Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

Herget–Rosenthal, Stefan; Trabold, Silke; Huesing, Johannes; Heemann, Uwe; Philipp, Thomas; Kribben, Andreas

doi:10.1111/j.1432-2277.2000.tb01083.x

Cited by 40 publications

(16 citation statements)

References 22 publications

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“…Paskalev et al [19]studied 40 transplant recipients and found serum cystatin C to be superior to serum creatinine, determined with the Jaffé method, in diagnostic accuracy but similar to creatinine clearance. In another report, by Herget-Rosenthal et al [16], a large number of patients (n = 110) were enrolled. However, they used creatinine clearance as a measure of GFR, which is associated with several limitations not seen with iohexol clearance.…”

Section: Discussionmentioning

confidence: 99%

“…There are some reports on measurement of serum cystatin C in patients with renal transplants [16, 17, 18, 19]. In three of the studies, serum cystatin C was suggested to be superior to serum creatinine [17, 18, 19].…”

Section: Introductionmentioning

confidence: 99%

“…However, in these studies serum creatinine was measured with the Jaffé procedure and the number of patients ranged from 25 to 40. Herget-Rosenthal et al [16]evaluated serum cystatin C in 110 adult renal transplant recipients but used creatinine clearance as GFR standard. They found a strong correlation between 1/cystatin C and creatinine clearance over the entire range of transplant function, but only equivalent to that between 1/creatinine and creatinine clearance.…”

Section: Introductionmentioning

confidence: 99%

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Serum Cystatin C Is a More Sensitive and More Accurate Marker of Glomerular Filtration Rate than Enzymatic Measurements of Creatinine in Renal Transplantation

Christensson¹,

Ekberg²,

Grubb³

et al. 2003

Nephron Physiol

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Background/Aims: Serum creatinine has several drawbacks as marker of glomerular filtration rate (GFR), and therefore serum cystatin C has been proposed as a more optimal GFR marker. Previous reports have suggested benefits of serum cystatin C measurements in patients with renal transplants. The purpose of the present study was to evaluate the diagnostic accuracy of cystatin C measurements compared with enzymatic creatinine measurements as serum markers of GFR (established from plasma clearance of iohexol) in a large cohort of stable renal transplant recipients and in the early postoperative phase. Methods: Renal transplant patients (n = 125) with stable graft function were evaluated from reciprocals of serum creatinine and cystatin C compared with iohexol clearance. Fourteen patients were examined immediately after the onset of renal function. Cystatin C was measured by a particle-enhanced turbidimetric method and creatinine by an enzymatic method. Results: In stable renal transplant recipients, serum cystatin C showed a significantly (p = 0.033) closer correlation (r = 0.89 or 79% co-variance) with iohexol clearance than did serum creatinine (r = 0.81 or 66% co-variance). Using the χ² test and a cut-off at 60 ml/min/1.73 m², serum cystatin C levels demonstrated significantly higher sensitivity for early GFR impairment (p = 0.0045) compared with serum creatinine measurements. On the first day after transplantation, serum cystatin C fell more rapidly than serum creatinine. Conclusion: Serum cystatin C levels correlate significantly closer to accurate measurements of GFR and are significantly more sensitive to detect early GFR impairment than enzymatic measurements of creatinine in serum.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Serum Cystatin C Is a More Sensitive and More Accurate Marker of Glomerular Filtration Rate than Enzymatic Measurements of Creatinine in Renal Transplantation

Christensson¹,

Ekberg²,

Grubb³

et al. 2003

Nephron Physiol

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“…In a steady-state muscular mass balance, the plasma creatinine concentration is assumed to reflect glomerular filtration rate (GFR) (15). However, plasma creatinine is far from being an ideal marker of GFR, despite its convenience and low cost (16).…”

Section: Discussionmentioning

confidence: 99%

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

Gruev¹,

Chakalarovski²,

Stojceva-Taneva³

et al. 2009

Journal of Medical Biochemistry

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Kratak sadr`aj: U radu je opisan uticaj glukokortikoidne imunosupresije na koncentraciju cistatina C u serumu pacijenata posle transplantacije bubrega. Kako bi se odredio uticaj imunosupresivne terapije, naro~ito glukokortikoida, na nivo cistatina C u serumu, upore|eno je 38 klini~ki stabilnih pacijenata koji su primali niske doze glukokortikoida sa 30 klini~ki stabilnih pacijenata koji su primali samo ciklosporin A, i 18 klini~ki stabilnih pacijenata koji su primali ciklosporin A zajedno sa azatioprinom. Klini~ka stabilnost je definisana kao odsustvo akutne reakcije, febrilne infekcije i ciklosporinske nefrotoksi~nosti uz stabilan klirens kreatinina utvr|en pomo}u formule Kokrofta i Golta. Grupa pacijenata koji su primali u kratkom periodu visoke doze metilprednizolona analizirana je 15 dana ranije, na dan aplikacije, tre}eg i 9-10 dana po zavr{etku terapije. Re zulta ti su potvrdili da u prva tri dana od primene (500 mg/dan) postoji zna~ajno pove}anje koncentracije cistatina C, koja se normalizovala po zavr{etku terapije. Rezultati dobijeni primenom niskih doza glukokorti ko ste roidne tera pije pokazuju zna~ajno pove}anje koncentracije cistatina C u odnosu na kontrolnu grupu. Ova preliminarna ispitivanja ukazuju na potrebu uvo|enja specifi~nog refe rentnog inter vala za pacijente na glukokortikoidnoj terapiji. Summary:The aim of the present study is to describe the influence of glucocorticoid immunosuppression on serum cys tatin C concentration in renal transplant patients. To evaluate the influence of immunosuppressive regimens, especially glucocorticoids, on serum cystatin C level, 38 clini cally stable patients on immunosuppression therapy with low-dose glucocorticoids were compared to 30 clinically stable patients receiving cyclosporin A alone, and 18 clinically stable patients receiving cyclosporin A together with azathioprine. Clinical stability was defined as the absence of acute rejection, febrile infection, and cyclosporin A toxicity, as well as stability of creatinine clearance as estimated by the formula of Cockroft and Gault. All groups were compared for estimated creatinine clearance (CrCl) values and had comparable gender, age and time since transplantation. The group receiving short-course, high-dose methylprednisolone was analyzed at four time points: a) before methylpredni solone commencement (median, 15 days); b) the day methylprednisolone was introduced (before medication); c) after 3 days of methylprednisolone therapy; and d) on a follow-up 9-10 days after the last dose. Intravenous admini stra tion of high-dose methylprednisolone led to significant diffe rences in cystatin C levels at different time points (before administration, after three doses, and 8 days after discon tinuation). Glucocorticoid medication in adult renal transplant patients is associated in a dose-de pendent manner with increased cystatin C, leading to systematic under esti mation of GFR. Moreover, our data illustrate the need for specific reference intervals in patients on gluco corticoid thera py. In clinical routin...

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“…To date, data on the diagnostic accuracy of cystatin C in renal transplant patients from small study groups have been published. Only one larger study comprising 110 patients did not show any diagnostic advantage of cystatin C [16][17][18][19][20][21][22][23][24][25]. We, therefore, assessed the diagnostic accuracy of serum creatinine and cystatin C as markers of GFR in 173 consecutive adult renal transplant patients.…”

Section: Introductionmentioning

confidence: 99%

Cystatin C as an Endogenous Marker of Glomerular Filtration Rate in Renal Transplant Patients

Pöge¹,

Stoschus²,

Stoffel‐Wagner

et al. 2003

Kidney Blood Press Res

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Background: Serum creatinine is the most common endogenous marker used to estimate the glomerular filtration rate (GFR). However, creatinine depends considerably on muscle mass, and its tubular secretion increases, especially in chronic renal failure. Cystatin C is a 13-kD protease inhibitor which is produced by all nucleated cells and is independent of muscle mass and sex. Cystatin C is eliminated by glomerular filtration and metabolized by proximal tubular cells. Its measurement has been proposed as an alternative and more sensitive marker of GFR than creatinine in patients with slight to moderately decreased GFR. Methods: We investigated serum cystatin C levels in comparison with creatinine as a single measurement for estimation of GFR in 173 patients after renal transplantation. GFR was calculated as creatinine clearance according to standard equations. Results: Serum creatinine correlated well with cystatin C (r = 0.84; p < 0.0001). No significant differences were obtained for the comparison of the linear correlation of 1/creatinine with creatinine clearance (r = 0.77; p < 0.0001) and for the linear correlation of 1/cystatin C with creatinine clearance (r = 0.73; p < 0.0001). However, we found a significant advantage of cystatin C in detecting a clinical relevant reduction of kidney function (GFR <70 ml/min; p = 0.0047, McNemar test). Conclusion: Cystatin C is an alternative marker for the assessment of GFR in renal allograft recipients that may be superior to creatinine.

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Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation?

Cited by 40 publications

References 22 publications

Serum Cystatin C Is a More Sensitive and More Accurate Marker of Glomerular Filtration Rate than Enzymatic Measurements of Creatinine in Renal Transplantation

Serum Cystatin C Is a More Sensitive and More Accurate Marker of Glomerular Filtration Rate than Enzymatic Measurements of Creatinine in Renal Transplantation

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

Cystatin C as an Endogenous Marker of Glomerular Filtration Rate in Renal Transplant Patients

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