndrome in 20% (5/25). At the start of HPN 80% (20/25) had a normal eGFR. Four children (17%) had an abnormal eGFR. In the group of patients with normal eGFR at the start of HPN 30% (6/20) had at least one episode of decreased eGFR in the following 3 years, however there was no significant decline in eGFR at the end of the 3 year study period. Overall there was no statistically significant deterioration of eGFR in the study population (p = 0.7898). Conclusion: In our cohort of children on long term HPN no significant decline of eGFR could be demonstrated within 3 years of starting PN.
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Affiliation(s)
- Assylzhan Messova
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Robert Dziubak
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, United Kingdom
| | - Jutta Köglmeier
- Unit of Nutrition and Intestinal Failure Rehabilitation, Department of Paediatric Gastroenterology, Great Ormond Street Hospital for Children, London, United Kingdom
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71
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Wattanavaekin K, Kitporntheranunt M, Kreepala C. Cystatin C as a novel predictor of preterm labor in severe preeclampsia. Kidney Res Clin Pract 2018; 37:338-346. [PMID: 30619689 PMCID: PMC6312773 DOI: 10.23876/j.krcp.18.0080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 12/13/2022] Open
Abstract
Background The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes. Methods Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes. Results Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity. Conclusion GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.
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Affiliation(s)
| | - Maethaphan Kitporntheranunt
- Department of Obstetrics and Gynecology, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Chatchai Kreepala
- Department of Internal Medicine, Faculty of Medicine, Srinakharinwirot University, Nakhon Nayok, Thailand
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Gunasekaran V, Dey S, Chakrawarty A, Chatterjee P, Sati HC, Dwivedi SN, Dey AB. Raised serum cystatin C can be a potential biomarker of frailty detected by cumulative deficit model. Aging Med (Milton) 2018; 1:149-153. [PMID: 31942492 PMCID: PMC6880677 DOI: 10.1002/agm2.12038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/14/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Identification of frailty by clinical criteria is often delayed to the advanced stage. A reliable biomarker to identify frailty or its risk does not currently exist. We aimed to determine the association between serum cystatin C and frailty in subjects without renal dysfunction. METHODS We carried out a cross-sectional observational study in the Department of Geriatric Medicine, All India Institute of Medical Sciences, New Delhi, India. The study involved 125 participants, aged 65 years or older. Frailty status was assessed with Frailty Index criteria (cumulative deficit model). Serum cystatin C was estimated with the nephelometry method and its association with frailty was analyzed. RESULTS Mean age of the study sample was 76.32 years with 72 (57.6%) male and 53 (42.4%) female participants. Seventy-three subjects were frail; the mean cystatin C levels in the frail and non-frail groups were 1.28 mg/L (±0.39) and 1.12 mg/L (±0.27), respectively, and the difference was significant (P < 0.05). A cutoff of 1.12 mg/L was found to be 60.27% sensitive and 57.69% specific in identification of frailty. Multivariate analysis showed that higher cystatin C level was associated with 2.52 (1.05-6.02) times the risk of being frail. CONCLUSION Higher levels of cystatin C were found in frail subjects. Cystatin C seems to be a promising marker for identifying frailty in older adults without renal abnormalities.
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Affiliation(s)
| | - Sharmistha Dey
- Department of BiophysicsAll India Institute of Medical SciencesNew DelhiIndia
| | - Avinash Chakrawarty
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Prashun Chatterjee
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
| | - Hem Chandra Sati
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Sada Nand Dwivedi
- Department of BiostatisticsAll India Institute of Medical SciencesNew DelhiIndia
| | - Aparajit Ballav Dey
- Department of Geriatric MedicineAll India Institute of Medical SciencesNew DelhiIndia
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Ha S, Lee JJ. A Comparison of the Accuracy of Different Single Plasma Sample Methods for Measuring Glomerular Filtration Rate Using 51Cr-EDTA in Children. Nucl Med Mol Imaging 2018; 52:293-302. [PMID: 30100942 DOI: 10.1007/s13139-018-0529-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/24/2018] [Accepted: 05/27/2018] [Indexed: 10/28/2022] Open
Abstract
Purpose Among the different methods of measuring glomerular filtration rate (GFR) using 51Cr-ethylenediaminetetraacetic acid clearance, the two-plasma-sample method (TPSM) is widely used, and highly accurate. The single-plasma-sample method (SPSM) is occasionally used for simplicity, at the expense of accuracy. Our aims were (1) to investigate the correlation and (2) to compare the accuracy of six known SPSMs in pediatric patients in reference to TPSM. Methods We retrospectively reviewed 122 pediatric cases (65 boys, age 7.3 ± 4.6 years) and analyzed 307 GFR measurements. SPSMs included Groth and Aasted at 120 min, Ham at 120 min, Christensen and Groth at 120 and 240 min, and Jacobsson at 120 and 240 min. Reference GFR (GFRref) was defined using TPSM GFR corrected by the Jodal and Brochner-Mortensen equation. GFRref < 30 mL min-1 1.73 m-2 were excluded. The standard error of the estimate (SEE) and the number of cases with differences > 10% (N10%) were used to evaluate accuracy. Results SPSMs generally correlated well with GFRref (r = 0.92~0.99) and were relatively accurate (SEE = 9.21~15.60). Groth and Aasted showed the smallest SEE, while Jacobsson at 240 min showed the smallest N10% for all GFRref ranges. As for the decreased GFRref, Ham was most accurate followed by Jacobsson at 240 min. Conclusions Jacobsson at 240 min provided good accuracy in all GFRref ranges and was well correlated with TPSM. Jacobsson at 240 min might be the most appropriate method to substitute for TPSM in pediatric patients. Ham could be an alternative in patients with impaired renal function.
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Affiliation(s)
- Sejin Ha
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
| | - Jong Jin Lee
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505 South Korea
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Kandasamy Y, Rudd D, Smith R. The relationship between body weight, cystatin C and serum creatinine in neonates. J Neonatal Perinatal Med 2018; 10:419-423. [PMID: 29286938 DOI: 10.3233/npm-171719] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Serum creatinine (SCr) measurement to determine glomerular filtration rate (GFR) in neonates has many pitfalls. Cystatin C (CysC) appears to be a more reliable biomarker. METHODS We investigated the effect of birth weight on SCr and CysC measurements in a cohort of 74 infants, consisting of both term and ex-premature infants at term postmenstrual age. SCr and Cys C measurements were carried out at the same time. RESULTS Eighty six infants were recruited into this study out of which complete data were available in 80 infants. The cohort consists of both term and premature infants at term PMA (31 terms and 49 preterms). The median SCr level was 17 [12-26] umol/L and mean CysC level was 1.64 [0.27] mg/L. SCr had a significant correlation with weight (r = 0.3; P = 0.011), whereas serum CysC had no correlation with the infant's weight (r = 0.01; P = 0.95). There were no statistically significant difference in SCr and CysC between male and female infants. CONCLUSION Unlike CysC, SCr had a significant correlation with birth weight. SCr based GFR measurement may cause a delay in diagnosis of acute kidney injury in smaller neonates.
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Affiliation(s)
- Y Kandasamy
- Department of Neonatology, The Townsville Hospital, QLD, Australia.,Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, NSW, Australia.,College of Public Health, Medical and Veterinary Sciences, The James Cook University, QLD, Australia
| | - D Rudd
- College of Public Health, Medical and Veterinary Sciences, The James Cook University, QLD, Australia
| | - R Smith
- Mothers and Babies Research Centre, Hunter Medical Research Institute, John Hunter Hospital, The University of Newcastle, NSW, Australia
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76
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El-Gammacy TM, Shinkar DM, Mohamed NR, Al-Halag AR. Serum cystatin C as an early predictor of acute kidney injury in preterm neonates with respiratory distress syndrome. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:352-357. [PMID: 29786454 DOI: 10.1080/00365513.2018.1472803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Preterm neonates with respiratory distress syndrome (RDS) are at increased risk of acute kidney injury (AKI). Our study aimed at determining whether serum cystatin C (sCysC) on day 3 of life (D3) can early predict AKI in preterm neonates with RDS. This prospective study was conducted on 75 preterm neonates; 50 with RDS and 25 without RDS. On D3, sCysC, serum creatinine (sCr) and blood urea nitrogen (BUN) were measured and estimated glomerular filtration rate (eGFR) was calculated. sCr and BUN levels were measured again on days 5 and 7. Neonates were evaluated for development of AKI during first week of life according to the modified pediatric RIFLE (pRIFLE) criteria. Thirteen neonates with RDS developed AKI (26%).There was no significant difference between RDS and control groups with respect to sCysC. RDS neonates with AKI had significantly higher sCysC than those without AKI (1.62 ± 0.12 versus 1.16 ± 0.09 mg/l; p < .001). RDS grade III-IV neonates had significantly higher sCysC than RDS grade I-II. There was a significant positive correlation between D3 sCysC and (D5 and D7 sCr and BUN). Receiver operating characteristic (ROC) curve showed that D3 sCysC can predict AKI in preterm neonates with RDS at a cutoff point of >1.3 mg/l with sensitivity of 92.30% and specificity of 96%. We conclude that neonates with RDS are at increased risk of AKI. sCysC on day 3 of life can predict AKI earlier than Cr and eGFR.
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Affiliation(s)
| | - Dina Mohamed Shinkar
- a Department of Pediatrics, Faculty of Medicine , Ain Shams University , Cairo , Egypt
| | - Noha Refaat Mohamed
- b Clinical Pathology Department, Faculty of Medicine , Ain Shams University , Cairo , Egypt
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Cambiaghi A, Díaz R, Martinez JB, Odena A, Brunelli L, Caironi P, Masson S, Baselli G, Ristagno G, Gattinoni L, de Oliveira E, Pastorelli R, Ferrario M. An Innovative Approach for The Integration of Proteomics and Metabolomics Data In Severe Septic Shock Patients Stratified for Mortality. Sci Rep 2018; 8:6681. [PMID: 29703925 PMCID: PMC5923340 DOI: 10.1038/s41598-018-25035-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/09/2018] [Indexed: 12/29/2022] Open
Abstract
In this work, we examined plasma metabolome, proteome and clinical features in patients with severe septic shock enrolled in the multicenter ALBIOS study. The objective was to identify changes in the levels of metabolites involved in septic shock progression and to integrate this information with the variation occurring in proteins and clinical data. Mass spectrometry-based targeted metabolomics and untargeted proteomics allowed us to quantify absolute metabolites concentration and relative proteins abundance. We computed the ratio D7/D1 to take into account their variation from day 1 (D1) to day 7 (D7) after shock diagnosis. Patients were divided into two groups according to 28-day mortality. Three different elastic net logistic regression models were built: one on metabolites only, one on metabolites and proteins and one to integrate metabolomics and proteomics data with clinical parameters. Linear discriminant analysis and Partial least squares Discriminant Analysis were also implemented. All the obtained models correctly classified the observations in the testing set. By looking at the variable importance (VIP) and the selected features, the integration of metabolomics with proteomics data showed the importance of circulating lipids and coagulation cascade in septic shock progression, thus capturing a further layer of biological information complementary to metabolomics information.
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Affiliation(s)
| | - Ramón Díaz
- Proteomics Platform - Parc Científic de Barcelona, Barcelona, Spain
| | | | - Antonia Odena
- Proteomics Platform - Parc Científic de Barcelona, Barcelona, Spain
| | - Laura Brunelli
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | - Pietro Caironi
- Anestesia e Rianimazione, Azienda Ospedaliero-Universitaria S. Luigi Gonzaga, Orbassano, Italy.,Dipartimento di Oncologia, Università degli Studi di Torino, Turin, Italy
| | - Serge Masson
- IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy
| | | | | | - Luciano Gattinoni
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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Roomizadeh P, Gheissari A, Kelishadi R, Mahmoudi F, Abedini A. First Report on the Percentiles of the Glomerular Filtration Rate in Iranian Children Using the 2009 Schwartz Equations. IRANIAN JOURNAL OF MEDICAL SCIENCES 2018; 43:202-207. [PMID: 29749989 PMCID: PMC5936852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The glomerular filtration rate (GFR) is widely considered the best overall index of renal function. The Schwartz equations are designed for measuring the GFR in children between 1 and 16 years of age. In the present study, we investigated the percentiles of the GFR in a general population of Iranian children with no known renal disease via the 2009 Schwartz equations (updated and combined equations). Between 2010 and 2011, we selected 687 children aged 7-16 years from the Iranian province of Isfahan. Blood samples were analyzed for blood urea nitrogen, creatinine, and cystatin C. For each child, we calculated the GFR using 2 Schwartz equations. The Wilcoxon test was applied to examine the differences in the estimated GFRs between the equations. To determine the correlation between the GFRs obtained via the updated and combined Schwartz equations in the boys and the girls and also for the correlation between age and the GFR, we performed the Pearson or Spearman correlation coefficients. The statistical analyses were conducted using MedCalc, version 12.1.4.0 (MedCalc Software, Mariakerke, Belgium). The mean GFR was 100.06±19.80 mL/min/1.73 m2 based on the updated equation and 96.10±18.44 mL/min/1.73 m2 according to the combined equation. No significant differences were observed between these equations in estimating the GFRs. The correlation analysis for determining the association between age and the GFR estimated by the updated (r=0.05, P=0.1) and combined (r=0.06, P=0.09) Schwartz equations was not statistically significant. In conclusion, in the current study we showed that the updated and combined Schwartz equations exhibited high concordance in estimating GFR values in this age group.
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Affiliation(s)
- Peyman Roomizadeh
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alaleh Gheissari
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran;,Department of Pediatric Nephrology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Roya Kelishadi
- Child Growth and Development Research Center, Department of Pediatrics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farhad Mahmoudi
- Medical Students’ Research Center, Isfahan University of Medical sciences, Isfahan, Iran
| | - Amin Abedini
- Isfahan Kidney Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Yang Y, Li SJ, Pan JJ, Hu YH, Zhou XY, Cheng R, Chen XQ. Reference values for serum cystatin C in very low-birthweight infants: From two centres of China. J Paediatr Child Health 2018; 54:284-288. [PMID: 28960558 DOI: 10.1111/jpc.13732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 07/05/2017] [Accepted: 08/07/2017] [Indexed: 12/13/2022]
Abstract
AIM To determine the level of cystatin C (Cys-C) values in preterm babies for the purpose of becoming a good endogenous marker of renal function. METHODS A total of 366 very low-birthweight infants (including 70 extremely low-birthweight babies) with gestational age <37 weeks born in two centres were studied. RESULTS In very low-birthweight infants, the mean level of Cys-C was 1.96 ± 0.44 mg/L in blood samples taken on day 1, 1.78 ± 0.49 mg/L on day 7 and 1.71 ± 0.47 mg/L on day 28. In extremely low-birthweight infants, the mean level of Cys-C was 2.00 ± 0.49 mg/L on day 1, 1.63 ± 0.38 mg/L on day 7 and 1.62 ± 0.55 mg/L on day 28, respectively. Compared to serum creatinine and blood urea nitrogen, Cys-C level was independent of birthweight and gestational age. CONCLUSION Cys-C is regarded as an alternative for assessing renal function in very low-birthweight infants, but its advantages over serum creatinine and blood urea nitrogen has not been fully proved yet. Hence, larger sample study is still necessary.
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Affiliation(s)
- Yang Yang
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-Jun Li
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Jing-Jing Pan
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Yu-Hua Hu
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao-Yu Zhou
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Rui Cheng
- Department of Neonates, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Chen
- Department of Pediatrics, The First Affiliated Hospital, Nanjing Medical University, Nanjing, China
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Gao J, Meyer K, Borucki K, Ueland PM. Multiplex Immuno-MALDI-TOF MS for Targeted Quantification of Protein Biomarkers and Their Proteoforms Related to Inflammation and Renal Dysfunction. Anal Chem 2018; 90:3366-3373. [DOI: 10.1021/acs.analchem.7b04975] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Jie Gao
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
| | - Klaus Meyer
- Bevital AS, Jonas Lies veg 87, Laboratory Building, Ninth Floor, 5021 Bergen, Norway
| | - Katrin Borucki
- Institute for Clinical Chemistry and Pathobiochemistry, Otto-von-Guericke University Magdeburg, Leipziger Strasse 44 , 39120 Magdeburg, Germany
| | - Per Magne Ueland
- Department of Clinical Science, University of Bergen, 5021 Bergen, Norway
- Laboratory of Clinical Biochemistry, Haukeland University Hospital, 5021 Bergen, Norway
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Zi M, Xu Y. Involvement of cystatin C in immunity and apoptosis. Immunol Lett 2018; 196:80-90. [PMID: 29355583 PMCID: PMC7112947 DOI: 10.1016/j.imlet.2018.01.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/06/2018] [Accepted: 01/16/2018] [Indexed: 12/26/2022]
Abstract
As an abundantly expressed cysteine protease inhibitor widely distributed in the organisms, cystatin C is involved in various physiological processes. Due to its relatively small molecular weight and easy detection, cystatin C is commonly used as a measure for glomerular filtration rate. In pathological conditions, however, growing evidences suggest that cystatin C is associated with various immune responses against either exogenous or endogenous antigens, which ultimately result in inflammatory autoimmune diseases or tumor development if not properly controlled. Thus the fluctuation of cystatin C levels might have more clinical implications than a reflection of kidney functions. Here, we summarize the latest development of studies on the pathophysiological functions of cystatin C, with focus on its immune regulatory roles at both cellular and molecular levels including antigen presentation, secretion of cytokines, synthesis of nitric oxide, as well as apoptosis. Finally, we discuss the clinical implications and therapeutic potentials of what this predominantly expressed protease inhibitor can bring to us.
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Affiliation(s)
- Mengting Zi
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, School of Life Science, Anhui Normal University, Wuhu 241000, China
| | - Yuekang Xu
- Anhui Provincial Key Laboratory for Conservation and Exploitation of Biological Resources, School of Life Science, Anhui Normal University, Wuhu 241000, China.
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Robles NR, Mena C, Chavez E, Bayo MA, Gonzalez Candia B, Cidoncha A, Lopez Gomez J, Cubero JJ. A comparison of cystatin C concentrations between patients with chronic interstitial nephritis and glomerular diseases. J Clin Lab Anal 2018; 32. [DOI: 10.1002/jcla.22166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/14/2017] [Indexed: 11/08/2022] Open
Affiliation(s)
| | - Candido Mena
- Centro de Salud “Jose María Alvarez”; Don Benito Spain
| | - Edgar Chavez
- Servicio de Nefrologia. Hospital Infanta Cristina; Badajoz Spain
| | | | | | - Antonio Cidoncha
- Servicio de Analisis Clínicos; Hospital de Don Benito-Villanueva de la Serena; Don Benito Spain
| | - Juan Lopez Gomez
- Servicio de Analisis Clínicos; Hospital Infanta Cristina; Badajoz Spain
| | - Juan Jose Cubero
- Servicio de Nefrologia. Hospital Infanta Cristina; Badajoz Spain
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Mian AN, Schwartz GJ. Measurement and Estimation of Glomerular Filtration Rate in Children. Adv Chronic Kidney Dis 2017; 24:348-356. [PMID: 29229165 DOI: 10.1053/j.ackd.2017.09.011] [Citation(s) in RCA: 131] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Rapid, accurate, and precise measures of kidney function are essential for daily management of patients. While plasma and urinary clearances provide the greatest accuracy for assessing glomerular filtration rate (GFR), these are often impractical particularly for the care of children. Serum creatinine, the most commonly used endogenous marker, is simple, convenient, and practical but less accurate because of the influence of non-GFR determinants such as muscle mass, which increases with age in children. GFR estimating equations have been developed for adults and children to improve the accuracy of endogenous biomarkers, such as creatinine and cystatin C, by accounting for some of the non-GFR determinants, thus enhancing the practitioner's ability to assess GFR. In the steady state, when height is used as a surrogate for growth, there is a strong correlation between height/SCr and GFR. Current national guidelines recommend routine reporting of the estimated GFR alongside the serum creatinine value for adults using the Chronic Kidney Disease Epidemiology Collaboration creatinine-based formula and the updated Schwartz "bedside" formula (CKiD 2009) for children.
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84
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Muñoz J, Soblechero P, Duque FJ, Macías-García B, Ruiz P, Zaragoza C, Barrera R. Effects of Oral Prednisone Administration on Serum Cystatin C in Dogs. J Vet Intern Med 2017; 31:1765-1770. [PMID: 28921665 PMCID: PMC5697201 DOI: 10.1111/jvim.14820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/20/2017] [Accepted: 08/01/2017] [Indexed: 11/27/2022] Open
Abstract
Background Oral administration of glucocorticoid alters serum cystatin C (sCysC) concentration in humans. Objective To determine if oral administration of prednisone alters sCysC in dogs without pre‐existing renal disease. Animals Forty six dogs were included: 10 dogs diagnosed with steroid responsive meningitis arteritis (SRMA; group A), 20 dogs diagnosed of pituitary‐dependent hyperadrenocorticism (PDH; group B), and 16 healthy control dogs (group C). Methods Retrospective observational study. SRMA diagnosed dogs were administered prednisone 4 mg/kg/24 h PO 7 days, reducing the dose to 2 mg/kg/24 h 7 days before medication withdrawal. In group A, sampling was performed at days 0, 7, 14 and a final control at day 21. Blood and urine samples were collected in the 3 groups, and in group A, sampling was performed at all time points (days 1, 7, 14, and 21). Results In group A, sCysC was significantly higher at day 7 compared to the control group (0.4 ± 0.04 mg/L vs. 0.18 ± 0.03 mg/L mean ± SEM respectively P < 0.01); sCysC values decreased to basal at day 14 when the dose was decreased and after 1 week of withdrawal of prednisone (0.27 ± 0.03 mg/L for group A at day 14 and 0.15 ± 0.02 mg/L at day 21; P > 0.05). Dogs with PDH included in group B did not have significant differences in sCysC (0.22 ± 0.03 mg/L) compared to control (P > 0.05). Conclusions and Clinical Importance Oral administration of prednisone unlike altered endogenous glucocorticoid production, increases sCysC in dogs in a dose‐dependent fashion.
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Affiliation(s)
- J Muñoz
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - P Soblechero
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - F J Duque
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - B Macías-García
- Assisted Reproduction Unit, Minimally Invasive Surgery Centre JesúsUsón, Cáceres, Spain
| | - P Ruiz
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - C Zaragoza
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
| | - R Barrera
- Animal Medicine Department, Faculty of Veterinary Sciences, University of Extremadura, Cáceres, Spain
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85
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Shamsi A, Bano B. Journey of cystatins from being mere thiol protease inhibitors to at heart of many pathological conditions. Int J Biol Macromol 2017; 102:674-693. [PMID: 28445699 PMCID: PMC7112400 DOI: 10.1016/j.ijbiomac.2017.04.071] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/18/2017] [Accepted: 04/19/2017] [Indexed: 02/04/2023]
Abstract
Cystatins are thiol proteinase inhibitors (TPI), present ubiquitously in animals, plants and micro-organisms. These are not merely inhibitors rather they are at heart of many pathological conditions ranging from diabetes to renal failure. These are essential for maintenance of protein balance of the cell; once this balance gets disturbed, it may lead to cell death. Thus, cystatins cannot be merely regarded as TPI's as these have been found to play a pivotal role in tumorigenesis and neurodegenerative diseases. Many studies have reported the variation in cystatin level in incidences of different types of cancer; highlighting an important role played by these inhibitors in cancer development and progression. Cystatin C is increasingly replacing creatinine as a biomarker of glomerular filtration rate (GFR) thereby highlighting the importance of this important inhibitor. Some recent studies have also reported the interaction pattern of various anti-cancer drugs with cystatins in a bid to find how these drugs affect this important inhibitors and whether these drugs have any side effect on cystatins. Thus, in this growing disease era it can be said that cystatins are no more just inhibitors blocking the activity of thiol proteases rather they play a pivotal role in variety of pathological conditions.
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Affiliation(s)
- Anas Shamsi
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, 202002, India
| | - Bilqees Bano
- Department of Biochemistry, Faculty of Life Sciences, Aligarh Muslim University, Aligarh, 202002, India.
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86
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The diagnostic value of serum creatinine and cystatin c in evaluating glomerular filtration rate in patients with chronic kidney disease: a systematic literature review and meta-analysis. Oncotarget 2017; 8:72985-72999. [PMID: 29069842 PMCID: PMC5641185 DOI: 10.18632/oncotarget.20271] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/30/2017] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Serum biomarkers, such as serum creatinine (SCr) and serum cystatin C (SCysC), have been widely used to evaluate renal function in patients who have chronic kidney disease (CKD). OBJECTIVE This article aims to assess the value of determining SCr and SCysC levels in patients that have long-term kidney disease. Approaches: MEDLINE, EmBase, the Cochrane Library and other databases were searched using both MeSH terms and text words to collect research that assessed the diagnostic value of using SCr and SCysC to evaluate Glomerular Filtration Rate (GFR) in patients with CKD. Data were converted into fourfold tables. Summary Receiver Operating Characteristic Curves and meta-analyses were accomplished via Meta-Disc version 1.4. RESULTS In total, 21 relevant articles involving 3112 study subjects were included in our review. Results showed that the collective sensitivity for SCr and SCysC was 0.77 (95% CI: 0.69-0.84) and 0.87 (95% CI: 0.82-0.91), respectively. The pooled specificity for SCr and SCysC was 0.91 (95% CI: 0.86-0.94) and 0.87 (95% CI: 0.82-0.91), respectively. Subgroup analyses demonstrated that when GFR cut-off values are set to 60 (ml/min/1.73 m2), the pooled sensitivity is 0.94 (95% CI: 0.90-0.96) for SCysC and 0.75 (95% CI: 0.68-0.82) for SCr. CONCLUSIONS The diagnostical accuracy for impaired kidney function favors SCysC. Confidence intervals for the pooled sensitivity and specificity for SCr and SCysC overlap. However, SCysC is more sensitive for estimating GFR than SCr when GFR cut-off values are set to 60 (ml/min/1.73 m2).
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87
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Abstract
Acute kidney injury (AKI) is characterized by an acute decline in renal function and is associated to increased mortality rate, hospitalization time, and total health-related costs. The severity of this ‘fearsome’ clinical complication might depend on, or even be worsened by, the late detection of AKI, when the diagnosis is based on the elevation of serum creatinine (SCr). For these reasons, in recent years a great number of new tools, biomarkers and predictive models have been proposed to clinicians in order to improve diagnosis and prevent the development of AKI. The purpose of this narrative paper is to review the current state of the art in prediction and early detection of AKI and outline future challenges.
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Affiliation(s)
- Simona Pozzoli
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
| | - Marco Simonini
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - Paolo Manunta
- Chair of Nephrology - IRCCS San Raffaele Scientific Institute, Genomics of Renal Diseases and Hypertension Unit, Università Vita Salute San Raffaele, Via Olgettina 60, 20132, Milan, Italy
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88
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Evaluating Muscle Mass by Using Markers of Kidney Function: Development of the Sarcopenia Index. Crit Care Med 2017; 45:e23-e29. [PMID: 27611976 DOI: 10.1097/ccm.0000000000002013] [Citation(s) in RCA: 162] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Sarcopenia is associated with a poor prognosis in the ICU. The purpose of this study was to describe a simple sarcopenia index using routinely available renal biomarkers and evaluate its association with muscle mass and patient outcomes. DESIGN A retrospective cohort study. SETTING A tertiary-care medical center. PATIENTS High-risk adult ICU patients from October 2008 to December 2010. INTERVENTIONS The gold standard for muscle mass was quantified with the paraspinal muscle surface area at the L4 vertebrae in the subset of individuals with an abdominal CT scan. Using Pearson's correlation coefficient, serum creatinine-to-serum cystatin C ratio was found to be the best performer in the estimation of muscle mass. The relationship between sarcopenia index and hospital and 90-day mortality, and the length of mechanical ventilation was evaluated. MEASUREMENTS AND MAIN RESULTS Out of 226 enrolled patients, 123 (54%) were female, and 198 (87%) were white. Median (interquartile range) age, body mass index, and body surface area were 68 (57-77) years, 28 (24-34) kg/m, and 1.9 (1.7-2.2) m, respectively. The mean (± SD) Acute Physiology and Chronic Health Evaluation III was 70 (± 22). ICU, hospital, and 90-day mortality rates were 5%, 12%, and 20%, respectively. The correlation (r) between sarcopenia index and muscle mass was 0.62 and coefficient of determination (r) was 0.27 (p < 0.0001). After adjustment for Acute Physiology and Chronic Health Evaluation III, body surface area, and age, sarcopenia index was independently predictive of both hospital (p = 0.001) and 90-day mortality (p < 0.0001). Among the 131 patients on mechanical ventilator, the duration of mechanical ventilation was significantly lower on those with higher sarcopenia index (-1 d for each 10 unit of sarcopenia index [95% CI, -1.4 to -0.2; p = 0.006]). CONCLUSIONS The sarcopenia index is a fair measure for muscle mass estimation among ICU patients and can modestly predict hospital and 90-day mortality among patients who do not have acute kidney injury at the time of measurement.
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89
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Xu Z, Leng C, Yang B, Wang H, Sun J, Liu Z, Yang L, Ge W, Zhu J. Serum cystatin C is associated with large cerebral artery stenosis in acute ischemic stroke. Oncotarget 2017; 8:67181-67188. [PMID: 28978025 PMCID: PMC5620165 DOI: 10.18632/oncotarget.18061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 04/19/2017] [Indexed: 01/08/2023] Open
Abstract
Large cerebral artery stenosis is a major cause of acute ischemic stroke (AIS); however, the correlation between serum cystatin C (CysC) and the stenosis of large cerebral arteries in patients with AIS has not been established. We performed a retrospective review of acute ischemic stroke patients, who were examined by cerebral digital subtraction angiography(DSA). Participants (252 cases) included 131 patients without stenosis and 121 patients with large cerebral artery stenosis. Serum CysC levels in patients with large cerebral artery stenosis were much higher than that of control subjects (p<0.001). However, serum CysC levels were not related to the location of stenosis. Further, logistic regression analyses showed that increased serum CysC was an independent risk factor of large cerebral artery stenosis in patients with acute ischemic stroke. Total participants were subdivided into quintiles based on serum CysC levels. Compared with the first quintile, the odds ratios of risk for large cerebral artery stenosis in the fourth and the fifth quintile were 1.26 (p<0.05) and 4.71(p<0.05) respectively, after the adjustment for age, sex, and smoking, hypertension, type 2 diabetes mellitus(DM), dyslipidemia, creatinine(Cr), urea, uric acid, and C reactive protein(CRP). Therefore, a significant positive correlation was observed between elevated serum CysC levels and large cerebral artery stenosis in patients with acute ischemic stroke. In summary, our findings provide new insights into the correlation between increased serum CysC and large cerebral artery stenosis in patients with acute ischemic stroke.
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Affiliation(s)
- Zhiqiang Xu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Cuihua Leng
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Bo Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Haili Wang
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jing Sun
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Zhaoxia Liu
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Lingli Yang
- Department of Neurology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
| | - Wei Ge
- Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou City, Jiangsu, China
| | - Jiangtao Zhu
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou City, Jiangsu, China
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90
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Estimation of glomerular filtration rate in cancer patients with abnormal body composition and relation with carboplatin toxicity. Cancer Chemother Pharmacol 2017; 80:45-53. [DOI: 10.1007/s00280-017-3326-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 05/02/2017] [Indexed: 11/30/2022]
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91
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Ismail OZ, Bhayana V, Kadour M, Lepage N, Gowrishankar M, Filler G. Improving the translation of novel biomarkers to clinical practice: The story of cystatin C implementation in Canada. Clin Biochem 2017; 50:380-384. [DOI: 10.1016/j.clinbiochem.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 10/20/2022]
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92
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Leem AY, Park MS, Park BH, Jung WJ, Chung KS, Kim SY, Kim EY, Jung JY, Kang YA, Kim YS, Kim SK, Chang J, Song JH. Value of Serum Cystatin C Measurement in the Diagnosis of Sepsis-Induced Kidney Injury and Prediction of Renal Function Recovery. Yonsei Med J 2017; 58:604-612. [PMID: 28332367 PMCID: PMC5368147 DOI: 10.3349/ymj.2017.58.3.604] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/16/2017] [Accepted: 01/23/2017] [Indexed: 01/18/2023] Open
Abstract
PURPOSE Acute kidney injury (AKI) is common in critically ill patients. Serum cystatin C has emerged as a reliable marker of AKI. We sought to assess the value of serum cystatin C for early detection and prediction of renal function recovery in patients with sepsis. MATERIALS AND METHODS Sepsis patients (113 AKI patients and 49 non-AKI patients) admitted to the intensive care unit (ICU) were included. Serum creatinine and cystatin C levels and glomerular filtration rate were measured on days 0, 1, 3, and 7. RESULTS Serum cystatin C levels were significantly higher in AKI patients than in non-AKI patients at all time points. Multivariate analysis showed that only serum cystatin C levels on day 0 were associated with AKI development [odds ratio (OR)=19.30; 95% confidence interval (CI)= 2.58-144.50, p<0.001]. Linear mixed model analysis showed significant variation in cystatin C levels between the recovery and non-recovery groups over time (p=0.001). High levels of serum cystatin C at day 0 (OR=1.64; 95% CI=1.00-2.68, p=0.048) were associated with recovery of AKI. CONCLUSION Serum cystatin C level was found to be associated with the development and worsening of AKI in ICU patients with sepsis.
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Affiliation(s)
- Ah Young Leem
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moo Suk Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Hoon Park
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Won Jai Jung
- Division of Respiratory and Critical Care Medicine, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung Soo Chung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Song Yee Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Young Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Ye Jung
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Ae Kang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Sam Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se Kyu Kim
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chang
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Joo Han Song
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Institute of Chest Disease, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
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93
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Nakhjavan-Shahraki B, Yousefifard M, Ataei N, Baikpour M, Ataei F, Bazargani B, Abbasi A, Ghelichkhani P, Javidilarijani F, Hosseini M. Accuracy of cystatin C in prediction of acute kidney injury in children; serum or urine levels: which one works better? A systematic review and meta-analysis. BMC Nephrol 2017; 18:120. [PMID: 28372557 PMCID: PMC5379579 DOI: 10.1186/s12882-017-0539-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 03/24/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is still an ongoing discussion on the prognostic value of cystatin C in assessment of kidney function. Accordingly, the present study aimed to conduct a meta-analysis to provide evidence for the prognostic value of this biomarker for acute kidney injury (AKI) in children. METHODS An extensive search was performed in electronic databases of Medline, Embase, ISI Web of Science, Cochrane library and Scopus until the end of 2015. Standardized mean difference (SMD) with a 95% of confidence interval (95% CI) and the prognostic performance characteristics of cystatin C in prediction of AKI were assessed. Analyses were stratified based on the sample in which the level of cystatin C was measured (serum vs. urine). RESULTS A total of 24 articles were included in the meta-analysis [1948 children (1302 non-AKI children and 645 AKI cases)]. Serum (SMD = 0.96; 95% CI: 0.68-1.24; p < 0.0001) and urine (SMD = 0.54; 95% CI:0.34-0.75; p < 0.0001) levels of cystatin C were significantly higher in children with AKI. Overall area under the curve of serum cystatin C and urine cystatin C in prediction of AKI were 0.83 (95% CI: 0.80-0.86) and 0.85 (95% CI: 0.81-0.88), respectively. The best sensitivity (value = 0.85; 95% CI: 0.78-0.90) and specificity (value = 0.61; 95% CI: 0.48-0.73), were observed for the serum concentration of this protein and in the cut-off points between 0.4-1.0 mg/L. CONCLUSION The findings of the present study showed that cystatin C has an acceptable prognostic value for prediction of AKI in children. Since the serum level of cystatin C rises within the first 24 h of admission in patients with AKI, this biomarker can be a suitable alternative for traditional diagnostic measures.
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Affiliation(s)
- Babak Nakhjavan-Shahraki
- Pediatric Chronic Kidney Disease Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Neamatollah Ataei
- Pediatric Chronic Kidney Disease Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Baikpour
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Ataei
- Department of Nuclear Medicine, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnaz Bazargani
- Pediatric Chronic Kidney Disease Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Abbasi
- Pediatric Chronic Kidney Disease Research Center, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa Ghelichkhani
- Department of Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Javidilarijani
- Department of Pediatric Nephrology, Children's Hospital Medical Center, Tehran University of Medical Sciences, Tehran, Iran.,Department of Pediatric Nephrology, Atieh Hospital, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Poursina Ave, Tehran, Iran.
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Abstract
The use of serum creatinine levels to estimate glomerular function in infants is admittedly fraught with inherent inaccuracies which are both physiological and methodological in nature. This characteristic can understandably reduce the neonatal clinician's confidence in the ability of serum creatinine levels to provide useful information relevant to their patients' medical care. The aim of this review is to provide further insight into the peculiarities of serum creatinine trends in both premature and term infants with special focus on the maturational and developmental changes occurring in the kidney during this crucial time-period. Though newer markers of glomerular function are gaining increasing traction in the clinical realm, the most prominent of which is currently cystatin C, creatinine nonetheless remains an important player in the scientific evolution of glomerular filtration rate (GFR) estimation. Not only do its limitations provide a level of distinction for newer markers of GFR, but its advantages persist in refining the precision of newer GFR formulae which incorporate multiple patient characteristics.
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Affiliation(s)
- Justin T Kastl
- Division of Pediatric Nephrology, University of South Dakota Sanford School of Medicine, Sanford Children's Hospital, 1600 W 22nd St., Sioux Falls, SD 57117, USA.
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95
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Yong Z, Pei X, Zhu B, Yuan H, Zhao W. Predictive value of serum cystatin C for acute kidney injury in adults: a meta-analysis of prospective cohort trials. Sci Rep 2017; 7:41012. [PMID: 28112204 PMCID: PMC5253621 DOI: 10.1038/srep41012] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 12/14/2016] [Indexed: 12/28/2022] Open
Abstract
The role of serum cystatin C (Scys) for the detection of acute kidney injury (AKI) has not been fully discussed. This meta-analysis was aimed to investigate the overall diagnostic accuracy of Scys for AKI in adults, and further identify factors affecting its performance. Studies before Sept. 2016 were retrieved from PubMed, Embase, Web of Science and the Cochrane Library. A total of 30 prospective cohort studies (involving 4247 adults from 15 countries, 982 patients occurring AKI) were included. The revised Quality Assessment for Studies of Diagnostic Accuracy (QUADAS-2) tools demonstrated no significant bias had influenced the methodological quality of the included studies. Scys showed a high predictive power for all-cause AKI, that the area under the receiver operating characteristic curve was 0.89. The detailed assessment parameters, such as sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio for Scys were 0.82, 0.82, 4.6, 0.22 and 21, respectively. Although Scys could be slightly influenced by the following factors: settings, AKI diagnostic criteria, ethnicity, determination method, age and gender, these factors above did not reach statistically significance. In conclusion, Scys could be a vital promising marker to screen out AKI.
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Affiliation(s)
- Zhenzhu Yong
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, P.R. China
| | - Xiaohua Pei
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, P.R. China
| | - Bei Zhu
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, P.R. China
| | - Haichuan Yuan
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, P.R. China
| | - Weihong Zhao
- Division of Nephrology, Department of Geriatrics, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing 210029, Jiangsu, P.R. China
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96
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Yang SK, Liu J, Zhang XM, Hu C, Zhang W, Sun L, Zhang H. Diagnostic Accuracy of Serum Cystatin C for the Evaluation of Renal Dysfunction in Diabetic Patients: A Meta-Analysis. Ther Apher Dial 2016; 20:579-587. [PMID: 27921376 DOI: 10.1111/1744-9987.12462] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 05/06/2016] [Accepted: 06/03/2016] [Indexed: 12/18/2022]
Affiliation(s)
- Shi-kun Yang
- Departments of Nephrology; The Third Xiangya Hospital Central South University; Changsha Hunan Province China
| | - Jun Liu
- Departments of Nephrology; The Third Xiangya Hospital Central South University; Changsha Hunan Province China
| | - Xian-ming Zhang
- Departments of Nephrology; The Third Xiangya Hospital Central South University; Changsha Hunan Province China
| | - Chun Hu
- Department of Nephrology; The Second Xiangya Hospital, Central South University; Changsha Hunan Province China
| | - Wei Zhang
- Departments of Nephrology; The Third Xiangya Hospital Central South University; Changsha Hunan Province China
| | - Lin Sun
- Department of Nephrology; The Second Xiangya Hospital, Central South University; Changsha Hunan Province China
| | - Hao Zhang
- Departments of Nephrology; The Third Xiangya Hospital Central South University; Changsha Hunan Province China
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97
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Jurczak P, Groves P, Szymanska A, Rodziewicz-Motowidlo S. Human cystatin C monomer, dimer, oligomer, and amyloid structures are related to health and disease. FEBS Lett 2016; 590:4192-4201. [DOI: 10.1002/1873-3468.12463] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/10/2016] [Accepted: 10/14/2016] [Indexed: 12/17/2022]
Affiliation(s)
| | - Patrick Groves
- Department of Biomedical Chemistry; University of Gdansk; Poland
| | - Aneta Szymanska
- Department of Biomedical Chemistry; University of Gdansk; Poland
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98
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Choi BS, Moon HS, Seo SH, Hyun C. Evaluation of serum cystatin-C and symmetric dimethylarginine concentrations in dogs with heart failure from chronic mitral valvular insufficiency. J Vet Med Sci 2016; 79:41-46. [PMID: 27725349 PMCID: PMC5289235 DOI: 10.1292/jvms.16-0188] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Reduction in glomerular filtration rate (GFR) is a common complication in advanced stages of heart failure (HF). The convenient and precise assessment for GFR would be useful for early detection of renal impairment in HF dogs. Our hypothesis of this study was the GFR would be reduced in advanced stages of HF from chronic mitral valvular insufficiency (CMVI), as indicated by renal markers including serum cystatin-C (Cys-C) and symmetric dimethylarginine (SDMA) concentrations. Forty-three client-owned dogs consisting of 33 dogs with different stages of HF from CMVI and 10 age-matched healthy dogs were enrolled in this study. Serum Cys-C and SDMA concentrations along with other renal (i.e., urea nitrogen and creatinine) and echocardiographic markers were evaluated in healthy and CMVI dogs. Serum Cys-C concentrations were 1.4 ± 0.4 mg/l in control, 2.1 ± 0.9 mg/l in ISACHC I, 2.9 ± 0.8 mg/l in ISACHC II and 3.6 ± 0.6 mg/l in ISACHC III dogs, whereas serum SDMA concentrations were 8 ± 2 µg/dl in control, 14 ± 3 µg/dl in ISACHC I, 18 ± 6 µg/dl in ISACHC II and 22 ± 7 µg/dl in ISACHC III dogs. There was close correlation of serum Cys-C and SDMA concentrations to serum creatinine, urea nitrogen and the severity of HF. Our study demonstrated that the GFR was decreased in dogs with CMVI having earlier stages of HF.
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Affiliation(s)
- Bom-Sul Choi
- Section of Small Animal Internal Medicine, College of Veterinary Medicine, Kangwon National University, Chuncheon, Korea
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99
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Zhao JB, Liu Y, Wu DX, Chen JY, Duan CY, Chen SQ, Tan N. Contrast Volume to Cystatin C-Based Glomerular Filtration Ratio Predicts the Risk of Contrast-Induced Nephropathy After Cardiac Catheterization. Angiology 2016; 68:207-215. [PMID: 27166381 DOI: 10.1177/0003319716648027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Cystatin C is considered to be a better alternative to creatinine for estimating glomerular filtration rate (GFR). The aim of this study was to investigate whether a contrast volume to estimated GFR based on cystatin C (V/eGFRcys) is a better predictor of contrast-induced nephropathy (CIN). We enrolled 1195 consecutive patients undergoing elective cardiac catheterization. Receiver–operating characteristic (ROC) curves were used to identify the optimal cutoff value of V/eGFRcys for detecting CIN. Multivariate regression models were used to evaluate whether V/eGFRcys is an independent risk factor for CIN. A total of 19 (1.6%) patients developed CIN. There was a significant association between a higher V/eGFRcys ratio and CIN risk ( P = .008). A ROC curve analysis indicated that a V/eGFRcys ratio of 2.29 was a fair discriminator for CIN. After adjusting for other known CIN risk factors, V/eGFRcys ratios >2.29 remained significantly associated with CIN (odds ratio = 2.93, 95% confidence interval: 1.02-8.44, P = .047). In conclusion, a V/eGFRcys >2.29 was a significant and independent predictor of CIN after cardiac catheterization.
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Affiliation(s)
- Jian-bin Zhao
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Deng-xuan Wu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Ji-yan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Chong-yang Duan
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Shi-qun Chen
- Department of Biostatistics, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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100
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Gursoy AY, Pabuccu EG, Kiseli M, Candar T, Demirtaş S, Caglar GS. Is cystatin C level altered in women with polycystic ovary syndrome? Clin Chem Lab Med 2016; 54:e265-7. [PMID: 26910747 DOI: 10.1515/cclm-2015-1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 12/30/2015] [Indexed: 11/15/2022]
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