Cystatin C and Estimates of Renal Function: Searching for a Better Measure of Kidney Function in Diabetic Patients

Pucci, Laura; Triscornia, S.; Lucchesi, Daniela; Fotino, Carmen; Pellegrini, Giovanni; Pardini, E.; Miccoli, Roberto; Prato, Stefano Del; Penno, Giuseppe

doi:10.1373/clinchem.2006.076042

Cited by 156 publications

(126 citation statements)

References 40 publications

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“…RFD2, no renal function decline; RFD+, renal function decline; ACR, urinary albumin/creatinine ratio. the normal range (12)(13)(14), the use of these equations (15,16) in this study generally underestimated RFD prevalence compared with ascertainment by serial GFR (not shown).…”

Section: Discussionmentioning

confidence: 60%

Early Renal Function Decline in Type 2 Diabetes

Pavkov

Knowler

Lemley

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Early decline in GFR may reflect progressive kidney disease in type 1 diabetes, but its predictive value in type 2 diabetes is uncertain.Design, setting, participants, & measurements In this longitudinal study, GFR was measured serially over approximately 4.0 years in 195 Pima Indians with type 2 diabetes. Renal function decline (RFD) was defined during this initial period by an average GFR loss $3.3%/yr, as defined previously in type 1 diabetes. Subsequently, participants were followed for up to 17.8 years to ESRD onset, death, or December 31, 2010, whichever came first.Results RFD prevalence during the initial period was 32% in 68 participants with normal baseline albuminuria (albumin/creatinine ratio [ACR] , 30 mg/g), 42% in 88 with microalbuminuria (ACR 30 to ,300 mg/g), and 74% in 39 with macroalbuminuria (ACR $300 mg/g; P,0.001). The cumulative incidence of ESRD 10 years after the initial period was 41% in those with RFD and 15% in those without (P,0.001); 41 of the 49 ESRD cases (83.7%) occurred in participants who had or developed macroalbuminuria during the initial period. When adjusted for age, sex, diabetes duration, and hemoglobin A1c, the ESRD hazard rate was 4.78 times (95% confidence interval, 2.39-9.58) as high in those with RFD as in those without; further adjustment for albuminuria attenuated this association (hazard ratio, 1.79; 95% confidence interval, 0.82-3.91).Conclusions In type 2 diabetes, loss of GFR often occurs before the onset of macroalbuminuria, but a decline predictive of ESRD is strongly dependent on progression to macroalbuminuria.

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Section: Discussionmentioning

confidence: 60%

Early Renal Function Decline in Type 2 Diabetes

Pavkov

Knowler

Lemley

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…Perlemoine et al did not find CysC to offer any advantage in detecting GFR -80 mL/min/1.73 m 2 , except in the sub-group of patients with a creatinine of less than 1 mg/dL (88 mmol/L) (96). Of these different studies, the study by Pucci et al which examined 288 diabetic patients (both types) with GFR measurement by plasma iohexol clearance and a wide range of GFR is undoubtedly one of the most important studies (162). The authors found a significantly better correlation between CysC and GFR than between creatinine and GFR.…”

Section: Diabetic Patientsmentioning

confidence: 99%

Cystatin C: current position and future prospects

Séronie-Vivien

Delanaye

Piéroni³

et al. 2008

Clinical Chemistry and Laboratory Medicine

163

145

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Cystatin C is a low-molecular-weight protein which has been proposed as a marker of renal function that could replace creatinine. Indeed, the concentration of cystatin C is mainly determined by glomerular filtration and is particularly of interest in clinical settings where the relationship between creatinine production and muscle mass impairs the clinical performance of creatinine. Since the last decade, numerous studies have evaluated its potential use in measuring renal function in various populations. More recently, other potential developments for its clinical use have emerged. This review summarises current knowledge about the physiology of cystatin C and about its use as a renal marker, either alone or in equations developed to estimate the glomerular filtration rate. This paper also reviews recent data about the other applications of cystatin C, particularly in cardiology, oncology and clinical pharmacology. Clin Chem Lab Med 2008;46:1664-86.

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“…Ovaj parametar je pokazao dobru korelaciju sa metodama zlatnog standarda za određivanje JGF [1,4]. Cistatin C se do sada pokazao i kao osjetljiv parametar za procjenu početnog oštećenja bubrežne funkcije, što kod oboljelih od DM omogućava prevenciju i preduzimanje mjera u usporavanju ili zaustavljanju progresije hronične bubrežne bolesti i razvoju terminalne bubrežne insuficijencije [9,10].…”

Section: Uvodunclassified

“…Poznato je da se normalne vrijednosti kreatinina u serumu mogu održavati sve dok se bubrežna funkcija ne ošteti za polovinu od normalne. Pucci i saradnici [9] su u svom istraživanju pokazali prednost cistatina C, u odnosu na kreatinin, za procjenu početnog oštećenja bubrežne funkcije kod oboljelih od oba tipa DM. Cistatin C je u njihovom istraživanju bio povišen kada su vrijednosti JGF bile blizu referentnih vrijednosti (90ml/min/1,73m 2 ) ili u opsegu od 60 do 90 ml/min/1,73m 2 .…”

Section: Diskusijaunclassified

“…U našem istraživanju vrijednosti cistatina C su bile u značajnoj korelaciji sa glavnim faktorima rizika za oštećenje bubrežne funkcije u DM: vrijednostima sistolnog krvnog pritiska, HbA1c i dužinom trajanja DM. Ovu povezanost su utvrdili i drugi autori [9,15]. Cistatin C nije pokazao značajnu korelaciju sa dobi, polom i BMI kod oboljelih od DM, što mu daje prednost u odnosu na kreatinin.…”

Section: Diskusijaunclassified

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Primjena cistatina C u određivanju jačine glomerularne filtracije kod oboljelih od tipa 2 dijabetes melitusa

Risović

Popović-Pejičić

Vlatković

2016

BII

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Kratak sadržajUvod. Funkcija bubrega se u praksi najčešće procjenjuje izračunavanjem jačine glomerularne filtracije (JGF) na osnovu koncentracije kreatinina u serumu. Primjena relativno novijeg parametra, cistatina C pokazala se pouzdanom i osjetljivom u procjeni bubrežne funkcije. Cilj rada je bio da se kod oboljelih od dijabetes melitusa (DM) tipa 2 odredi JGF pomoću 24-časovnog klirensa kreatinina, primjenom jednačina iz serumskog kreatinina i cistatina C, te da se utvrdi stepen senzitivnosti i specifičnosti primjenjenih metoda.Metode. Šezdeset ispitanika, dobi od 40-70 godina starosti, podijeljeno je u dvije grupe od po 30 ispitanika: grupa oboljelih od DM tipa 2 i kontrolna grupa. Za određivanje JGF korišćen je 24-časovni klirens kreatinina, jednačine prema Modification of Diet in Renal Disease (MDRD) za kreatinin i Chronic Kidney Disease Epidemiology (CKD-EPI) za cistatin C.Rezultati. Prosječne vrijednosti serumskog cistatina C su bile statistički značajno više kod oboljelih od DM u poređenju sa kontrolnom grupom (p <0,001). Utvrđena je statistički visoko značajna pozitivna korelacija između JGF izračunate pomoću jednačina koje koriste koncentracije kreatinina i cistatina C u serumu (r =0,74, p< 0,001). Jednačina po CKD-EPI pokazala je veću senzitivnost i specifičnost kod svih ispitanika. Ova senzitivnost je bila izraženija kod oboljelih od DM i iznosila je za CKD-EPI 0,938, za MDRD 0,878, za 24-časovni klirens kreatinina 0,818, a specifičnost za CKD-EPI 0,878, za MDRD 0,867, a za 24-časovni klirens kreatinina 0,802.Zaključak. Koncentracija cistatina C u serumu se pokazala kao pouzdan, senzitivan i specifičan parametar za izračunavanje JGF, posebno osjetljiv kod osoba sa blagim smanjenjem funkcije bubrega.

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Cystatin C and Estimates of Renal Function: Searching for a Better Measure of Kidney Function in Diabetic Patients

Abstract: ؊1 cut-points, diagnostic efficiencies of cystatin C (89% and 92%) were better than those of the other variables (79%-82% and 85%-86%, respectively; P ‫؍‬ 0.01).

Cited by 156 publications

References 40 publications

Early Renal Function Decline in Type 2 Diabetes

Early Renal Function Decline in Type 2 Diabetes

Cystatin C: current position and future prospects

Primjena cistatina C u određivanju jačine glomerularne filtracije kod oboljelih od tipa 2 dijabetes melitusa

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