Serum cystatin-C Levels Research Articles

The Relationship between Serum Cystatin-C Levels and Impaired Cognitive Function in Patients with Chronic Kidney Disease

Background: Cystatin-C acts as a neuroprotector in the central nervous system at normal levels, but high serum cystatin-C levels are associated with impaired cognitive function. Serum cystatin-C levels increase in impaired renal function, and cognitive impairment are comorbidities that can increase the morbidity and mortality of chronic kidney disease patients. This study aimed to assess the relationship between serum cystatin-C levels and cognitive function in chronic kidney disease patients.
 Methods: This study used a cross-sectional design with 73 samples of non-hemodialysis chronic kidney disease patients. Cognitive function was assessed using the MoCa-Ina. Serum cystatin-C levels of all samples were measured by the ELISA method. Data analysis was carried out using SPSS.
 Results: Impaired cognitive function in CKD patients was found to be 76.7%. The median serum cystatin-C level of CKD patients with impaired cognitive function (n=56) was 1.015 mg/dL, and without cognitive impairment (n=17) was 0.929 mg/dL. There was no significant relationship between serum cystatin-C levels (cut-off point 0.98 mg/dL) and impaired cognitive function (OR : 2.05, 95% CI : 0.680-6.175, p= 0.198).
 Conclusion: There is no relationship between serum cystatin-C levels and cognitive function impairment in non-hemodialysis chronic kidney disease patients.

Postoperative day 1 serum cystatin C level predicts postoperative delayed graft function after kidney transplantation.

BackgroundDelayed graft function (DGF) commonly occurs after kidney transplantation, but no clinical predictors for guiding post-transplant management are available.Materials and methodsData including demographics, surgery, anesthesia, postoperative day 1 serum cystatin C (S-CysC) level, kidney functions, and postoperative complications in 603 kidney transplant recipients who met the enrollment criteria from January 2017 to December 2018 were collected and analyzed to form the Intention-To-Treat (ITT) set. All perioperative data were screened using the least absolute shrinkage and selection operator. The discrimination, calibration, and clinical effectiveness of the predictor were verified with area under curve (AUC), calibration plot, clinical decision curve, and impact curve. The predictor was trained in Per-Protocol set, validated in the ITT set, and its stability was further tested in the bootstrap resample data.ResultPatients with DGF had significantly higher postoperative day 1 S-CysC level (4.2 ± 1.2 vs. 2.8 ± 0.9 mg/L; P < 0.001), serum creatinine level (821.1 ± 301.7 vs. 554.3 ± 223.2 μmol/L; P < 0.001) and dialysis postoperative (74 [82.2%] vs. 25 [5.9%]; P < 0.001) compared with patients without DGF. Among 41 potential predictors, S-CysC was the most effective in the parsimonious model, and its diagnostic cut-off value was 3.80 mg/L with the risk score (OR, 13.45; 95% CI, 8.02–22.57; P < 0.001). Its specificity and sensitivity indicated by AUC was 0.832 (95% CI, 0.779–0.884; P < 0.001) with well fit calibration. S-CysC yielded up to 50% of clinical benefit rate with 1:4 of cost/benefit ratio.ConclusionThe postoperative day 1 S-CysC level predicts DGF and may be used as a predictor of DGF but warrants further study.

The effectiveness of the sarcopenia index in predicting septic\xa0shock and death in elderly patients with community-acquired\xa0pneumonia

BackgroundCommunity-acquired pneumonia (CAP) causes high morbidity and mortality in all age groups worldwide. Lower muscle radiodensity was associated with worse clinical outcomes (including shock) and higher in-hospital mortality. Prompt detection of sarcopenia in older adults with CAP is important. The measurement of muscle mass often involves specialized and expensive techniques. A relatively simple and inexpensive method such as the sarcopenia index (SI) to measure muscle mass would be helpful. Therefore, we performed a retrospective cohort study to assess the association between SI and septic shock risk and mortality in older patients with CAP.Study designIn this retrospective cohort study, information on hospitalized CAP patients, including general information and septic shock, were obtained from the medical record database of the Southwest Medical University Zigong Affiliated Hospital, China. Data on patient survival and mortality (all-cause) were acquired from government authorities and telephonic follow-up. Serum creatinine (Cr) and cystatin-C (CysC) levels on admission were included in the database. The SI was determined as the serum Cr/CysC ratio × 100 and the participants were assigned to low and high SI groups. The association between SI and septic shock was evaluated by logistic regression, and that between SI and mortality by Cox regression analysis.ResultsIn total, 769 older adults (≥ 60 years) with CAP were included, of which 480(62.4%) were male and 289(37.6%)were female. We found that the total prevalence of septic shock in older adults with CAP was 16.0%. In the female group, septic shock was more prevalent in the low SI group than in the high SI group (low SI vs. high SI, 22.22% vs. 11.52%, p = 0.024). Following adjustment for confounders, there was a significant association between high SI and a lower risk of septic shock in female patients (OR = 0.38, 95%CI: 0.16–0.94; p < 0.05). The total death toll of older adults with CAP was 332(43.2%). Irrespective of sex, there was a higher risk of mortality in the low SI group (total group: low SI vs. high SI, 63.02% vs. 36.57%, p < 0.001; male group: low SI vs. high SI, 63.03% vs. 39.34%, p < 0.001; female group: low SI vs. high SI, 73.61% vs. 28.57%, p < 0.001) and, after adjustment for confounding factors and irrespective of sex, high SI was a protective factor for mortality in older adults with CAP (total group: HR = 0.64, 95%CI: 0.48–0.84; p < 0.05; male: HR = 0.69, 95%CI: 0.49–0.97; p < 0.05; female: HR = 0.39, 95%CI: 0.24–0.62; p < 0.05).ConclusionWhile the SI effectively predicts mortality in older adults with CAP, it was only found to be associated with septic shock in older females.

Early detection of kidney diseases in diabetic patients with serum cystatin-C

Background: Prevalence of chronic kidney disease (CKD) is increased worldwide. According to Kidney Disease Improving Global Outcomes guidelines, CKD is defined as abnormalities of kidney structure or function, present for >3 months with implications for health. In individuals with Type-2 diabetes, assessment of kidney function is mandatory, as diabetic nephropathy constitutes the major cause of CKD which leads to end-stage renal disease in diabetic patients. Cystatin-“C”, an alternative biomarker of kidney function, is a better predictor of CKD and is less affected by age, race, or muscle mass. Hence, the presence of elevated serum cystatin C is directly linked with risk of developing a progressive form of CKD. Aim and Objectives: This study aims to evaluate the importance of serum cystatin C as a marker for early detection of CKD in diabetic and non-diabetic patients. Materials and Methods: A total of 25 non-diabetics with CKD (Group-I) and 25 diabetics with CKD (Group-II) were included in the study. Cystatin C and glucose were estimated in the serum sample. Latex-enhanced immunoturbidimetric assay method was used for the estimation of serum cystatin-C. Random blood glucose was estimated using glucose oxidase-peroxidase method. Student’s t-test was used for comparison between CKD with non-diabetics and CKD with diabetics by SPSS statistical package version 20.0. “P” < 0.05 was considered as statistically significant. The results of the two groups are expressed as Mean ± SD. Results: Serum cystatin-C levels were significantly increased (P < 0.001) in Group-I when compared to Group-II. There was a significant negative correlation (r = –0.447, P < 0.001) between serum cystatin C and estimating glomerular filtration rate was observed, which indicates that there is a possibility of renal damage in non-diabetic subjects. Conclusion: Cystatin C can be used as a good alternative marker compared to creatinine for assessing severe kidney damage.

Elevated Cystatin-C Levels Are Associated with Increased Mortality in Acute Coronary Syndrome Patients: An HIJ-PROPER Sub-Analysis

Background and Aims: We investigated the association between serum cystatin-C (Cys-C) levels and cardiovascular events in patients with acute coronary syndrome (ACS). Methods: Data of 1,100 patients from the prospective parent study were included. Patients hospitalized for ACS were divided into 4 groups based on quartiles (Q) of Cys-C levels (mg/L) within 24 h of admission: Q1, ≤0.82; Q2, 0.82 < estimated level ≤0.95; Q3, 0.95< estimated level ≤1.12; and Q4, >1.12. The primary endpoint of this study was all-cause mortality, and the secondary endpoint was composite of all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, unstable angina pectoris, or ischemia-driven revascularization. Results: During a median observation period of 4.0 years, the primary endpoint was noted in 5, 12, 18, and 36 patients in Q1–Q4, respectively, with corresponding incidence rates of 1.8%, 4.4%, 6.5%, and 13.5%, respectively (p < 0.0001 for difference among 4 groups). This association persisted even after adjusting for patient characteristics and other laboratory results at baseline (p = 0.04). A stepwise increase in the incidence rate of the secondary endpoint with an incline in Cys-C levels was observed in the nonadjusted model (26.6%, 33.3%, 32.3%, and 39.1% in Q1–Q4, respectively; p = 0.01) but not in the adjusted model (p = 0.3). No difference was observed in the incidence rate of nonfatal myocardial infarction (p = 0.89), nonfatal stroke (p = 0.3), unstable angina pectoris (p = 0.49), and ischemia-driven revascularization (p = 0.47) with an incline in Cys-C levels. Conclusion: Elevated Cys-C levels were associated with increased all-cause mortality but not cardiovascular events other than mortality in ACS patients.

Serum Cystatin C in Chronic Kidney Disease: A Case-Control Study

Background: Chronic kidney disease (CKD) is a major public health concern in recent years mainly due to its adverse clinical outcomes. It is most commonly attributed to diabetes mellitus (DM) and hypertension (HTN). Among the several novel biomarkers discovered to detect impaired renal function, serum cystatin C (SCysC) has gained importance. Objectives: The aim of the study was to compare SCysC and serum creatinine (SCr) in CKD subjects and apparently healthy controls. Methods: This case-control study comprising of 120 diagnosed cases of CKD and 40 controls was conducted at a tertiary care hospital. SCr and SCysC levels were estimated using modified Jaffe’s method and particle enhanced immunoturbidimetric method, respectively. Estimated glomerular filtration rate (eGFR) was calculated using CKD EPI formula. Comparison of SCr and SCysC between cases and controls was done using Mann Whitney U test. Pearson’s correlation test was used to study the correlation between variables. Statistical significance was considered at P&lt;0.05. Results: Both SCr and SCysC levels were higher in cases compared to controls (P&lt;0.001). In the group comprising of Stage 1 and Stage 2 CKD subjects, all the subjects showed normal SCr levels, while 96.8% of the subjects showed elevated SCysC levels. SCysC (r=-0.800) showed better correlation than SCr (r=-0.724) with eGFR (P&lt;0.001). A strong correlation was found between SCysC and SCr levels (r=-0.887, P&lt;0.001). Conclusion: SCysC is a good indicator of renal dysfunction and may be used to screen patients with long duration of DM or HTN for CKD.

Analysis Of Serum Cystatin C Levels In People With Type 2 Diabetes Mellitus As A Biomarker Of Early Detection Of Atherosclerosis

Type 2 diabetes mellitus (DMT2) is associated with atherosclerosis, which causes the disease. cardiovascular and increased mortality. It is still difficult to detect ateroskelerosis in the early stages. Arterial stenosis often develops without symptoms in patients. DMT2, then causes cardiovascular disease. Therefore, development diagnostics to easily detect early-stage atherosclerosis are needed. In this study, we focused on cystatin C serum, an inhibitor of cysteine proteinase. Some research results, it has reported a significant correlation between serum Cystatin C levels and Arterial stiffness in a group of normal individuals. Cystatin C serum has a correlation strong with a value of elasticity of the carotid artery walls that reflect the degree of atherosclerosis subclinical. This is a new sign that is quite potential as a biomarker of early detection atherosclerosis. The purpose of the study is to know the picture serum Cystatin C levels as an early marker to determine the presence of possible complications of atherosclerosis in DMT2 patients, as well as the usefulness of Cystatin-C in predicting atherosclerosis of the early stages. Research methods are analytical research with use cross-sectional design. The study was conducted by calculating the value of Cystatin C blood serum with DMT2. The study subjects were people with DMT2 in RSUD.Labuang Baji Makassarand its network. Sum the sample in this study was 20 people. Determination of the research subject is done by conducting a search on medical records of DMT2 patients who meet the criteria of inclusion and exclusion to achieve minimum number of samples. The study subjects were classified into two groups based on medical record data searches are subclinical atherosclerosis group and nonclinical group ateroskelorosis. The research sample is a serum sample. Serum sample examination is carried out in the Clinical Prodia Laboratory using PENIA method. The results of this study reported the results that Cystatin-C Serum is closely correlated with subclinical atherosclerosis (arterial stiffness. Increase in serum cystatin-C levels indicates the risk of atherosclerosis in Patients with DMT2. The results of this study reported that serum cystatin C levels in dmt2 patients in the nonclinical atherosclerosis group (n = 10) showed normal cystatin levels (0.50 - 0.96 mg/L), while serum Cystatin-C levels in dmt2 group patients showed normal cystatin levels (0.50 - 0.96 mg/L), while serum cystatin-C levels in DMT2 group patients Subclinical atherosclerosis (n = 10) has an increase in serum cystatin-C levels (&gt; 0.90 mg/L). Level cystatin C serum is associated with SA in DMT2 patients. Cystatin C was identified as a predictor of atherosclerosis risk, after adjusting for a variety of factors associated with diabetes.

Relationship between serum cystatin-c and coronary lesion severity in coronary artery disease patients with a normal glomerular filtration rate.

ObjectiveCardiovascular disease is a major cause of death. This study evaluated the relationship between serum cystatin-c and coronary lesion severity in coronary artery disease (CAD) patients with a normal glomerular filtration rate.MethodsNine hundred and fifty-nine patients were retrospectively included and divided into non-CAD and CAD groups according to coronary angiography results. CAD patients were classified into three groups by Gensini score tertiles. Multivariable logistic regression was used to study the relationship between serum cystatin-c and coronary lesion severity.ResultsSerum cystatin-c levels were significantly higher in CAD patients than in non-CAD patients. Correlation analysis revealed significant correlations between serum cystatin-c levels with the Gensini score and the number of diseased vessels. The area under the receiver operating characteristic curve of serum cystatin-c was 0.544 and 0.555 for predicting a high Gensini score and three-vessel disease, respectively. Multivariate stepwise regression analysis demonstrated that the serum cystatin-c level was an independent predictor of a high Gensini score [odds ratio (OR) = 2.177, 95% confidence interval (CI) 1.140–3.930] and three-vessel disease (OR = 1.845, 95% CI 0.994–3.424) after adjusting for the conventional CAD risk factors.ConclusionsSerum cystatin-c was elevated in CAD patients and may be an independent predictor of CAD severity.

Metabolic syndrome in women with and without interstitial cystitis/bladder pain syndrome.

The aim of this study was to compare the frequency of metabolic syndrome (MetS) in patients with and without interstitial cystitis/bladder pain syndrome (IC/BPS). This case-control study evaluated the indicators of MetS in 287 females with IC/BPS and in 287 females without IC/BPS in West China Hospital between January 2010 and January 2020. Then, the number of voids per day, frequency of night urination, O'Leary-Sant Interstitial Cystitis Symptom/Problem Index, and visual analog scale were examined in the two groups. Based on both the National Cholesterol Education Program Adult Treatment Panel III recommendations and the International Diabetes Federation criteria, the distribution of MetS was statistically higher in patients with IC/BPS than in the control group, with 34.8% vs 17.8% (P < 0.0001) and 34.2% vs 20.9% (P = 0.0005), respectively. Regarding symptom scores, the IC/BPS group demonstrated significantly higher scores than the control group in all aspects (P < 0.0001). More patients with anxiety (P < 0.0001), insomnia (P < 0.0001), hypertension (P = 0.0001), and diabetes mellitus (P = 0.017) were observed in the IC/BPS group. Moreover, the findings indicated that patients with IC/BPS had a higher BMI (P = 0.0001) and larger waist circumference (P = 0.0001). Blood tests presented a significantly higher level of fasting glycemia, serum cystatin-C, and triglycerides in patients with IC/BPS. Furthermore, higher ORs for the occurrence of MetS among cases were observed, although this was not statistically significant. MetS frequency was relatively high in patients with IC/BPS. Further research is needed to understand the common pathophysiologic mechanism of IC/BPS and MetS.

Impact of comorbidity on the predictive value of cystatin-C in patients admitted for acute decompensated heart failure: insights from a prospective study

Abstract Background Comorbidities are strongly associated with poor clinical outcome in heart failure patients. The Age-adjusted Charlson comorbidity index (ACCI), which is well-known widely used comorbidity index, recently has been used as a robust prognostic model in heart failure patients. On the other hand, Cystatin C, as a novel and important biomarker of renal function, has been recently reported as a useful long-term risk stratification score in heart failure patients. However, there is no information available on the impact of comorbidities on the prognostic value of cystatin-C in patients admitted for acute decompensated heart failure (ADHF). Methods We prospectively studied 458 consecutive ADHF patients with survival discharge. Patients with hemodialysis were excluded. Echocardiography and venous blood sampling were performed just before discharge and serum cystatin-C level was measured. Comorbidity was measured with the Age-adjusted Charlson comorbidity index (ACCI). ACCI was commonly used for the evaluation of the comorbid condition which is weighted and scored, with additional points added for age. The endpoint was all-cause death (ACD). Results During a follow-up period of 2.8±1.5 years, 132 patients had ACD. At multivariate Cox analysis, ACCI (p=0.0015) and cystatin-C level (p=0.0145) were significantly and independently associated with ACD. Patients with high ACCI (≥6: determined by ROC analysis) had a significantly greater risk of ACD (37.2% vs 17.8%, p&amp;lt;0.0001, HR 2.45 [1.61–3.70]). In the subgroup of higher ACCI, patients with higher cystatin-C level (≥1.56: determined by ROC analysis) had a significantly higher risk of ACD (50.3% vs 23.4%). Furthermore, in the subgroup of lower ACCI, patients with higher cystatin-C level had also significantly higher risk of ACD (34.2% vs 12.1%). Conclusions The prognostic value of cystatin-C is not affected by comorbidities and cystatin-C provide prognostic information even in patients admitted for ADHF, irrespective of comorbid burden. All-cause death-free rate in ADHF pts Funding Acknowledgement Type of funding source: None

Evaluation of the effect of serum cystatin-C and ACE I/D and ACE G2350A polymorphisms on kidney function among hypertensive sewage workers.

Cadmium (Cd) as nephrotoxicant metal exerts its potent effect mainly on renal tubules disturbing its functions. A cross-sectional study was conducted on 55 sewage workers occupationally exposed to Cd and 50 control subjects. The study aimed to assess the effect of low-level Cd exposure on blood pressure and renal function in terms of serum cystatin-C levels. The associations between genetic polymorphisms of ACEI/D and ACE G2350A and hypertension and tubular injury among workers were studied. We analyzed blood and urine Cd concentration (U-Cd), serum cystatin-C, ACE I/D polymorphisms, and ACE G2350A, and blood pressure was measured. Results recorded a significant rise in serum and U-Cd and cystatin-C levels in sewage workers compared with controls. Significant distribution in genotype frequency of ACE I/D and ACE G2350A gene was detected. An association in DD genotype of ACE I/D with a rise in serum and U-Cd was observed in workers. In wild type genotype GG of ACE G2350A gene, a significant rise in serum cystatin-C levels and diastolic pressure was found while in heterozygote genotype GA significant rise in U-Cd levels was detected. Also, the association of AA genotype of ACE G2350A gene with a significant rise in serum and U-Cd and cystatin-C levels was shown among workers compared with control groups. Our findings indicated an association of ACE DD polymorphism in conjugation with GG genotype of ACE2 with hypertension and tubular injury in sewage workers.

Association of cathepsin B and cystatin C with an age-related pulmonary subclinical state in a healthy Chinese population.

Background:Cathepsin B (CTSB) and cystatin C (CYSC) are new biomarkers for several physiological and pathological processes as their activities increase with age. The aim of this study was to explore population-level associations between serum CTSB and CYSC with an age-related pulmonary subclinical state.Methods:We examined 401 healthy participants (aged 36–87 years, of which 44.3% were male) in northern Chinese cities. We used a standard spirometer to determine lung function. Serum CTSB and CYSC levels were measured by enzyme-linked immunosorbent assay (ELISA).Results:For all participants, serum CTSB was related to maximum vital capacity (VC MAX), forced vital capacity (FVC), forced expiratory volume in 1 s, peak expiratory flow, forced expiratory flow at 25% of FVC, forced expiratory volume in 3 s (FEV3), and inspiratory vital capacity (VC IN). These associations were lost after full adjustment. CYSC remained significantly associated with inspiratory capacity (IC), breath frequency (BF; p < 0.001), minute ventilation (MV), the ratio of FEV3 and FVC (FEV3%FVC), and expiratory reserve volume (p < 0.05) after adjusting for all other possible confounders. In males, serum CYSC levels exhibited significant and independent associations with FVC, FEV3 (p < 0.05), and IC (p < 0.001) and serum CTSB levels exhibited significant and independent associations with BF (p < 0.05).Conclusions:Our results confirmed serum CYSC concentration associations with an age-related lung function in healthy people. However, the association between serum CTSB and lung function was not well confirmed. Serum measurements of CYSC may provide valuable predictors of pulmonary function in healthy people, especially healthy elderly adults.The reviews of this paper are available via the supplemental material section.

Serum cystatin-c as predictive factor of preeclampsia: A meta-analysis of 27 observational studies.

Serum cystatin-c is a protein that is filtered freely through the glomerulus and reabsorbed and degraded by proximal tubular cells and can be used as a biomarker of renal function. Its levels rise during the third trimester and decrease in the postpartum period. The purpose of the present meta-analysis is to assess the performance of serum cystatin-c for the prediction of preeclampsia. We used the Medline, Scopus, Clinicaltrials.gov, EMBASE, Cochrane Central Register of Controlled Trials CENTRAL and Google Scholar. We selected all observational studies (both prospective and retrospective) that investigated the accuracy of cystatin-c in predicting preeclampsia. Statistical meta-analysis was performed with the RevMan 5.3 and Stata/IC 13.0 software, using hierarchical models to develop the SROC curve. The quantitative synthesis was based in 27 studies with a total number of 2,320 women. Serum cystatin-c levels were higher in preeclamptic women compared to healthy pregnant controls (MD: 0.40 mg/l, 95% CI [0.33, 0.46]). The pooled sensitivity of serum cystatin-c for the prediction of preeclampsia was 0.85 (95% CI [0.79-0.89]) and the pooled specificity 0.84 (95% CI [0.77-0.90]. Fagan's nomogram indicated that the post-test probability increased to 14% (positive test) and decreased to 1% (negative test), when the pre-test probability was set at 3%. According to the findings of our study serum cystatin-c seems to be a promising biomarker for the detection of preeclampsia during the third trimester of pregnancy. Therefore, its implementation in future predictive models in the field is recommended.

Serum Sistatin-C Düzeyleri Diyastolik Kalp Yetmezliğinde Öngördürücü Olabilir

Özet :Amaç: Önceden diyastolik kalp yetmezliği sistolik kalp yetmezliğinin gibi değerlendirilirken günümüzde bunların birbirinden ayrı patofizyolojik mekanizmalarla ilerlediği bilinmektedir. Biz bu çalışmada serum Sistatin C konsantrasyonu ile kalbin diyastolik fonksiyonları arasındaki ilişkiyi göstermeyi denedik. Yöntem: Bu çalısmaya Mayıs 2010 ve Eylül 2010 tarihleri arasında Düzce Universitesi Tıp Fakültesi Hastanesi Kardiyoloji polikliniğine başvuran bireyler dahil edildi. Deneklerin diyastolik parametreleri değerlendirildi ve Sistatin C düzeyleri çalışıldı.Denekler diyastolik fonksiyonlarına göre normal ,grade 1, grade 2 olarak üç gruba ayrıldı ve serum sistain-c düzeyi ile bu gruplar arasında ilişki araştırıldı. Bulgular: Bu çalışmada, Grade I ve Grade II diyastolik disfonksiyonu olan denekler ile diyastolik fonksiyonu olmayan denekler serum Sistatin C seviyelerine göre karşılaştırıldı. Diyastolik disfonksiyon olan gruplarda Sistatin C düzeyinde anlamlı düzeyde artmış olduğu gösterildi (normal -grade 1:p&amp;lt;0,0001,Normal-grade 2: P&amp;lt;0,004). Sistatin C değeri için cutof değerini 0,997 ng/ml olarak bulduk. Bu noktada sistatin C nin diyastolik disfonsiyonu göstermede spesifitesi % 80, sensitivitesi % 78.95 bulundu . Sonuç: Serum sistain C düzeyi diyastolik disfonksiyonun erken tespitinde ve takibinde faydalı olabilir.Abstract:Aim: Formerly diastolic heart failure eveluated as sistolic heart failure but nowadays we know their distinc patophisyolojical mechanism.In this study we tried to Show the relations between diastolic dysfunction and serum cyctatin C consantrations. Methods : We included the individuals who admitted to cardiology clinic of Düzce University Medical Faculty between May 2010 and September 2010. We evaluate the serum cystatin C consantrations and diastolic dysfunction among 88 person. we evoluated the diastolic parameters with 2D echocardiography , TDI and PW doppler mesuraments.The 88 study participants were categorized according to their diastolic parameters into three groups normal ,grade 1 and grade 2. We made cystatistical analysis in each groups and parameters. Results: İn this study the participants who has grade 1 and grade 2 diastolic disfunction were compaired with normal participants (who has normal Diastolic function) according to their serum cycstatin C consentrations.We shown the sytatisticly significant incrise of serum cycstatin C levels in the group of diastolic disfunction Grade 1 and Grade 2.(nomal-grade 1:p&amp;lt;0,0001,normal-grade 2:p&amp;lt;0,004). And we find that the cut off ratio for Cystatin C was 0,997 ng/ml . On this point Cystatin c was %80 specific and %78.95 sensitive for diastolic disfunction. Conclusion: Serum Cystatin C levels may be useful in the early detection and monitoring of diastolic dysfunction.

Glomerular and Tubular Functions in Children and Adults with Transfusion-Dependent Thalassemia.

This study aimed at assessing renal functions in patients with transfusion-dependent thalassemia (TDT). Fifty patients and 30 controls were enrolled in this prospective study. Serum levels of electrolytes and albumin were measured by a spectrophotometer. Serum levels of cystatin-C and urinary levels of β2-microglobulin were measured by nephelometric method. Thirty-eight patients were receiving deferasirox and 8 were on deferiprone. Serum electrolytes and albumin levels of the patients were found to be within normal ranges. Urinary β2-microglobulin and serum cystatin-C levels were significantly higher in patients than controls. They did not significantly differ between the subgroup of patients on deferiprone and the control group, whereas they were found to be higher in patients using deferasirox compared to controls. Urinary β2-microglobulin levels significantly increased in patients who were receiving high-dose deferasirox compared to those who were receiving a daily dose of 15-20 mg/kg or controls. Subclinical renal injury may be present in TDT patients.

Role of serum cystatin-C and beta-2 microglobulin as early markers of renal dysfunction in children with beta thalassemia major.

BackgroundAlthough advancements have been made in the management of thalassemic patients, many unrecognized complications have emerged, such as renal abnormalities.AimTo measure serum levels of cystatin-C and β-2 microglobulin in children with beta-thalassemia major (β-TM) and investigate their significance as early markers of glomerular and tubular dysfunctions.Subjects and methodsThe study was performed on 70 children with (β-TM) and 20 apparently healthy children matched for age and sex as a control group. For all the enrolled children, a comprehensive medical history was obtained and complete physical examination was performed, blood urea, serum creatinine, serum ferritin, estimated glomerular filtration rate (eGFR) by Schwartz formula and creatinine clearance, albumin/creatinine ratio in urine, serum cystatin-C levels and β-2 microglobulin were measured.ResultsThalassemic children had significantly higher cystatin-C and β-2 microglobulin levels compared with control. In addition, serum cystatin-C and β-2 microglobulin were positively correlated with urea, creatinine, serum ferritin, albumin/creatinine ratio, duration of chelation therapy and frequency of blood transfusion/year and negatively correlated with creatinine clearance, hemoglobin, and eGFR. Our data demonstrated that cystatin-C and β-2 microglobulin had higher sensitivity and specificity (91.4%, 90.0%, and 85.7%, 100%, respectively) than serum creatinine and creatinine clearance (83.0%, 100% and 81.4%, 100%, respectively) for small changes in GFR.ConclusionCystatin-C and β-2 microglobulin are specific and sensitive early biomarkers for monitoring glomerular and tubular dysfunction in children with β-TM.

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.

BackgroundSerum 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).ObjectiveThis 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.ResultsIn 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.ConclusionsThe 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).

Association Between Serum Cystatin C and Creatinine in Chronic Kidney Disease Subjects Attending a Tertiary Health Care Centre.

Chronic Kidney Disease (CKD) is an emerging health problem due to the increasing prevalence of conditions like diabetes mellitus and hypertension. Most patients are diagnosed during the later stages of CKD when the clinical symptoms become apparent. There is a need for early diagnosis to prevent disease progression and associated morbidities. Serum Creatinine (SCr) is commonly used among clinicians to determine renal function. However, SCr is affected by several factors and cannot be entirely relied upon. In pursuit of an alternative indicator of renal function, several biomarkers have been discovered and their utility in prompt diagnosis has been evaluated. Among such biomarkers, serum cystatin C (SCysC) has been extensively studied. To determine and compare the levels of SCr and SCysC in CKD subjects across various severity groups based on estimated Glomerular Filtration Rate (eGFR). The study comprised of 120 CKD subjects. SCr was estimated by modified Jaffe's method and SCysC was estimated by particle enhanced immunoturbidimetric method. Estimated GFR (eGFR) was determined using Chronic Kidney Disease Epidemiology collaboration (CKD EPI) 2009 creatinine based formula. Based on eGFR, CKD subjects were further categorized into four groups. Statistical analysis was done using SPSS. Data were represented as median and interquartile range. Kruskal Wallis test was used for comparison between more than two groups. Correlation was done using Pearson's test. Statistical significance was considered as p <0.05. Both SCr and SCysC levels increased significantly across CKD groups (p<0.001). In CKD subjects with eGFR ≥ 60 ml/min/1.732 m2, the median value of SCr (1.01 mg/dl) was well within the normal range while median value of SCysC (1.34 mg/l) was found to be more than the upper reference limit. A positive correlation was present between SCysC and SCr (r=0.875, p<0.001). Both SCysC (r=-0.736) and SCr (r=-0.719) had a negative correlation with eGFR (p<0.001). SCysC is useful in detecting individuals with CKD having mild decrease in GFR compared to SCr. Both SCr and SCysC levels increase with decrease in eGFR. SCysC may be used to screen patients with poorly controlled diabetes mellitus or hypertension when SCr level is inconclusive.

The influence of oral cimetidine administration on creatinine clearance in chilren with chronic renal failure: A preliminary study

Background Serum creatinine and creatinine clearance are usedto assess glomerular filtration rate but have a major disadvantagesince a variable amount of creatinine is secreted in the proximaltubule. This may cause an unpredictable overestimation of GFR.Tubular creatinine secretion can be blocked by cimetidine throughcompetitive inhibition of cation transport in the proximal tubularluminal membrane.Objective Cimetidine administration might improve the reliabilityof creatinine as a marker of glomerular filtration.Methods A preliminary study with a one-group pretest-posttestdesign in 11 children with chronic renal failure. Serum cystatin Clevel as reference value was compared with creatinine clearancemeasured before and after oral ingestion of cimetidine. The doseof cimetidine was adjusted with the GFR using Schwartz formula.Statistical evaluation was done with the Wilcoxon signed rankstest.Result The mean creatinine clearance before cimetidine adminis-tration was 27.4 (SD 14.6) ml/minute/1.73 m 2 BSA, and decreasedafter cimetidine to 21.1 (SD 13,1) ml/minute/1.73 m 2 BSA (p=0.015).Conclusion Oral cimetidine was effective in inhibiting creatininetubular secretion. This study could not prove that cimetidine im-proves the accuracy of creatinine clearance

Correlation between serum cystatin-C levels and cognitive impairment

Objective To investigate the correlation between serum cystatin-C (Cys-C) levels and cognitive impairment. Methods A perspective study involving 273 patients in our hospital was performed from 2013 to 2015.They were divided into the cognitive impairment group and the control group.Cys-C measurement results and cognitive impairment assessment scores were collected.Possible influence factors were adjusted, and the correlation between Cys-C levels and mild cognitive impairment was analyzed. Results The distribution of age, hypertension, diabetes mellitus, smoking, drinking, dyslipidemia, and creatinine showed significant differences between the groups at different Cys-C levels (all P<0.05). There was a significant difference in the Cys-C level between the cognitive impairment group and the control group 〔(0.727±0.082) mg/L vs. (0.514±0.045)mg/L, t=23.68, P<0.01〕. The Cys-C level was negatively correlated with the scores of mini-mental state examination (MMSE) and Montreal cognitive assessment (MOCA) in the cognitive impairment group (r=-0.318 and -0.572, P<0.05). The incidence of cognitive impairment was elevated with increasing Cys-C levels (χ2=13.12, P<0.01). Logistic regression analysis showed that high levels of Cys-C (OR=3.298, 95% CI: 1.417-7.675, P=0.001), history of diabetes mellitus (OR=7.971, 95% CI: 3.036-31.562, P=0.03), education level (OR=2.237, 95% CI: 1.022-4.896, ), smoking (OR=5.692, 95% CI: 1.060-2.614), drinking (OR=1.227, 95% CI: 0.083-1.228), and dyslipidemia (OR=2.267, 95% CI: 1.177-4.366) are independent risk factors for cognitive impairment. Conclusions High serum cystatin C levels are closely correlated with the risk of cognitive impairment occurrence. Key words: Cysteine proteinase inhibitors; Cognitive impairment