1
|
Fan J, Zuo L, Hou M, Wang B, An Y, Hao B, Yu D. Sex-Specific Computed Tomography Abdominal Fat and Skeletal Muscle Characteristics in Type 2 Diabetic Retinopathy Patients With/Without Comorbid Diabetic Kidney Disease. Acad Radiol 2023; 30:2686-2695. [PMID: 36828721 DOI: 10.1016/j.acra.2023.01.033] [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: 12/07/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 02/25/2023]
Abstract
RATIONALE AND OBJECTIVES To investigate differences in sex-specific computed tomography abdominal fat and skeletal muscle (SM) characteristics between type 2 diabetic retinopathy (DR) patients with and without diabetic kidney disease (DKD). MATERIALS AND METHODS This retrospective study included type 2 diabetes mellitus DR patients with/without DKD between January 2019 and July 2021. Visceral adipose tissue (VAT), subcutaneous adipose tissue, perirenal adipose tissue (PAT), intramuscular adipose tissue, and SM areas were measured. Univariate and multivariate logistic regression analyses were used to analyze risk factors for DKD. Correlation and multiple linear regression analyses were used to clarify the association between computed tomography abdominal fat, SM characteristics, and cystatin C. RESULTS Two hundred and forty-one patients were enrolled and divided into DR with DKD group (n = 142) and DR without DKD group (n = 99). In men, hypertension (OR: 5.21; 95%CI: 1.93-14.05; p = 0.001), diastolic pressure (OR: 1.07; 95%CI: 1.01-1.12; p = 0.011), hemoglobin (OR: 0.94; 95%CI: 0.92-0.97; p < 0.001) and PAT attenuation value (OR: 1.09; 95%CI: 1.01-1.17; p = 0.026) were independent risk factors for DKD progression in DR patients, while the VAT index (VATI) (OR: 1.03; 95%CI: 1.01-1.05; p = 0.014) was an independent risk factor for female patients. Multiple linear regression analysis revealed significant correlations between hypertension (β = 0.22, p = 0.002) and hemoglobin (β = -0.53, p < 0.001) with cystatin C in men, and a significant correlation between VATI and cystatin C (β = 0.35, p = 0.037) in women after adjustment for confounders. CONCLUSION Female DR patients with elevated VAT level may suffer from a higher risk of DKD than that in male patients.
Collapse
Affiliation(s)
- Jinlei Fan
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Liping Zuo
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Mingyuan Hou
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Bowen Wang
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Yueming An
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Baoli Hao
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China
| | - Dexin Yu
- Department of Radiology, Qilu Hospital of Shandong University, Jinan, Shandong, 250012, China.
| |
Collapse
|
2
|
Paes-Leme FDO, de Souza EM, Ceregatti MG, Campos MTG, Vaz de Melo PD, da Costa-Val AP. Cystatin C assay validation using the immunoturbidimetric method to evaluate the renal function of healthy dogs and dogs with acute renal injury. Vet World 2022; 15:1595-1600. [PMID: 35993081 PMCID: PMC9375203 DOI: 10.14202/vetworld.2022.1595-1600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Acute kidney injury (AKI) is associated with a grave prognosis. A clinical assessment of kidney function can be performed based on the glomerular filtration rate (GFR). Cystatin C (CysC) can indicate the GFR or kidney function and its measurement is currently performed using immunological methods such as nephelometry, immunoturbidimetry, and enzyme-linked immunosorbent assays in human medicine. However, these techniques are not specific for use in veterinary medicine. This study aimed to validate an immunoturbidimetric assay for serum CysC (sCy) in dogs, determine the sCy reference intervals for healthy dogs, evaluate sCy stability in serum samples, and compare sCy with serum creatinine (sCr) in healthy dogs and dogs with AKI.
Materials and Methods: Forty-three dogs were divided into a control group (n = 19) and an AKI group (n = 24). An immunoturbidimetric method including commercially available human CysC calibrated with canine CysC was used to evaluate canine serum samples.
Results: An average recovery of 97% was observed for canine serum samples. The reference interval for CysC in healthy dogs was 0.57–1.29 mg/L. The sCy concentration in dogs with AKI was significantly higher (2.82 ± 1.46 mg/L) than in healthy dogs (0.93 ± 0.18 mg/L). Statistical analysis confirmed a strong correlation between sCy and sCr (r = 0.94; p < 0.05) in dogs with AKI.
Conclusion: The immunoturbidimetric method of evaluating sCy yielded satisfactory results and can be used for canine samples when a species-specific calibrator is used. Furthermore, sCy is a reliable marker of renal dysfunction in dogs. It is best to store samples for sCy evaluation at temperatures between 4°C and 8°C.
Collapse
Affiliation(s)
| | - Eliana Matias de Souza
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Mariah Gois Ceregatti
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Marco Túlio Gomes Campos
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | | | - Adriane Pimenta da Costa-Val
- Department of Clinics and Surgery, Veterinary School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| |
Collapse
|
3
|
Liao X, Zhu Y, Xue C. Diagnostic value of serum cystatin C for diabetic nephropathy: a meta-analysis. BMC Endocr Disord 2022; 22:149. [PMID: 35655297 PMCID: PMC9164876 DOI: 10.1186/s12902-022-01052-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 05/17/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Although dozens of studies have investigated the relationship between the content of serum cystatin C (Cys-C) and diabetic nephropathy (DN), the results are still controversial. Hence, This study aims to explore the accuracy of serum Cys-C for diagnosing DN by meta-analysis. METHODS The studies about serum Cys-C diagnosing DN were searched from six online databases from inception to September 22, 2020. The data were processed by Stata 15.0 statistic software. The corresponding diagnostic effect sizes, such as sensitivity and specificity, were obtained. We drew a summary receiver operating characteristic (SROC) curve. We assess the risk of literature bias was following the QUADAS-2 guidelines. RESULTS Twenty-six published studies were identified. The results showed a pooled sensitivity of 0.86 (95% confidence interval (CI): 0.82-0.90), specificity of 0.89 (95%CI: 0.85-0.92), positive likelihood ratio of 7.59 (95%CI: 5.66-10.19), negative likelihood ratio of 0.16 (95%CI: 0.12-0.21), and diagnostic odds ratio of 48.03 (95%CI: 30.64-75.29). The area under the SROC curve was given a value of 0.94 (95%CI: 0.91-0.96). CONCLUSION Serum cystatin C has an excellent diagnostic value with good sensitivity and specificity for diabetic nephropathy.
Collapse
Affiliation(s)
- Xueling Liao
- Department of Nephrology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China
- Department of Nephrology, Affiliated Hospital of Guilin Medical University, Guilin, 541001, Guangxi, China
| | - Yan Zhu
- Department of Nephrology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China
| | - Chao Xue
- Department of Nephrology, the Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, Guangxi, China.
| |
Collapse
|
4
|
The Level of Plasma Cystatin C in Patients with Chronic Kidney Disease. Nephrourol Mon 2022. [DOI: 10.5812/numonthly-123517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic kidney disease (CKD) is an increasingly common disease worldwide and has become a global health problem, especially in Vietnam. Cystatin C is a marker for the detection, classification, and prognosis of CKD. Cystatin C is filtered entirely through the glomerular membrane, reabsorbed, and metabolized completely in the renal tubules. In case of damage to the kidneys, glomerular filtration rate declines, and some substances increase in the blood, such as cystatin C. The concentration of cystatin C changes with damage to the renal system. Objectives: This study aimed to estimate the concentration of cystatin C and its variation in the different stages of CKD. Methods: A descriptive, cross-sectional study was conducted on 40 healthy individuals and 137 patients with CKD grade III, IV, and V in 103 Hospital. The concentration of cystatin C was estimated in all subjects. Results: Cystatin C plasma levels were significantly higher in the CKD group (9.17 ± 3.75 mg/L) than in the control group (0.82 ± 0.12 mg/L). Cystatin C plasma levels increased linearly with the serious kidney failure as the stage of CKD. Conclusions: Cystatin C is an effective marker for estimating kidney damage in CKD.
Collapse
|
5
|
Wang N, Lu Z, Zhang W, Bai Y, Pei D, Li L. Serum Cystatin C Trajectory Is a Marker Associated With Diabetic Kidney Disease. Front Endocrinol (Lausanne) 2022; 13:824279. [PMID: 35634510 PMCID: PMC9130469 DOI: 10.3389/fendo.2022.824279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To explore the association of the trajectory of serum Cystatin C (Cysc) with diabetic kidney disease (DKD), a retrospective cohort study of Chinese subjects was carried out. Method A review of 2,928 diabetes mellitus (DM) patients admitted to the clinic and ward of the Endocrinology Department, Shengjing Hospital of China Medical University from January 1, 2014 to December 31, 2014 was performed. Subsequent visits to the hospital were followed until December 31, 2020. The primary endpoint was the incidence of DKD as diagnosed by urinary albumin/creatinine ratio ≥30 mg/g and/or estimated glomerular filtration rate <60 ml/min per 1.73 m2. Healthy control subjects were identified from a health checkup database in Shengjing Hospital from 2016 to 2019. The latent class growth mixed modeling (LCGMM) method was used to analyze latent classes of serum Cysc in healthy and DM subjects. Finally, the hazard ratios (HRs) of latent classes of Cysc in DM subjects were analyzed by Cox regression analysis. Results A total of 805 type 2 diabetes mellitus (T2DM) and 349 healthy subjects were included in the trial. The HRs of quartiles of baseline Cysc in T2DM subjects were 7.15 [95% confidence interval (CI), 2.79 to 25.57], 2.30 (95% CI, 1.25 to 4.24), and 2.05 (95% CI, 1.14 to 3.70), respectively, for quartile 4 (Q4), Q3, and Q2 when compared with Q1. Through LCGMM, a 1-class linear model was selected for the Cysc latent class in healthy subjects. In contrast, a 3-class linear model was selected for that in DM subjects. The slopes of the three latent classes in T2DM subjects were larger than the slope in healthy subjects. The HRs of incident DKD were 3.43 (95% CI, 1.93 to 6.11) for the high-increasing class and 1.80 (95% CI, 1.17 to 2.77) for the middle-increasing class after adjusting for confounding variables. Conclusions Patients with T2DM had a higher velocity of increase in Cysc than healthy subjects. Patients with high baseline Cysc values and high latent increasing velocity of Cysc had a higher risk of developing DKD in later life. More attention should be paid to patients with these high-risk factors.
Collapse
Affiliation(s)
- Nana Wang
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zhenyu Lu
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Wei Zhang
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yu Bai
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| | - Dongmei Pei
- Department of Health Management, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Li
- Endocrinology Department, Shengjing Hospital of China Medical University, Shenyang, China
| |
Collapse
|
6
|
Trutin I, Bajic Z, Turudic D, Cvitkovic-Roic A, Milosevic D. Cystatin C, renal resistance index, and kidney injury molecule-1 are potential early predictors of diabetic kidney disease in children with type 1 diabetes. Front Pediatr 2022; 10:962048. [PMID: 35967553 PMCID: PMC9372344 DOI: 10.3389/fped.2022.962048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Diabetic kidney disease (DKD) is the main cause of end-stage renal disease in patients with diabetes mellitus type I (DM-T1). Microalbuminuria and estimated glomerular filtration rate (eGFR) are standard predictors of DKD. However, these predictors have serious weaknesses. Our study aimed to analyze cystatin C, renal resistance index, and urinary kidney injury molecule-1 (KIM-1) as predictors of DKD. METHODS We conducted a cross-sectional study in 2019 on a consecutive sample of children and adolescents (10-18 years) diagnosed with DM-T1. The outcome was a risk for DKD estimated using standard predictors: age, urinary albumin, eGFR, serum creatinine, DM-T1 duration, HbA1c, blood pressure, and body mass index (BMI). We conducted the analysis using structural equation modeling. RESULTS We enrolled 75 children, 36 girls and 39 boys with the median interquartile range (IQR) age of 14 (11-16) years and a median (IQR) duration of DM-T1 of 6 (4-9) years. The three focal predictors (cystatin C, resistance index, and urinary KIM-1) were significantly associated with the estimated risk for DKD. Raw path coefficients for cystatin C were 3.16 [95% CI 0.78; 5.53; p = 0.009, false discovery rate (FDR) < 5%], for renal resistance index were -8.14 (95% CI -15.36; -0.92; p = 0.027; FDR < 5%), and for urinary KIM-1 were 0.47 (95% CI 0.02; 0.93; p = 0.040; FDR < 5%). CONCLUSION Cystatin C, renal resistance index, and KIM-1 may be associated with the risk for DKD in children and adolescents diagnosed with DM-T1. We encourage further prospective cohort studies to test our results.
Collapse
Affiliation(s)
- Ivana Trutin
- Department of Pediatrics, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Zarko Bajic
- Research Unit "Dr. Mirko Grmek", University Psychiatric Hospital "Sveti Ivan", Zagreb, Croatia
| | - Daniel Turudic
- Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
| | - Andrea Cvitkovic-Roic
- Helena Clinic for Pediatric Medicine, Zagreb, Croatia.,Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Danko Milosevic
- School of Medicine, University of Zagreb, Zagreb, Croatia.,Department of Pediatrics, General Hospital Zabok and Hospital of Croatian Veterans, Bracak, Croatia
| |
Collapse
|
7
|
Cheng Y, Shang J, Liu D, Xiao J, Zhao Z. Development and validation of a predictive model for the progression of diabetic kidney disease to kidney failure. Ren Fail 2020; 42:550-559. [PMID: 32524865 PMCID: PMC7946054 DOI: 10.1080/0886022x.2020.1772294] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction: A good prediction model plays an important role in determining the progression to diabetic kidney disease. We aimed to create a model to predict progression to kidney failure in patients with diabetic kidney disease.Methods: We retrospectively assessed 641 patients with type 2 diabetic kidney disease as derivation cohort and 280 patients as external out time validation cohort. We used a combination of clinical guidance and univariate logistic regression to select the relevant variables. We calculated the discrimination and calibration of different models. The best model was selected according to the optimal combination of discrimination and calibration.Results: During the 3 years follow up, there were 272 outcomes (42%) in derivation cohort and 138 outcomes (49%) in external validation cohort. The final variables selected in the multivariate logistics regression were age, gender, hemoglobin, NLR, serum cystatin C, eGFR, 24-h urine protein, and the use of oral hypoglycemic drugs. We developed four different models as clinical, laboratory, lab-medication, and full models according to these independent risk factors. Laboratory model performed well in both discrimination and calibration among all the models (C-statistics: external validation 0.863; p value of the Hosmer-Lemeshow, .817). There was no significant difference in NRI among laboratory model, lab-medication model, and full model (p > .05). So, we chose the laboratory model as the optimal model.Conclusion: We constructed a nomogram which contained hemoglobin, NLR, serum cystatin C, eGFR, and 24-h urine protein to predict the risk of patients with diabetic kidney disease initiating renal replacement in 3 years.
Collapse
Affiliation(s)
- Yaqi Cheng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Shang
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dong Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jing Xiao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhanzheng Zhao
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
8
|
Gomes HCDS, Cabral ACV, Andrade SP, Leite HV, Teixeira PG, Campos PP, Gomes JAA. Cystatin C as an indicator of renal damage in pre-eclampsia. Hypertens Pregnancy 2020; 39:308-313. [PMID: 32427499 DOI: 10.1080/10641955.2020.1766488] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To assess the predictive abilities of serum and urinary cystatin C levels for glomerular lesions in pregnant women with pre-eclampsia. METHODS In this study, kidney function markers were compared between38 pregnant women with pre-eclampsia and 22 healthy pregnant women. RESULTS The serum and urine levels of cystatin C and urea were significantly higher in the pre-eclampsia group than in the control group. Receiver operating characteristic curve analysis demonstrated that the serum cystatin C level (91.7%) had a superior diagnostic accuracy for pre-eclampsia than the other markers. CONCLUSION Serum cystatin C level maybe a significant marker of pre-eclampsia.
Collapse
Affiliation(s)
| | | | - Silvia Passos Andrade
- Department of Physiology and Biophysics, Federal University of Minas Gerais , Minas Gerais, Brazil
| | - Henrique Vítor Leite
- Department of Gynecology and Obstetrics, Federal University of Minas Gerais , Minas Gerais, Brazil
| | | | - Paula Peixoto Campos
- Department of Pathology, Federal University of Minas Gerais , Minas Gerais, Brazil
| | | |
Collapse
|
9
|
Viswanathan V, Krishnamoorthy E, Kumpatla S, Lunghar B, Soni A, Rani A. Clinical and biochemical characteristics and the association of angiotensin type 1 receptor with normoalbuminuric chronic kidney disease among South Indian type 2 diabetes population. Int J Diabetes Dev Ctries 2019. [DOI: 10.1007/s13410-019-00719-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
10
|
Performance of Cystatin C-Based Equations for Estimation of Glomerular Filtration Rate in Diabetes Patients: A Prisma-Compliant Systematic Review and Meta-Analysis. Sci Rep 2019; 9:1418. [PMID: 30723243 PMCID: PMC6363744 DOI: 10.1038/s41598-018-38286-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 12/06/2018] [Indexed: 02/01/2023] Open
Abstract
The accuracy of estimated glomerular filtration rate (eGFR) equations in diabetes mellitus (DM) patients has been extensively questioned. We evaluated the performance of cystatin C-based equations alone or in combination with creatinine to estimate GFR in DM patients. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with “diabetes mellitus” and “cystatin C” as search terms. Studies comparing cystatin C-based eGFR equations with measured GFR (mGFR) in DM patients were eligible. Accuracies P10, P15, P20, and P30 indicated the proportion of eGFR results within 10, 15, 20, and 30% of mGFR. Single-arm meta-analyses were conducted, and the Quality of Diagnostic Accuracy Studies-II tool (QUADAS-2) was applied. Twenty-three studies comprising 7065 participants were included, and 24 equations were analyzed in a broad range of GFRs. Meta-analyses were completed for 10 equations. The mean P30 accuracies of the equations ranged from 41% to 87%, with the highest values found with both CKD-EPI equations. Mean P10-P15 achieved 35% in the best scenario. A sensitivity analysis to evaluate different mGFR methods did not change results. In conclusion, cystatin C-based eGFR equations represent measured GFR fairly at best in DM patients, with high variability among the several proposed equations.
Collapse
|
11
|
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: 24] [Impact Index Per Article: 3.4] [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).
Collapse
|
12
|
Kozono A, Hiraki Y, Adachi R, Nagano M, Inoue D, Tsuji Y, Kamimura H, Karube Y. Comparison of predictive accuracy of teicoplanin concentration using creatinine clearance and glomerular filtration rate estimated by serum creatinine or cystatin C. J Infect Chemother 2016; 22:314-8. [DOI: 10.1016/j.jiac.2016.01.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Revised: 12/07/2015] [Accepted: 01/28/2016] [Indexed: 02/07/2023]
|
13
|
Cystatin C attenuates insulin signaling transduction by promoting endoplasmic reticulum stress in hepatocytes. FEBS Lett 2015; 589:3938-44. [DOI: 10.1016/j.febslet.2015.11.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 11/11/2015] [Indexed: 12/16/2022]
|
14
|
Zand F, Sabetian G, Abbasi G, Rezaianzadeh A, Salehi A, Khosravi A, Geramizadeh B, Taregh SU, Javadpour S. Early Acute Kidney Injury based on Serum Creatinine or Cystatin C in Intensive Care Unit after Major Trauma. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:485-92. [PMID: 26538776 PMCID: PMC4628138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Acute kidney injury (AKI) is a common problem in critically ill patients and is independently associated with increased morbidity and mortality. Recently, serum cystatin C has been shown to be superior to creatinine in early detection of renal function impairment. We compared estimated GFR based on serum cystatin C with estimated GFR based on serum creatinine for early detection of renal dysfunction according to the RIFLE criteria. METHODS During 9 months, three hundred post trauma patients that were referred to the intensive care unit of a referral trauma hospital were recruited. Serum creatinine and serum cystatin C were measured and the estimated GFR within 24 hours of ICU admission was calculated. The primary outcome was the incidence of AKI according to the RIFLE criteria within 2(nd) to 7(th) day of admission. RESULTS During the first week of ICU admission, 21% of patients experienced AKI. After adjusting for major confounders, only the patients with first day's serum cystatin level higher than 0.78 mg/l were at higher risk of first week AKI (OR=6.14, 95% CI: 2.5-14.7, P<0.001). First day's serum cystatin C and injury severity score were the major risk factors for ICU mortality (OR=3.54, 95% CI: 1.7-7.4, P=0.001) and (OR=4.6, 95% CI: 1.5-14, P=0.007), respectively. CONCLUSION Within 24 hours after admission in ICU due to multiple trauma, high serum cystatin C level may have prognostic value in predicting early AKI and mortality during ICU admission. However, such correlation was not seen neither with creatinine nor cystatin C based GFR.
Collapse
Affiliation(s)
- Farid Zand
- Shiraz Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Golnar Sabetian
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Golnar Sabetian, MD; Trauma Research Center, Rajaee Hospital, Chamran Blvd., Shiraz, Iran Tel: +98 71 36360697 Fax: +98 71 36248980
| | - Ghasem Abbasi
- Department of Anesthesia, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Rezaianzadeh
- Department of Epidemiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Alireza Salehi
- Research Center in Traditional Medicine and History of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Khosravi
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Bita Geramizadeh
- Shiraz Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shuja Ulhaq Taregh
- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Shohreh Javadpour
- Department of Critical Care Nursing, Jahrom University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
15
|
Liang S, Li Q, Zhu HY, Zhou JH, Ding R, Chen XM, Cai GY. Clinical factors associated with the diagnosis and progression of diabetic nephropathy. Cell Biochem Biophys 2015; 70:9-15. [PMID: 24652002 DOI: 10.1007/s12013-014-9892-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
As an important complication of diabetic mellitus, diabetic nephropathy (DN) has been the main cause of end-stage renal disease. It is of great importance to diagnose DN early, and to identify the risk factors of disease progression in order to carry out in-time and effective therapies. Previous literatures have reported the role of several clinical factors in the diagnosis and progression of DN, including age, longer diabetes duration, diabetic retinopathy, higher level of hypertension and HbA1c, and so on. However, the significance of these clinical factors is still controversial and limited. This review aimed to evaluate the values and limitations of these factors in diagnosing and predicting the renal outcome of DN.
Collapse
Affiliation(s)
- Shuang Liang
- Department of Nephrology, State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital, Beijing, 100853, China
| | | | | | | | | | | | | |
Collapse
|
16
|
Perrin NES, Berg UB. Estimated glomerular filtration rates cannot replace measured GFR in type 1 diabetes patients with hyperfiltration. Acta Paediatr 2015; 104:730-7. [PMID: 25739704 DOI: 10.1111/apa.12993] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Revised: 01/08/2015] [Accepted: 03/02/2015] [Indexed: 01/02/2023]
Abstract
AIM This study of children and young adults with type 1 diabetes with normal to high glomerular filtration rates (GFR) compared estimated GFR (eGFR) with measured GFR (mGFR). METHODS GFR was measured by inulin clearance, and we carried out simultaneous analyses of standardised creatinine and cystatin C. eGFR was calculated using different formulas. RESULTS We enrolled 106 patients, including 56 males, aged 21.9 (standard deviation 9.2) years with 13.7 (9.1) years' duration of diabetes and a mean haemoglobin A1c (HbA1c ) of 7.7% (61 mmol/mol). The median mGFR was 128 (111-143) mL/min/1.73 m(2) . Most of the eGFR estimations failed to detect a significant proportion of hyperfiltration based on inulin clearance. The best accuracy (P30) between eGFR and mGFR was seen with eGFRCKD - EPI (92%), eGFRcys C Berg (86%), eGFRcys C CAPA (78%) and eGFRcys C Inker (84%) where eGFRCKD - EPI and eGFR cys C Berg showed the lowest bias. Most eGFRcys C measurements showed greater accuracy when combined with eGFRcr (P30 92-94%). CONCLUSION The best accuracy (P30) and lowest bias were found with eGFRCKD - EPI and eGFR Berg. in this cohort. However, eGFR cannot accurately replace mGFR to detect hyperfiltration and follow GFR over time in young patients with type 1 diabetes.
Collapse
Affiliation(s)
- NES Perrin
- Department of Clinical Science; Intervention and Technology; Division of Peadiatrics; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - UB Berg
- Department of Clinical Science; Intervention and Technology; Division of Peadiatrics; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| |
Collapse
|
17
|
Almualm Y, Zaman Huri H. Chronic kidney disease screening methods and its implication for Malaysia: an in depth review. Glob J Health Sci 2015; 7:96-109. [PMID: 25946939 PMCID: PMC4802081 DOI: 10.5539/gjhs.v7n4p96] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 12/01/2014] [Indexed: 12/17/2022] Open
Abstract
Chronic Kidney Disease has become a public health problem, imposing heath, social and human cost on societies worldwide. Chronic Kidney Disease remains asymptomatic till late stage when intervention cannot stop the progression of the disease. Therefore, there is an urgent need to detect the disease early. Despite the high prevalence of Chronic Kidney Disease in Malaysia, screening is still lacking behind. This review discusses the strengths and limitations of current screening methods for Chronic Kidney Disease from a Malaysian point of view. Diabetic Kidney Disease was chosen as focal point as Diabetes is the leading cause of Chronic Kidney Disease in Malaysia. Screening for Chronic Kidney Disease in Malaysia includes a urine test for albuminuria and a blood test for serum creatinine. Recent literature indicates that albuminuria is not always present in Diabetic Kidney Disease patients and serum creatinine is only raised after substantial kidney damage has occurred. Recently, cystatin C was proposed as a potential marker for kidney disease but this has not been studied thoroughly in Malaysia. Glomerular Filtration Rate is the best method for measuring kidney function and is widely estimated using the Modification of Diet for Renal Disease equation. Another equation, the Chronic Kidney Disease Epidemiology Collaboration Creatinine equation was introduced in 2009. The new equation retained the precision and accuracy of the Modification of Diet for Renal Disease equation at GFR < 60ml/min/1.73m2, showed less bias and improved precision at GFR>60ml/min/1.73m2. In Asian countries, adding an ethnic coefficient to the equation enhanced its performance. In Malaysia, a multi-ethnic Asian population, the Chronic Kidney Disease Epidemiology Collaboration equation should be validated and the Glomerular Filtration Rate should be reported whenever serum creatinine is ordered. Reporting estimated Glomerular Filtration Rate will help diagnose patients who would have been otherwise missed if only albuminuria and serum creatinine are measured.
Collapse
Affiliation(s)
- Yasmin Almualm
- 1- (currently)Department of Community Health, Faculty of Medicine, National University of Malaysia 2- (at the time research was conducted ) Clinical Investigation Centre, Faculty of Medicine , University of Malaya.
| | | |
Collapse
|
18
|
Giglio D. A New Equation for Estimating Glomerular Filtration Rate in Cancer Patients. Chemotherapy 2014; 60:63-72. [DOI: 10.1159/000365724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/03/2014] [Indexed: 11/19/2022]
|
19
|
Rao X, Wan M, Qiu C, Jiang C. Role of cystatin C in renal damage and the optimum cut-off point of renal damage among patients with type 2 diabetes mellitus. Exp Ther Med 2014; 8:887-892. [PMID: 25120619 PMCID: PMC4113639 DOI: 10.3892/etm.2014.1815] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Accepted: 03/18/2014] [Indexed: 01/09/2023] Open
Abstract
The aims of the present study were to evaluate the roles of serum cystatin C (SCysC) and urinary cystatin C (UCysC) in renal function impairment and investigate the optimum cut-off point for renal function impairment among patients with type 2 diabetes mellitus (DM). A total of 742 inpatients and outpatients with type 2 DM (age, 20–75 years) were enrolled in this population-based cross-sectional study. The levels of SCysC and UCysC were determined and the odds ratios (ORs) and 95% confidence interval (CIs) of the calculated risk ratios of the different renal damage indicators were obtained. The levels of UCysC, urinary β2-microglobulin (Uβ2-MG), urinary albumin (UALB) and SCysC in the renal function impairment groups were observed in the following order: GFR-C>GFR-B>GFR-A (P<0.05 or P<0.01). According to the levels of GFR were divided into 4 groups, group GFR-A ≥ 80ml/min, GFR-B group 50–80 ml/min, group Ccr-C 20–50 ml/min, group GFR-D <20 ml/min. Following adjustment for age and gender, multivariate correlation analysis results revealed that levels of Uβ2-MG, UCysC and UALB negatively correlated with the glomerular filtration rate (GFR; P<0.05 or P<0.01). In addition, the duration of DM and the levels of SCysC and serum uric acid were shown to positively correlate with the GFR (P<0.05 or P<0.01). ORs for early renal function impairment significantly increased from the DM duration category of four years (OR, 1.74; 95% CI, 1.54–1.92). Receiver operating characteristic analysis demonstrated that the optimum DM cut-off point was four years, in which 60.79% sensitivity and 69.66% specificity were observed. Therefore, UCsyC levels may be used as an efficient indicator for the evaluation of early renal function impairment among patients with type 2 DM. In addition, renal lesions may initially occur in the renal tubule and then form in the renal glomerulus of patients with type 2 DM.
Collapse
Affiliation(s)
- Xiaopang Rao
- Department of Endocrinology, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Meiyan Wan
- Department of Nephrology, Qingdao Municipal Hospital, Qingdao, Shandong 266100, P.R. China
| | - Caixia Qiu
- Department of Endocrinology, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| | - Chongcai Jiang
- Department of Endocrinology, Chengyang People's Hospital, Qingdao, Shandong 266109, P.R. China
| |
Collapse
|
20
|
Uruska A, Araszkiewicz A, Zozulinska-Ziolkiewicz D, Wegner M, Grzelka A, Wierusz-Wysocka B. Does serum cystatin C level reflect insulin resistance in patients with type 1 diabetes? Clin Biochem 2014; 47:1235-8. [PMID: 24956263 DOI: 10.1016/j.clinbiochem.2014.06.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 06/09/2014] [Accepted: 06/10/2014] [Indexed: 01/06/2023]
Abstract
OBJECTIVES The aim of study was to evaluate the relationship between serum cystatin C and insulin resistance (IR) in type 1 diabetic patients being the participants of Poznan Prospective Study. DESIGN AND METHODS The study was performed on 71 Caucasian patients (46 men); with type 1 diabetes, who were recruited into the Poznan Prospective Study, at the age of 39±6.1 meanly, and treated with intensive insulin therapy since the onset of the disease. The follow-up period and diabetes duration were 15±1.6 years. Insulin resistance (IR) was assessed by estimated glucose disposal rate (eGDR) calculation with cut-off point 7.5 mg/kg/min. Patients were divided into two groups, according to the presence or absence of IR. RESULTS From among 71 patients, 31 patients (43.7%) presented decreased sensitive to insulin with eGDR below 7.5 mg/kg/min. Patients who had eGDR <7.5 mg/kg/min (insulin resistant), compared with subjects with eGDR >7.5 mg/kg/min (insulin sensitive), had higher level of serum cystatin C [0.59 (IQR:0.44-0.84) vs 0.46 (IQR:0.37-0.55) mg/L, p=0.009]. A significant negative correlation between cystatin C and eGDR was revealed (Rs=-0.39, p=0.001). In regression model cystatin C was related to insulin resistance, adjusted for sex, BMI, eGFR and duration of diabetes [OR 0.03 (0.001-0.56), p=0.01]. CONCLUSIONS Higher level of serum cystatin C is related to decreased insulin sensitivity in patients with type 1 diabetes. This relationship seems to have an important clinical implication.
Collapse
Affiliation(s)
- A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland.
| | - A Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - D Zozulinska-Ziolkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - M Wegner
- Lipid Metabolism Laboratory, Department of General Chemistry, Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Grunwaldzka 6, 60-780 Poznan, Poland
| | - A Grzelka
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| | - B Wierusz-Wysocka
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Raszeja Hospital, Mickiewicza 2, 60-834 Poznan, Poland
| |
Collapse
|
21
|
Estimation of glomerular filtration rate by a radial basis function neural network in patients with type-2 diabetes mellitus. BMC Nephrol 2013; 14:181. [PMID: 23988079 PMCID: PMC3766235 DOI: 10.1186/1471-2369-14-181] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Accepted: 08/12/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Accurate and precise estimates of glomerular filtration rate (GFR) are essential for clinical assessments, and many methods of estimation are available. We developed a radial basis function (RBF) network and assessed the performance of this method in the estimation of the GFRs of 207 patients with type-2 diabetes and CKD. METHODS Standard GFR (sGFR) was determined by (99m)Tc-DTPA renal dynamic imaging and GFR was also estimated by the 6-variable MDRD equation and the 4-variable MDRD equation. RESULTS Bland-Altman analysis indicated that estimates from the RBF network were more precise than those from the other two methods for some groups of patients. However, the median difference of RBF network estimates from sGFR was greater than those from the other two estimates, indicating greater bias. For patients with stage I/II CKD, the median absolute difference of the RBF network estimate from sGFR was significantly lower, and the P50 of the RBF network estimate (n = 56, 87.5%) was significantly higher than that of the MDRD-4 estimate (n = 49, 76.6%) (p < 0.0167), indicating that the RBF network estimate provided greater accuracy for these patients. CONCLUSIONS In patients with type-2 diabetes mellitus, estimation of GFR by our RBF network provided better precision and accuracy for some groups of patients than the estimation by the traditional MDRD equations. However, the RBF network estimates of GFR tended to have greater bias and higher than those indicated by sGFR determined by (99m)Tc-DTPA renal dynamic imaging.
Collapse
|
22
|
Assal HS, Tawfeek S, Rasheed EA, El-Lebedy D, Thabet EH. Serum cystatin C and tubular urinary enzymes as biomarkers of renal dysfunction in type 2 diabetes mellitus. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2013; 6:7-13. [PMID: 23966807 PMCID: PMC3738377 DOI: 10.4137/cmed.s12633] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Renal tubulointerstitium plays an important role in the development and progression of diabetic nephropathy. The aim of this study was to assess serum cystatin C and 2 renal tubular enzymes, neutrophil gelatinase associated lipocalin (NGAL) and N-acetyl-beta-D-glucosaminidase (NAG), as screening markers for early renal dysfunction in patients with type 2 diabetes mellitus (T2DM). ROC curve analysis showed that urinary NAG is the most sensitive marker of microalbuminuria and early renal damage with sensitivity of 83.3%, while serum cystatin C was the most sensitive and specific marker of macroalbuminuria and damage progress with sensitivity of 70.8% and specificity of 83.3% versus 70.6% and 83.3% for uNGAL; and 64.7% and 66.7% for NAG, respectively. Our data indicate that urinary NAG is the most sensitive marker for early renal damage in diabetic patients. However, for damage progress, serum cystatin C is the most sensitive and specific marker for follow-up and monitoring renal dysfunction.
Collapse
Affiliation(s)
- Heba S Assal
- Department of Internal Medicine, Medical Research Division, National Research Centre, Egypt
| | | | | | | | | |
Collapse
|
23
|
Simple cystatin C formula for estimation of glomerular filtration rate in overweight patients with diabetes mellitus type 2 and chronic kidney disease. EXPERIMENTAL DIABETES RESEARCH 2012; 2012:179849. [PMID: 23008697 PMCID: PMC3447360 DOI: 10.1155/2012/179849] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 06/28/2012] [Accepted: 07/12/2012] [Indexed: 02/07/2023]
Abstract
In clinical practice the glomerular filtration rate (GFR) is estimated from serum creatinine-based equations like the Cockcroft-Gault formula (C&G) and Modification of Diet in Renal Disease formula (MDRD). Recently, serum cystatin C-based equations, the newer creatinine formula (The Chronic Kidney Disease Epidemiology Collaboration formula (CKD-EPI)), and equation that use both serum creatinine and cystatin C (CKD-EPI creatinine & cystatin formula) were proposed as new GFR markers. Present study compares serum creatinine-based equations, combined (including both serum creatinine and cystatin C) equation, and serum simple cystatin C formula (100/serum cystatin C) against 51CrEDTA clearance in 113 adult overweight Caucasians with diabetes mellitus type 2 (DM2) and chronic kidney disease (CKD). The results of present study demonstrated that the simple cystatin C formula could be a useful tool for the evaluation of renal function in overweight patients with DM2 and impaired kidney function in daily clinical practice in hospital and especially in outpatients. Despite the advantages of the simple cystatin C formula, cystatin C-based equations cannot completely replace the “gold standard” for estimation of the GFR in a population of DM2 patients with CKD, but may contribute to a more accurate selection of patients requiring such invasive and costly procedures.
Collapse
|
24
|
Shahni R, Gnudi L, King A, Jones P, Malik AN. Elevated levels of renal and circulating Nop-7-associated 2 (NSA2) in rat and mouse models of diabetes, in mesangial cells in vitro and in patients with diabetic nephropathy. Diabetologia 2012; 55:825-34. [PMID: 22095236 DOI: 10.1007/s00125-011-2373-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 10/18/2011] [Indexed: 12/11/2022]
Abstract
AIMS/HYPOTHESIS We previously found that Nop-7-associated 2 (NSA2), which is involved in ribosomal biogenesis in yeast and is a putative cell cycle regulator in mammalian cells, is elevated in the kidney of Goto-Kakizaki (GK) rat, a spontaneous model of type 2 diabetes. Here we tested the hypothesis that elevated NSA2 is involved in diabetic nephropathy (DN). METHODS We examined Nsa2/NSA2 expression and NSA2 production in two rodent models of diabetes, in cultured renal glomerular cells, and in diabetic patients with and without nephropathy. Patients with nephropathy who had a history of albuminuria were further divided as responders (DN-NA; DN patients normoalbuminuric at the time of this study with a history of albuminuria) and non-responders (DN-A; diabetic nephropathy patients with albuminuria) to current treatment for albuminuria. RESULTS Renal Nsa2/NSA2 mRNA increased in tandem with hyperglycaemia in GK rats, in a streptozotocin-induced mouse model of diabetes, and in human mesangial cells (HMCs) grown in high glucose (p < 0.05). In the mouse model of diabetes, hyperglycaemia resulted in increased Nsa2 expression and NSA2 levels in tubular and glomerular cells and in circulating cells; this increase was normalised by diabetes treatment. Circulating NSA2 mRNA levels were elevated in patients with DN independently of body weight (BMI), glycaemic (HbA(1c)) and haemodynamic (blood pressure) control, and showed an inverse correlation with renal function (GFR, p < 0.05). NSA2 levels were the only variable that showed a significant difference between patients with albuminuria (DN-A) compared with non-albuminuric patients (DN-NA) and diabetic controls (p < 0.05), this increase being independent of all other variables, including GFR. CONCLUSION We show for the first time that renal and circulating NSA2/NSA2 levels are increased in hyperglycaemia in experimental models of diabetes, and that circulating NSA2 is elevated in DN patients with albuminuria. Further studies will be required to assess whether NSA2 plays a role in the pathogenesis of DN.
Collapse
MESH Headings
- Adult
- Aged
- Albuminuria/etiology
- Animals
- Cell Cycle Proteins/blood
- Cell Cycle Proteins/genetics
- Cell Cycle Proteins/metabolism
- Cells, Cultured
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/metabolism
- Diabetes Mellitus, Type 1/pathology
- Diabetes Mellitus, Type 1/urine
- Diabetes Mellitus, Type 2/complications
- Diabetes Mellitus, Type 2/metabolism
- Diabetes Mellitus, Type 2/pathology
- Diabetes Mellitus, Type 2/urine
- Diabetic Nephropathies/blood
- Diabetic Nephropathies/metabolism
- Diabetic Nephropathies/pathology
- Diabetic Nephropathies/physiopathology
- Disease Models, Animal
- Female
- Gene Expression Regulation
- Humans
- Kidney/cytology
- Kidney/metabolism
- Kidney/pathology
- Kidney/physiopathology
- Male
- Mesangial Cells/metabolism
- Mice
- Mice, Inbred C57BL
- Middle Aged
- Nuclear Proteins/blood
- Nuclear Proteins/genetics
- Nuclear Proteins/metabolism
- RNA, Messenger/metabolism
- RNA-Binding Proteins
- Rats
- Rats, Inbred Strains
Collapse
Affiliation(s)
- R Shahni
- Diabetes Research Group, Division of Diabetes and Nutritional Sciences, School of Medicine, Kings College London, Hodgkin Building, London Bridge, London SE1 1UL, UK
| | | | | | | | | |
Collapse
|
25
|
Cystatin C as a marker of glomerular filtration rate: prospects and limitations. Curr Opin Nephrol Hypertens 2012; 20:631-9. [PMID: 21926620 DOI: 10.1097/mnh.0b013e32834b8850] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW There is much interest in cystatin C to replace or supplement serum creatinine to estimate the glomerular filtration rate (GFR). Here we review the performance of cystatin C and combined creatinine-cystatin C estimating equations compared to creatinine-based estimating equations in chronic and acute kidney disease. RECENT FINDINGS Drift in the cystatin C assay has had a large effect on the results reported using cystatin C, but these issues are not routinely considered in evaluation of GFR-estimating equations. The recently released primary reference material for cystatin C will allow less difference among assays in the future. There does not appear to be a consistent message among published studies as to whether cystatin C-based equations are better than creatinine-based equations in the general population or those with chronic kidney disease (CKD), as well as those with reduced muscle mass or chronic illness, or acute kidney injury. Cystatin C could be used in combination with creatinine as a confirmatory test for estimated GFR from creatinine. SUMMARY Cystatin C may have a role to estimate GFR in selected circumstances, and the next set of studies should be directed at developing implementation strategies for its use.
Collapse
|
26
|
Chaykovska L, von Websky K, Rahnenführer J, Alter M, Heiden S, Fuchs H, Runge F, Klein T, Hocher B. Effects of DPP-4 inhibitors on the heart in a rat model of uremic cardiomyopathy. PLoS One 2011; 6:e27861. [PMID: 22125632 PMCID: PMC3220703 DOI: 10.1371/journal.pone.0027861] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Accepted: 10/26/2011] [Indexed: 12/20/2022] Open
Abstract
Background Uremic cardiomyopathy contributes substantially to mortality in chronic kidney disease (CKD) patients. Glucagon-like peptide-1 (GLP-1) may improve cardiac function, but is mainly degraded by dipeptidyl peptidase-4 (DPP-4). Methodology/Principal Findings In a rat model of chronic renal failure, 5/6-nephrectomized [5/6N] rats were treated orally with DPP-4 inhibitors (linagliptin, sitagliptin, alogliptin) or placebo once daily for 4 days from 8 weeks after surgery, to identify the most appropriate treatment for cardiac dysfunction associated with CKD. Linagliptin showed no significant change in blood level AUC(0-∞) in 5/6N rats, but sitagliptin and alogliptin had significantly higher AUC(0-∞) values; 41% and 28% (p = 0.0001 and p = 0.0324), respectively. No correlation of markers of renal tubular and glomerular function with AUC was observed for linagliptin, which required no dose adjustment in uremic rats. Linagliptin 7 µmol/kg caused a 2-fold increase in GLP-1 (AUC 201.0 ng/l*h) in 5/6N rats compared with sham-treated rats (AUC 108.6 ng/l*h) (p = 0.01). The mRNA levels of heart tissue fibrosis markers were all significantly increased in 5/6N vs control rats and reduced/normalized by linagliptin. Conclusions/Significance DPP-4 inhibition increases plasma GLP-1 levels, particularly in uremia, and reduces expression of cardiac mRNA levels of matrix proteins and B-type natriuretic peptides (BNP). Linagliptin may offer a unique approach for treating uremic cardiomyopathy in CKD patients, with no need for dose-adjustment.
Collapse
Affiliation(s)
- Lyubov Chaykovska
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
| | - Karoline von Websky
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
| | - Jan Rahnenführer
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
| | - Markus Alter
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
- Charité - Universitätsmedizin Berlin, Medizinische Klinik für Endokrinologie und Nephrologie, Berlin, Germany
| | - Susi Heiden
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
| | - Holger Fuchs
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Frank Runge
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Thomas Klein
- Boehringer Ingelheim Pharma GmbH & Co. KG, Biberach an der Riss, Germany
| | - Berthold Hocher
- Charité - Universitätsmedizin Berlin, Center for Cardiovascular Research, Institute for Pharmacology and Toxicology, Berlin, Germany
- Institute of Nutritional Science, University of Potsdam, Potsdam-Nuthetal, Germany
- * E-mail:
| |
Collapse
|
27
|
Rigalleau V, Beauvieux MC, Gonzalez C, Raffaitin C, Lasseur C, Combe C, Chauveau P, De la Faille R, Rigothier C, Barthe N, Gin H. Estimation of renal function in patients with diabetes. DIABETES & METABOLISM 2011; 37:359-66. [PMID: 21680218 DOI: 10.1016/j.diabet.2011.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 05/07/2011] [Indexed: 01/02/2023]
Abstract
Diabetes is the leading cause of chronic kidney disease (CKD), which makes estimation of renal function crucial. Serum creatinine is not an ideal marker of glomerular filtration rate (GFR), which also depends on digestive absorption, and the production of creatinine in muscle and its tubular secretion. Formulas have been devised to estimate GFR from serum creatinine but, given the wide range of GFR, proteinuria, body mass index and specific influence of glycaemia on GFR, the uncertainty of these estimations is a particular concern for patients with diabetes. The most popular recommended formulas are the simple Cockcroft-Gault equation, which is inaccurate and biased, as it calculates clearance of creatinine in proportion to body weight, and the MDRD equation, which is more accurate, but systematically underestimates normal and high GFR, being established by a statistical analysis of results from renal-insufficient patients. This underestimation explains why the MDRD equation is repeatedly found to give a poor estimation of GFR in patients with recently diagnosed diabetes and is a poor tool for reflecting GFR decline when started from normal, as well as the source of unexpected results when applied to epidemiological studies with a 60mL/min/1.73m(2) threshold as the definition of CKD. The more recent creatinine-based formula, the Mayo Clinic Quadratic (MCQ) equation, and the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) improve such underestimation, as both were derived from populations that included subjects with normal renal function. Determination of cystatin C is also promising, but needs standardisation.
Collapse
Affiliation(s)
- V Rigalleau
- Service de Nutrition-Diabétologie, Hôpital Haut-Lévêque, avenue de Magellan, 33600 Pessac, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Jeon YK, Kim MR, Huh JE, Mok JY, Song SH, Kim SS, Kim BH, Lee SH, Kim YK, Kim IJ. Cystatin C as an early biomarker of nephropathy in patients with type 2 diabetes. J Korean Med Sci 2011; 26:258-63. [PMID: 21286018 PMCID: PMC3031011 DOI: 10.3346/jkms.2011.26.2.258] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 11/19/2010] [Indexed: 11/20/2022] Open
Abstract
This study was done to evaluate clinical usefulness of cystatin C levels of serum and urine in predicting renal impairment in normoalbuminuric patients with type 2 diabetes and to evaluate the association between albuminuria and serum/urine cystatin C. Type 2 diabetic patients (n = 332) with normoalbuminuria (n = 210), microalbuminuria (n = 83) and macroalbuminuria (n = 42) were enrolled. Creatinine, urinary albumin levels, serum/urine cystatin C and estimated glomerular filtration rate (eGFR by MDRD [Modification of Diet in Renal Disease] and CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equations) were determined. The cystatin C levels of serum and urine increased with increasing degree of albuminuria, reaching higher levels in macroalbuminuric patients (P < 0.001). In multiple regression analysis, serum cystatin C was affected by C-reactive protein (CRP), sex, albumin-creatinine ratio (ACR) and eGFR. Urine cystatin C was affected by triglyceride, age, eGFR and ACR. In multivariate logistic analysis, cystatin C levels of serum and urine were identified as independent factors associated with eGFR < 60 mL/min/1.73 m(2) estimated by MDRD equation in patients with normoalbuminuria. On the other hand, eGFR < 60 mL/min/1.73 m(2) estimated by CKD-EPI equation was independently associated with low level of high-density lipoprotein in normoalbuminuric patients. The cystatin C levels of serum and urine could be useful markers for renal dysfunction in type 2 diabetic patients with normoalbuminuria.
Collapse
Affiliation(s)
- Yun Kyung Jeon
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Mi Ra Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Jung Eun Huh
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Ji Young Mok
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sang Heon Song
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Sang Soo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Bo Hyun Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | | | - Yong Ki Kim
- Kim Yong Ki Internal Medicine Clinic, Busan, Korea
| | - In Joo Kim
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| |
Collapse
|
29
|
Weinert LS, Camargo EG, Soares AA, Silveiro SP. Glomerular filtration rate estimation: performance of serum cystatin C-based prediction equations. Clin Chem Lab Med 2011; 49:1761-71. [DOI: 10.1515/cclm.2011.670] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
|
30
|
Hamden K, Masmoudi H, Carreau S, Elfeki A. Immunomodulatory, beta-cell, and neuroprotective actions of fenugreek oil from alloxan-induced diabetes. Immunopharmacol Immunotoxicol 2010; 32:437-45. [PMID: 20100065 DOI: 10.3109/08923970903490486] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Immunological disorders and nephropathy are among the most frequent and serious complications of diabetes mellitus. This shows that fewer infiltrated inflammatory cells evidenced by reverted back to near the normal value of white blood cell, mean corpuscular volume, and lymphocytes counts as interleukin-6 in pancreas. Also, fenugreek oil significantly improved blood glucose levels, glucose intolerance, and insulin sensitivity compared to the diabetic group. The pancreatic islet and less beta-cells damage were observed after the administration of fenugreek oil to diabetic rats. Moreover, diabetic rats showed low activities of superoxide dismutase, catalase, glutathione peroxidase, and reduced glutathione content in kidney, which were restored to near normal levels by treatment with fenugreek oil. The increased levels of lipid peroxidation, creatinine, albumin, and urea in diabetic rats decreased significantly in diabetic rats treated with fenugreek oil. Diabetic rats treated with fenugreek oil restored almost a normal architecture of pancreas and kidney. In conclusion, this study reveals the efficacy of fenugreek oil in the amelioration of diabetes, hematological status, and renal toxicity which may be attributed to its immunomodulatory activity and insulin stimulation action along with its antioxidant potential.
Collapse
Affiliation(s)
- Khaled Hamden
- Animal Ecophysiology Laboratory, Faculty of Sciences of Sfax, University of Sfax, Sfax, Tunisia.
| | | | | | | |
Collapse
|
31
|
Abstract
PURPOSE OF REVIEW Estimated glomerular filtration rate (eGFR) is now commonly reported by clinical laboratories. Here, we review the performance of current creatinine and cystatin C-based estimating equations as well as demonstration of their utility in public health and clinical practice. RECENT FINDINGS Lower levels of GFR are associated with multiple adverse outcomes, including acute kidney injury and medical errors. The new Chronic Kidney Disease-Epidemiology Collaboration (CKD-EPI) equation improves performance and risk prediction compared with the Modification of Diet in Renal Disease study equation. Current cystatin C-based equations are not accurate in all populations, even in those with reduced muscle mass or chronic illness, in which cystatin C would be expected to outperform creatinine. eGFR reporting has led to a greater number of referrals to nephrologists, but the increased numbers do not appear to be excessive or burdensome. The Modification of Diet in Renal Disease study equation appears to be able to provide drug dosage adjustments similar to the Cockcroft-Gault equation. SUMMARY Estimated GFRs and their reporting can improve and facilitate clinical practice for chronic kidney disease. Understanding strengths and limitations facilitates their optimal use. Endogenous filtration markers, alone or in combination, which are less dependent on non-GFR determinants of the filtration markers, are necessary to lead to more accurate eGFRs.
Collapse
|
32
|
|
33
|
Becker BN, Vassalotti JA. A software upgrade: CKD testing in 2010. Am J Kidney Dis 2010; 55:8-10. [PMID: 20053344 DOI: 10.1053/j.ajkd.2009.11.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 11/11/2022]
Affiliation(s)
- Bryan N Becker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
| | | |
Collapse
|
34
|
Jassal SV. Clinical presentation of renal failure in the aged: chronic renal failure. Clin Geriatr Med 2010; 25:359-72. [PMID: 19765486 DOI: 10.1016/j.cger.2009.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic kidney disease is increasingly being recognized in elderly individuals across the world. An understanding of the methods used to estimate or to measure kidney function, the likelihood and factors associated with progressive decline in renal function, and the clinical syndromes associated with poor renal function are key topics for individuals working across many medical disciplines. This review addresses some of the important aspects of chronic kidney disease, and summarizes some of the clinical and laboratory features associated with progressive disease.
Collapse
Affiliation(s)
- Sarbjit Vanita Jassal
- University Health Network, 8NU-857, 200 Elizabeth Street, Toronto, Ontario, M5G 2C4 Canada.
| |
Collapse
|
35
|
Cystatin C for early detection of renal impairment in diabetes. Clin Biochem 2008; 42:108-10. [PMID: 18983837 DOI: 10.1016/j.clinbiochem.2008.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Revised: 09/27/2008] [Accepted: 10/08/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Evaluation of glomerular filtration rate is of crucial importance in diabetes. Cystatin C, a cysteine protease inhibitor seems to be an interesting parameter. DESIGN AND METHODS 67 diabetic patients with normal creatinine are evaluated. Cystatin C is compared to renal markers, by reference to Cr EDTA clearance. RESULTS Significant correlations are found between cystatin C and creatinine (r=0.54). GFR MDRD (r=-0.47) and GFR Cr EDTA (r=-0.47). The AUC of the receiver operating curves is better for GFR MDRD (0.83) and cystatin C (0.75) than for creatinine (0.63) considering the cut off value of 80 mL/min for GFR EDTA. CONCLUSION Cystatin C seems to be a more sensitive parameter than creatinine for the detection of an incipient nephropathy in diabetes.
Collapse
|