Differential Effect of Corticosteroids on Serum Cystatin C in Thrombocytopenic Purpura and Leukemia

Bárdi, Edit; Dobos, Erik; Kappelmayer, János; Kiss, Csongor

doi:10.1007/s12253-009-9243-0

Cited by 10 publications

(8 citation statements)

References 11 publications

(13 reference statements)

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“…Some have reported that cystatin C is disproportionally increased in patients with active malignancy [37,38], whereas others have failed to demonstrate this association [33]. Similar controversies exist regarding the independent effect of steroid therapy and the WBC count on cystatin C levels [24,39,40]. We were unable to find an association between the WBC count and cystatin C in our cohort.…”

Section: Discussioncontrasting

confidence: 70%

Cystatin C-estimated Glomerular Filtration Rate in Pediatric Autologous Hematopoietic Stem Cell Transplantation

Laskin

Nehus

Goebel

et al. 2012

Biology of Blood and Marrow Transplantation

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Formal evaluation of kidney function is essential to determine chemotherapy dosing based on established treatment protocols in children undergoing autologous stem cell transplantation. Cystatin C has been widely studied as a marker of the glomerular filtration rate (GFR), although data regarding its use in stem cell transplantation are limited. We evaluated the performance of cystatin C-based equations and determined their sensitivity to detect a nuclear GFR of \100 mL/min/1.73 m 2 in children undergoing autologous transplantation. We performed a retrospective cohort analysis in 16 children undergoing 26 transplantations using a modified Bland-Altman analysis to account for repeated measures. Cystatin C-based equations published by Hoek, Le Bricon, Rule, Filler, Zappitelli, Larsson, and Schwartz (the New Chronic Kidney Disease in Children formula, New CKiD formula) were evaluated and compared to the creatinine-based modified Schwartz equation. We found that cystatin C-based equations demonstrated improved sensitivity to detect a nuclear GFR of \100 mL/min/1.73 m 2 compared to the creatinine-based modified Schwartz equation, which significantly overestimated GFR. Most cystatin C-based equations, however, tended to underestimate the nuclear GFR. The New CKiD formula, combining cystatin C and creatinine, offered a sensitivity of 100% and a specificity of 95% for detecting a nuclear GFR \100 mL/min/1.73 m 2. Institutions using cystatin C-based GFR estimation should be aware of the specific prediction formula and GFR measurement techniques available at their center, as each method's performance can vary considerably. As more research becomes available, this easily measured marker should become a valuable component of GFR estimation, providing cost savings (a nuclear GFR is 5.5 times more costly than a cystatin C) and reducing radiation exposure.

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Section: Discussioncontrasting

confidence: 70%

Cystatin C-estimated Glomerular Filtration Rate in Pediatric Autologous Hematopoietic Stem Cell Transplantation

Laskin

Nehus

Goebel

et al. 2012

Biology of Blood and Marrow Transplantation

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“…This may result in a falsely increased incidence of AKI if assessed by CysC-based eGFR. In contrast, there is controversy over whether glucocorticoids aff ect serum CysC levels in pediatric patients (Bokenkamp et al 2002;Foster et al 2006;Bokenkamp et al 2007;Bardi et al 2010;Slort et al 2012). Therefore, in the present study, the incidence of AKI was compared separately by glucocorticoid therapy status.…”

Section: Discussionmentioning

confidence: 90%

“…Since glucocorticoids may affect serum CysC levels (Bardi et al 2010;Nakamura et al 2018;Cimerman et al 2000), the incidence of AKI based on CysC-based eGFR was compared by glucocorticoid therapy status. No significant differences were found in the incidence of AKI: 77.4% during chemotherapy with glucocorticoids and 77.3% during chemotherapy without glucocorticoids.…”

Section: Incidence Rate and Severity Of Akimentioning

confidence: 99%

Superiority of Cystatin C over Creatinine for Early Diagnosis of Acute Kidney Injury in Pediatric Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma

Yamazoe

Akagawa

Matsuno

et al. 2021

Tohoku J. Exp. Med.

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The exact incidence of acute kidney injury (AKI) during chemotherapy for acute lymphoblastic leukemia (ALL)/lymphoblastic lymphoma (LBL) is unknown. Furthermore, childhood cancer survivors are at risk of AKI-chronic kidney disease transition. Thus, early diagnosis of AKI is crucial. This study aimed to elucidate the incidence of AKI in patients undergoing chemotherapy for pediatric ALL/LBL and to compare the usefulness of serum cystatin C (CysC)-and creatinine (Cr)-based estimated glomerular filtration rate (eGFR) as diagnostic measures. Data of 16 patients with ALL/LBL treated with a total of 75 courses of chemotherapy were retrospectively analyzed. CysC-and Cr-based eGFR were measured before and three times per week during therapy. To calculate the eGFR, an equation for Japanese children was used. AKI was diagnosed when eGFR dropped by ≥ 25% from the highest eGFR value obtained during the latest 2 weeks since the start of chemotherapy. AKI was graded based on the pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease scale. All patients developed AKI during chemotherapy; however, more than 90% of the cases were mild and eventually recovered. No significant differences were found in the incidence of AKI between CysC-and Cr-based eGFR (p = 0.104). The median time to AKI diagnosis was significantly shorter in the CysC-based eGFR than in the Cr-based eGFR (8 vs. 17 days, p < 0.001). In this study, all patients with pediatric ALL/LBL could develop mild AKI during treatment. CysC-based eGFR is a more effective measure than Cr-based eGFR for the early diagnosis of AKI.

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“…CysC usually peaks 2-3 days after steroid administration and the effect diminishes by 7 days. Findings in children have been more conflicting, with some studies finding no or limited changes in cysC after administration of high-dose short-course steroids or during chronic steroid administration, while others found dose-dependent increases in cysC [83][84][85][86].…”

Section: Corticosteroidsmentioning

confidence: 99%

Cystatin C: A Primer for Pharmacists

et al. 2020

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Pharmacists are at the forefront of dosing and monitoring medications eliminated by or toxic to the kidney. To evaluate the effectiveness and safety of these medications, accurate measurement of kidney function is paramount. The mainstay of kidney assessment for drug dosing and monitoring is serum creatinine (SCr)-based estimation equations. Yet, SCr has known limitations including its insensitivity to underlying changes in kidney function and the numerous non-kidney factors that are incompletely accounted for in equations to estimate glomerular filtration rate (eGFR). Serum cystatin C (cysC) is a biomarker that can serve as an adjunct or alternative to SCr to evaluate kidney function for drug dosing. Pharmacists must be educated about the strengths and limitations of cysC prior to applying it to medication management. Not all patient populations have been studied and some evaluations demonstrated large variations in the relationship between cysC and GFR. Use of eGFR equations incorporating cysC should be reserved for drug management in scenarios with demonstrated outcomes, including to improve pharmacodynamic target attainment for antibiotics or reduce drug toxicity. This article provides an overview of cysC, discusses evidence around its use in medication dosing and in special populations, and describes practical considerations for application and implementation.

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Differential Effect of Corticosteroids on Serum Cystatin C in Thrombocytopenic Purpura and Leukemia

Cited by 10 publications

References 11 publications

Cystatin C-estimated Glomerular Filtration Rate in Pediatric Autologous Hematopoietic Stem Cell Transplantation

Cystatin C-estimated Glomerular Filtration Rate in Pediatric Autologous Hematopoietic Stem Cell Transplantation

Superiority of Cystatin C over Creatinine for Early Diagnosis of Acute Kidney Injury in Pediatric Acute Lymphoblastic Leukemia/Lymphoblastic Lymphoma

Cystatin C: A Primer for Pharmacists

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