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Al-Nasrawii, Maytham Salim, Balqees Sadoon Jasim, and Salim Hussein Hassan. "A COMPARATIVE ASSESSMENT OF SERUM CREATININE AND CYSTATIN C AS A SIGNIFICANCE OF NEPHROPATHY IN DIABETIC PATIENTS." Malaysian Journal of Public Health Medicine 20, no. 3 (December 31, 2020): 189–94. http://dx.doi.org/10.37268/mjphm/vol.20/no.3/art.527.
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The critical micro-vascular complications of diabetes ultimately result in renal dysfunction known as diabetic nephropathy (DN). Measurement of glomerular filtration rate (GFR) is considered to be an important parameter in renal function assessment, evaluating GFR by Creatinine level. Recently, Cystatin C is used as a substitute indicator in several studies to assess diabetic nephropathy. This work was conceived to determine whether serum cystatinC would replace serum creatinine (Scr) in patients with type2 diabetes for early evaluation of nephropathy. A Case-Control Study was enrolled on 30 Patients with diabetic and 30 apparently healthy as control, aged between 25 - 83 years. Levels of serum cystatine C and serum Creatinine were calculated for both groups. Serum Creatinine, as well as serum cystatin C levels, was significant relationship with diabetic pt. in compared to non-diabetic individuals. ROC analysis noted the cystatinC was more predict indicator in diagnosed Diabetic Nephropathy (DNP) from Serum Creatinine level. In Type 2 diabetics, CystatinC is a good marker for uncontrolled diabetic nephropathy relative to serum creatinine.
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Al-Nasrawii, Maytham Salim, Balqees Sadoon Jasim, and Salim Hussein Hassan. "A COMPARATIVE ASSESSMENT OF SERUM CREATININE AND CYSTATIN C AS A SIGNIFICANCE OF NEPHROPATHY IN DIABETIC PATIENTS." Malaysian Journal of Public Health Medicine 20, no. 3 (December 31, 2020): 189–94. http://dx.doi.org/10.37268/mjphm/vol.20/no.3/art.527.
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The critical micro-vascular complications of diabetes ultimately result in renal dysfunction known as diabetic nephropathy (DN). Measurement of glomerular filtration rate (GFR) is considered to be an important parameter in renal function assessment, evaluating GFR by Creatinine level. Recently, Cystatin C is used as a substitute indicator in several studies to assess diabetic nephropathy. This work was conceived to determine whether serum cystatinC would replace serum creatinine (Scr) in patients with type2 diabetes for early evaluation of nephropathy. A Case-Control Study was enrolled on 30 Patients with diabetic and 30 apparently healthy as control, aged between 25 - 83 years. Levels of serum cystatine C and serum Creatinine were calculated for both groups. Serum Creatinine, as well as serum cystatin C levels, was significant relationship with diabetic pt. in compared to non-diabetic individuals. ROC analysis noted the cystatinC was more predict indicator in diagnosed Diabetic Nephropathy (DNP) from Serum Creatinine level. In Type 2 diabetics, CystatinC is a good marker for uncontrolled diabetic nephropathy relative to serum creatinine.
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., Pusparini. "PERBANDINGAN CYSTATIN C DENGAN PARAMETER UJI FUNGSI GINJAL LAINNYA." INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY 14, no. 1 (March 15, 2018): 16. http://dx.doi.org/10.24293/ijcpml.v14i1.919.
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The Gold standard for the evaluation of the glomerular filtration rate (GFR) is inulin clearance, but in widespread use is prevented by several technical difficulties. The most commonly used marker for GFR is serum creatinine alone or in conjunction with 24 hoururine collection for determination of creatinine clearance, but these marker have several limitation include following: influence of age,sex, muscle mass on endogenous creatinine production, dietary intake and the difficulties of 24 hour urine collection. Fifty six patientwith chronic renal failure and 53 control had analyze for serum creatinin, creatinine clearance and serum cystatin C. The chronic renalfailure patient aged range from (64 + 14.54) year and the control group aged range from (62.5+ 17.5) year. The proposed of this studywas to compare cystatin C with another parameter for renal function test. The result showed that in control group serum creatinineand creatinine clearance had influence with age, sex and body mass index, but serum cystatin C was not. The normal value of cystatinC was (0.85 + 0.13) mg/dL In chronic renal failure group there were significant correlation between level of cystatin C with creatininclearance (p = 0.000, r = 0.69). The level of cystatin C increase higher than serum creatinine in patient with low clearance creatinine.In control group we were determined low creatinine clearance in patient with normal serum creatinine and cystatin C.
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Risch, Lorenz, and Andreas R. Huber. "Serum cystatin C in transplantation." Kidney International 61, no. 4 (April 2002): 1548. http://dx.doi.org/10.1046/j.1523-1755.2002.00288.x.
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Gashenko, Elena A., V. A. Lebedeva, G. S. Russkikh, E. A. Tsykalenko, A. B. Pupyshev, I. V. Brak, and T. A. Korolenko. "PROCATHEPSIN B AND ENDOGENOUS INHIBITORS OF CYSTEINE PROTEASES IN TUMORS OF REPRODUCTIVE SYSTEM." Russian Journal of Oncology 22, no. 5 (October 15, 2017): 261–65. http://dx.doi.org/10.18821/1028-9984-2017-22-5-261-265.
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Cysteine proteases are regulated by the rate of the conversion of their inactive proforms into active forms and by specific endogenous inhibitors (cystatins), playing the important role in their regulation, especially in tumor growth and metastasis process. The content of procatepsin B, endogenous inhibitors of cysteine proteases cystatin B and cystatin C in biological fluids (blood serum, ascites fluid) in women with malignant neoplasms of the genital organs was studied. The comparative study of the concentration of procotepsin B, cystatin B and C in blood serum in practically healthy women and women with tumors of the reproductive system was carried out with the use of the enzyme immunoassay nethod. A high content of procatepsin B was shown to be found in all the study groups. The concentration of cystatin B was within the limits of significance and concentration of cystatin C was not changed in same patients in the study groups as compared with the control. The level of cystatin C in the serum was found to be correlated with the progression of the disease. In ascitic fluid (in comparison with blood serum), a sharp increase in the concentration of procatepsin B was revealed, reflecting its elevated extracellular secretion by tumor cells.
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Meinardaniawati, Dinna, Sjarif Hidajat Effendi, and Sri Endah Rahayuningsih. "Kadar Cystatin-C Serum Sebagai Penanda Fungsi Ginjal Bayi Prematur." Sari Pediatri 15, no. 1 (November 16, 2016): 17. http://dx.doi.org/10.14238/sp15.1.2013.17-22.
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Latar belakang. Cystatin-C dipertimbangkan menjadi pemeriksaan potensial pengganti kreatinin serum sebagai penanda fungsi ginjal. Kadar cystatin-C serum lebih mendekati nilai laju filtrasi glomerulus dibandingkan dengan kreatinin serum. Beberapa penelitian menyatakan bahwa cystatin-C dipengaruhi oleh jenis kelamin, usia, dan ras meskipun tidak sebesar pengaruhnya terhadap kreatinin.Tujuan. Menganalisis korelasi kadar cystatin-C serum dengan kreatinin serum dan apakah kadar cystatin-C serum dapat digunakan sebagai penanda fungsi ginjal bayi prematur.Metode. Penelitian observasional analitik, cross-sectional, dilaksanakan Februari−Mei 2012. Subjek adalah bayi prematur usia kehamilan 32–<37 minggu, lahir di Rumah Sakit Dr. Hasan Sadikin Bandung, RSUD Cibabat Cimahi, dan RSUD Bandung. Dilakukan pemeriksaan kadar cystatin-C serum dengan metode particle-enhanced immunonephelometry dan kreatinin serum dengan metode Jaffe. Uji statistik menggunakan korelasi Pearson, kemaknaan berdasarkan nilai p<0,05.Hasil. Terdapat 37 subjek bayi prematur, 23/37 subjek dilahirkan spontan dengan perbandingan jenis kelamin hampir sama. Kadar cystatin-C dan kreatinin serum rerata adalah 1,68 mg/L (IK 95%; 1,32–2,09) dan 0,99 mg/dL (IK 95%; 0,62–1,48). Hasil analisis mendapatkan korelasi bermakna kadar cystatin-C dengan kreatinin serum (r=0,621; p<0,001).Kesimpulan. Semakin tinggi kadar kreatinin serum, maka semakin tinggi kadar cystatin-C serum. Cystatin-C dipertimbangkan sebagai penanda untuk menilai fungsi ginjal bayi prematur.
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Elliyanti, Aisyah, Iskandar Iskandar, and Syaiful Azmi. "CORRELATION OF RENOGRAM WITH CYSTATIN-C LEVELS AND CREATININE CLEARANCE IN MEASURING GLOMERULAR FILTRATION RATE." Majalah Kedokteran Andalas 38, no. 1 (May 20, 2015): 1. http://dx.doi.org/10.22338/mka.v38.i1.p1-6.2015.
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AbstrakRenogram 99mTc-DTPA (diethylenetriamine pentacetic acid) memiliki beberapa kelebihan dalam mengukur laju filtrasi glomerulus (LFG). Cystatin-c digunakan sebagai petanda biologik baru untuk memperkirakan LFG. Tujuan penelitian ini adalah untuk menentukan korelasi nilai LFG antara renogram dengan cystatin-c dan kliren kreatinin pada pasien dengan penyakit ginjal kronis (PGK). Subjek penelitian adalah pasien PGK stadium dua berdasarkan hasil estimasi LFG dengan rumus Cockroft-Gault. Pasien yang memenuhi kriteria diperiksa renogram, kadar kreatinin serum, cystatin-c dan klirens kreatinin.Rerata LFG dari 30 orang subjek yang diperiksa dengan renogram, cystatin-c, creatinine clearance, Cockroft-Gault’s formula berturut turut adalah 64.96 ml/min/1.73m2 (SD 28.047), 53.37 ml/min/1.73m2 (SD 21.29), 58.09 ml/min/1.73m2 (SD 35.45), 46.00 ml/min/1.73m2 (SD 12.06). Korelasi antara renogram dengan cystatin-c dengan nilai r = 0.585 dan p = 0.0007, antara renogram dengan klirens kreatinin dengan nilai r = 0.388 dan p = 0.03) dan antara renogram dengan rumus Cockroft-Gault’s dengan nilai r = -0.029 dan p=0.87. Pada penelitian ini didapatkan hasil korelasi yang lebih baik antara renogram dengan cystatin-c dari pada antara renogram dengan klirens kreatinin dan antara renogram dengan rumus Cockroft-Gault’s. Lebih lanjut, cystain-c merupakan alternatif yang lebih baik untuk memperkirakan LFG jika metode pemeriksaan LFG yang mendekati teknik pemeriksaan yang ideal tidak tersedia.AbstractRenogram using 99mTc-DTPA (diethylenetriamine pentacetic acid) has advantages in the measurement of glomerular filtration rate (GFR). Serum cystatin-c was recently projected to be the new marker of estimated GFR. The aim of this study is to establish correlation between GFRs, derived from renogram with cystatin-c levels and creatinine clearances in chronic kidney disease patients.We put to study thirty consecutive stage two of chronic kidney disease patients assigned based on GFR estimation by Cockroft-Gault’s formula, taking into account the serum creatinine. Cystatin-c and creatinine clearance were performed to determine of GFR and renogram was included in this study. A total of thirty subjects, the mean of GFRs were taken from renogram, cystatin-c, creatinine clearance, Cockroft-Gault’s formula were 64.96 ml/min/1.73m2 (SD 28.047), 53.37 ml/min/1.73m2 (SD 21.29), 58.09 ml/min/1.73m2 (SD 35.45), 46.00 ml/min/1.73m2 (SD 12.06) respectively. A correlation between renogram with cystatin-c (r = 0.585 and p = 0.0007) and renogram with creatinine clearance (r = 0.388 and p = 0.03) and renogram with Cockroft-Gault’s formula (r = -0.029 and p=0.87). This study has shown that a better correlation between renogram with cystatin-c than with creatinine clearance or Cockroft-Gault’s formula. Furthermore, cystain-c would be better alternative method incase having problems to obtain a closest ideal methods for GFR.
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Čabarkapa, Velibor, Zoran Stošić, Mirjana Đerić, Ljiljana Vučurević-Ristić, Radmila Žeravica, and Branislava Ilinčić. "Serum Cystatin C in Estimating Glomerular Filtration Rate." Journal of Medical Biochemistry 27, no. 1 (January 1, 2008): 46–51. http://dx.doi.org/10.2478/v10011-007-0042-4.
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Serum Cystatin C in Estimating Glomerular Filtration RateUsing serum cystatin C in estimating glomerular filtration rate (GFR) has in recent times been recommended. A number of simple formulas for calculating GFR have been derived specifically from serum cystatin C concentrations. The purpose of this study was to assess the significance of cystatin C and of the two most frequently applied of these formulas in estimating glomerular filtration rate compared to serum creatinine and its derived formulas for estimating glomerular filtration rate from creatinine concentrations. The study included 74 patients: 59 were in various stages of chronic renal insufficiency (divided into two subgroups: I with GFR ≥ 60 mL/min/1.73m2and II with GFR<60 mL/min/1.73m2) and 15 on hemodialysis. A control group of 30 healthy participants was also included in the study. Serum values of cystatin C ranged from: 0.86 ± 0.16 mg/L in subgroup I, and 1.77 ± 0.79 mg/L in subgroup II, to 6.9 ± 1.83 mg/L in patients on hemodialysis. The correlation between the two formulas derived from cystatin C and the clearance of creatinine, as well as the Cockcroft and Gault's formula, was significant, while one of the formulas derived from cystatin C did not show a significant correlation with MDRD. It was concluded that serum cystatin C is a significant marker in estimating glomerular filtration rate, especially in the advanced stages of chronic renal insufficiency.
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Alvarez, Ofelia A., Dale Wright, Gabriela Lopez, and Gaston Zilleruelo. "Serum Cystatin C Is a Better Marker for Renal Function Than Serum Creatinine in Children with Sickle Cell Disease." Blood 106, no. 11 (November 16, 2005): 3774. http://dx.doi.org/10.1182/blood.v106.11.3774.3774.
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Abstract High serum creatinine is a late manifestation for patients (pts) with sickle cell disease (SCD) who develop severe renal dysfunction, because creatinine is secreted by the renal tubules. Serum cystatin C is a cysteine proteinase inhibitor, that is produced by all nucleated cells in the body, does not undergo tubular secretion, and reflects glomerular filtration rate (GFR)accurately. Normal levels for serum cystatin C are 0.5–1.3 mg/L for children 1–17 years, and 0.5–1 mg/L for adults. The purpose of this study was to compare serum cystatin C and serum creatinine as markers of GFR in children with SCD with different levels of albuminuria. Twenty pts (mean age 16.4, range 9–21 years) had serum creatinine, serum cystatin, and 24-hour urine for creatinine clearance. Pts with normoalbuminuria (N=11) had mean serum creatinine of 0.55±0.14 mg/L, creatinine clearance of 168±36 ml/min/1.73m2, normal serum cystatin C 0.78±0.16 mg/L, and normal estimated GFR derived from cystatin of 106±27 ml/min/1.73m2. In contrast, pts with proteinuria (N=4) had higher or abnormal serum cystatin C (mean 1.25 ±0.34, range 0.9–1.7 mg/L) and reduced estimated GFR (mean 59±21, range 35–85) consistent with poor kidney function; nevertheless, the serum creatinine (0.7±0.2) and creatinine clearance remained normal (125±27). Pts with only microalbuminuria (N=5) maintained normal levels of cystatin C and estimated GFR by cystatin. We conclude that serum cystatin C discriminated better for kidney dysfunction than serum creatinine and creatinine clearance with significantly different values between patients with normoalbuminuria and macroalbuminuria (p=0.038). More studies are warranted in order to investigate further the value of serum cystatin C in the monitoring of patients with SCD and albuminuria.
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Ogawa, Yoshiji, Takashi Goto, Naoki Tamasawa, Jun Matsui, Yusuke Tando, Kazuhiro Sugimoto, Ken Tomotsune, Masahiko Kimura, Minoru Yasujima, and Toshihiro Suda. "Serum cystatin C in diabetic patients." Diabetes Research and Clinical Practice 79, no. 2 (February 2008): 357–61. http://dx.doi.org/10.1016/j.diabres.2007.09.016.
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Chen, Zhenfei, Jing Zhang, Jun Feng, Gaoliang Zhou, Xiaoqin Jin, and Jianyuan Pan. "Higher serum level of Cystatin C." Medicine 100, no. 2 (January 15, 2021): e24269. http://dx.doi.org/10.1097/md.0000000000024269.
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DOMEJ, Wolfgang, Gernot Peter TILZ, Zeno FÖLDES-PAPP, Ulrike DEMEL, Thomas RABOLD, and Herwig HOLZER. "Cystatin C of pleural effusion as a novel diagnostic aid in pleural diseases of different aetiologies." Clinical Science 102, no. 3 (February 14, 2002): 373–80. http://dx.doi.org/10.1042/cs1020373.
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There has been considerable recent interest in the potential use of serum cystatin C as a diagnostic tool. Here we examined the hypothesis that the cystatin C level in the pleural effusion can differ from the corresponding serum level. We evacuated pleural effusion fluids from 47 patients by thoracentesis. Cystatin C, β2-microglobulin, inorganic phosphate, creatinine and total protein were quantified in both pleural effusion fluids and corresponding sera. We determined cystatin C levels in pleural effusions and calculated the ratio of cystatin C levels in serum and effusion, to discriminate between effusions caused by severe renal impairment and other types of effusion. Extremely high concentrations of cystatin C in serum/effusion pairs were only measured in patients with renal failure (6.0±0.8/6.0±0.8mg/l, means±S.D., n = 11). A clearly defined region was found to correspond to pleural effusion caused by renal failure (r = 0.954). The quantification of cystatin C in the effusion was justified by the discovery that there were some patients with a high serum cystatin C level but a low effusion concentration, or a low serum cystatin C but a high effusion concentration, indicating causes other than renal failure. In conclusion, the pilot data indicate a relationship between the cystatin C concentration in pleural fluid and the underlying disease. Thus cystatin C levels in pleural effusion and serum may be a valuable criterion for the differential diagnosis of pleural diseases of different aetiologies.
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Yuri, Yuri, Praisilia Riani Najoan, Stefanus Gunawan, and Adrian Umboh. "Lead poisoning and cystatin-C in children." Paediatrica Indonesiana 55, no. 5 (October 1, 2015): 252. http://dx.doi.org/10.14238/pi55.5.2015.252-6.
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Background Lead pollution is a global problem both in developed and developing countries. Lead poisoning is associated with decreased glomerular filtration rate (GFR) and is a risk factor for acute kidney injury (AKI). Serum cystatin-C is a more precise test of GFR than serum creatinine level, as serum cystatin-C levels rise earlier than serum creatinine, when GFR decreases. Objective To assess for a possible correlation between lead poisoning and cystatin-C levels in children. Methods We conducted a cross-sectional study in children aged 6-11 years with a history of lead poisoning from elementary schools in Talawaan District, North Minahasa Regency from July to October 2013. Cystatin-C and blood lead levels (BLL) were measured in all subjects. Spearman’s rho test was used to analyze a potential correlation between BLL and cystatin-C level. Results This study included 41 children, comprising 21 boys and 20 girls. Their median age was 8.50 (range 6.8-10.7) years. Elevated levels of cystatin-C did not exceed normal values, however, we found a positive correlation between BLL and cystatin C (r=0.419, P=0.006). Conclusion There is a positive correlation between BLL and cystatin C level in children with lead poisoning. Regular monitoring of BLL, medical intervention, and an epidemiological study to help find the sources of contamination are needed for children with lead poisoning.
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Bevc, Sebastjan, Radovan Hojs, Robert Ekart, Matej Završnik, Maksimiljan Gorenjak, and Ludvik Puklavec. "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): 1–8. http://dx.doi.org/10.1155/2012/179849.
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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.
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Shima, TS, A. Khatun, F. Yeasmin, S. Ferdousi, K. Kirtania, and N. Sultana. "Cystatin C: A Better Predictor of Kidney Function in Diabetic Patients." Bangladesh Journal of Medical Biochemistry 4, no. 1 (February 13, 2013): 16–20. http://dx.doi.org/10.3329/bjmb.v4i1.13777.
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Serum cystatin C is a new promising marker of renal function. The aim of this study was to analyze serum cystatin C as a better predictor of renal function in diabetic nephropathy. In 60 diagnosed diabetic patients, serum cystatin C and serum creatinine were assessed. Glomerular filtration rate was estimated based on the cystatin C concentration according to Cockcroft- Gault formula and based on serum creatinine concentration according to Larsson formula. DTPA-GFR (Diethylenetriamene pentaacetate Renogram) was done as reference standard. The cross tabulation of DTPA-GFR was done with eGFR- creatinine and eGFRcystatin C. The calculated sensitivity, specificity and accuracy of eGFR- creatinine were 85%, 87.2% and 85% respectively. The eGFR- cystatin C showed higher sensitivity, specificity and accuracy than eGFR- creatinine in studied diabetic subjects. The cystatin C showed more significant correlation, r=0.78, p<0.001 than serum creatinine, r=0.59, p<0.001 with DTPA-GFR in diabetic patients. This study demonstrates that serum cystatin C may be used for early prediction for renal function impairment in diabetic kidney disease. DOI: http://dx.doi.org/10.3329/bjmb.v4i1.13777 Bangladesh J Med Biochem 2011; 4(1): 16-20
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Cavalcanti, Ernesta, Vittoria Barchiesi, Dionigio Cerasuolo, Flaviano Di Paola, Monica Cantile, Sabrina Chiara Cecere, Sandro Pignata, et al. "Correlation of Serum Cystatin C with Glomerular Filtration Rate in Patients Receiving Platinum-Based Chemotherapy." Analytical Cellular Pathology 2016 (2016): 1–5. http://dx.doi.org/10.1155/2016/4918325.
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Objectives. Serum cystatin C seems to be an accurate marker of glomerular filtration rate (GFR) compared to serum creatinine. The aim of this work was to explore the possibility of using serum cystatin C instead of serum creatinine to early predict renal failure in cancer patients who received platinum based chemotherapy.Design and Methods. Serum creatinine, serum cystatin C concentrations, and GFR were determined simultaneously in 52 cancer patients received carboplatin-based or cisplatin-based chemotherapy. Serum creatinine was assayed on Cobas C6000-Roche, serum cystatin C assay was performed on AIA 360-Tosoh, and GFR was determined in all patients, before the first cycle of chemotherapy and before the subsequent administrations.Results. In the overall series, for the prediction of a fall of GFR < 80 mL/min/1.73 m2, the AUC of the ROC curve for cystatin C was 0,667 and the best threshold was 1.135 mg/L (sensitivity 90.5%, specificity 61.1%). For a GFR fall < 60 mL/min/1.73 m2, the AUC of ROC curve for cystatin C was 74.3% and the best threshold was 1.415 mg/L (sensitivity 66.7%, specificity 73.2%).Conclusions. Baseline cystatin C values were not able to predict renal failure during subsequent treatment. In conclusion, serum cystatin C is not a reliable early marker to efficiently predict renal failure in patients receiving chemotherapy.
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Štabuc, Borut, Levin Vrhovec, Mirna Štabuc-Šilih, and Tomaž Edvard Cizej. "Improved Prediction of Decreased Creatinine Clearance by Serum Cystatin C: Use in Cancer Patients before and during Chemotherapy." Clinical Chemistry 46, no. 2 (February 1, 2000): 193–97. http://dx.doi.org/10.1093/clinchem/46.2.193.
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Abstract Background: Serum cystatin C, a cysteine protease inhibitor, has been suggested as a new marker of glomerular filtration rate (GFR). This study explored the possibility of replacing the creatinine clearance (CrCl) estimation of GFR with cystatin C in early detection of renal impairment in cancer patients on chemotherapy. Methods: Serum creatinine and cystatin C concentrations as well as 24-h CrCl were determined simultaneously in 72 cancer patients. Among them, 60 were treated with combined chemotherapy with cisplatin (CDDP). Creatinine was determined enzymatically with a spectrophotometric method. Serum cystatin C was determined by a particle-enhanced turbidimetric immunoassay. Results: Cystatin C and creatinine correlated significantly (P = 0.001) with CrCl. The correlation was significantly better for cystatin C than creatinine (r = 0.84 vs 0.74; P = 0.01). Stepwise regression analysis identified no differences for the correlations between cystatin C and CrCl in patients with or without metastases (r = 0.82 and 0.84, respectively) as well as before treatment and before the fourth cycle of chemotherapy (r = 0.70 and 0.75, respectively). A cystatin C cutoff concentration of 1.33 mg/L had 87% sensitivity and 100% specificity for detecting CrCl <78 mL/min. ROC analysis indicated that cystatin C was superior to serum creatinine for predicting CrCl <78 mL/min (P <0.04). Conclusions: Serum cystatin C is superior to serum creatinine for detection of decreased CrCl and potentially for the estimation of GFR in cancer patients independent of the presence of metastases or chemotherapy.
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Fleming, Susannah, Rafael Perera-Salazar, Kathryn S. Taylor, Louise Jones, FD Richard Hobbs, Tim James, Chris A. O’Callaghan, et al. "Frequency of Renal Monitoring — Creatinine and Cystatin C (FORM-2C): an observational cohort study of patients with reduced eGFR in primary care." British Journal of General Practice 71, no. 710 (May 27, 2021): e677-e684. http://dx.doi.org/10.3399/bjgp.2020.0940.
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BackgroundMonitoring is the mainstay of chronic kidney disease management in primary care; however, there is little evidence about the best way to do this.AimTo compare the effectiveness of estimated glomerular filtration rate (eGFR) derived from serum creatinine and serum cystatin C to predict renal function decline among those with a recent eGFR of 30–89 ml/min/1.73 m2.Design and settingObservational cohort study in UK primary care.MethodSerum creatinine and serum cystatin C were both measured at seven study visits over 2 years in 750 patients aged ≥18 years with an eGFR of 30–89 ml/min/1.73 m2 within the previous year. The primary outcome was change in eGFR derived from serum creatinine or serum cystatin C between 6 and 24 months.ResultsAverage change in eGFR was 0.51 ml/min/1.73 m2/year when estimated by serum creatinine and −2.35 ml/min/1.73 m2/year when estimated by serum cystatin C. The c-statistic for predicting renal decline using serum creatininederived eGFR was 0.495 (95% confidence interval [CI] = 0.471 to 0.519). The equivalent c-statistic using serum cystatin C-derived eGFR was 0.497 (95% CI = 0.468 to 0.525). Similar results were obtained when restricting analyses to those aged ≥75 or <75 years, or with eGFR ≥60 ml/min/1.73 m2. In those with eGFR <60 ml/min/1.73 m2, serum cystatin C-derived eGFR was more predictive than serum creatinine-derived eGFR for future decline in kidney function.ConclusionIn the primary analysis neither eGFR estimated from serum creatinine nor from serum cystatin C predicted future change in kidney function, partly due to small changes during 2 years. In some secondary analyses there was a suggestion that serum cystatin C was a more useful biomarker to estimate eGFR, especially in those with a baseline eGFR <60 ml/min/1.73 m2.
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Saghir, Sumera, Adnan Riaz, Aisha Hasan, Yasir Ali Bhatti, Ahmed Ashar Ghuman, and Muhammad Shakil. "Cystatin C an early marker of Glomerular dysfunction in thalassemia major." Professional Medical Journal 27, no. 02 (February 10, 2020): 300–308. http://dx.doi.org/10.29309/tpmj/2020.27.02.3566.
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Objectives: The objective of the present study is to investigate the role of cystatin C as an early marker of glomerular dysfunction in thalassemia major. Study Design: Cross sectional comparative study. Setting: Department of Biochemistry Post Graduate Medical institute with the Thalassemia Center in Sir Ganga Ram Hospital Lahore. Period: July 2017 and July 2018. Material & Methods: This study examined 90 male children all between the ages of 5-11, using non probability sampling techniques. The children were grouped as 21 healthy male children as control group I and 69 diagnosed male thalassemia major children further subdivided on the basis of serum ferritin level as group II, serum ferritin level <2500ng/ml, group III, serum ferritin level 2500-5000ng/ml and group IV serum ferritin level >5000ng/ml respectively. Individuals with hereditary renal diseases, on steroid therapy, or other co-morbid renal diseases were excluded from the study. Complete blood analysis, serum ferritin, creatinine and cystatin C were measured by Micro lab 300 and solid phase enzyme linked immune sorbent assay (ELISA) respectively. The results were compared by using SPSS version 20. Results: Group I: n=21 healthy children with ferritin between normal range 105.33 ± 30.03, serum creatinine 0.41 ± 0.05, serum cystatin C 0.57 ± 0.14. eGFR-creatinine 133.38±7.63, eGFR-cystatin C 122.9±17.63. Group II: n=20 (β-TM with ferritin <2500ng/ml). Mean ferritin was 1997.5±300.68 ng/ml (P<0.001), creatinine was 0.43± 0.05, serum cystatin C 0.66 ± 0.05 (P<0.05). eGFR-creatinine 121.45±4.89 P<0.05, eGFR-cystatin C 105.15±6.49 P<0.001. Group III: n= 25 (β-TM with ferritin 2500-5000 ng/ml). Mean ferritin level was 3850.0± 718.18 ng /ml (P<0.001), creatinine was 0.5±.07, cystatin C 0.96±0.13 (P<0.001). eGFR-creatinine 103.29±8.26(P<0.001), eGFR-cystatin C 75.75±10.67 (P<0.001). Group IV: n=24 (β-TM with ferritin >5000 ng/ml). Mean ferritin level was 6311.67±1060.61 ng/ml P value (P<0.001), creatinine was 0.57 ± 0.07, cystatin C 1.11 ± 0.09 (P<0.001). eGFR-creatinine 94.42±8.69 (P<0.001), eGFR cystatin C 64.67±4.23(P<0.001). Conclusion: A highly significant positive relation was found between serum ferritin-cystatin C as compared to creatinine among the study groups II, III and IV and significant inverse relationship between cystatin C and eGFR that concluded cystatin C as an early marker of glomerular dysfunction than creatinine in thalassaemia major children.
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Tanaka, Satoshi, Kei Ando, Kazuyoshi Kobayashi, Tetsuro Hida, Kenyu Ito, Mikito Tsushima, Masayoshi Morozumi, et al. "Utility of the Serum Cystatin C Level for Diagnosis of Osteoporosis among Middle-Aged and Elderly People." BioMed Research International 2019 (January 16, 2019): 1–6. http://dx.doi.org/10.1155/2019/5046852.
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Purpose. Osteoporosis is a common age-related disorder leading to increased bone fragility and risk of fracture. Early diagnosis of osteoporosis is a vital step in providing early therapeutic intervention. Serum cystatin C is a marker of early renal dysfunction, a predictor of cardiovascular and inflammatory diseases, and an inhibitor of the differentiation of osteoclast precursor cells. The purpose of this study was to evaluate the relationship between serum cystatin C and osteoporosis. Methods. We enrolled 46 subjects who attended a health checkup and underwent measurement of bone status by quantitative ultrasound and determination of the level of serum cystatin C. A comparative study was conducted between those with and without osteoporosis for all subjects collectively and in two subgroups aged <65 and ≥65 years. Results. Serum cystatin C levels were strongly correlated with age, creatinine, and bone status data, with significant negative correlations with stiffness, T-score, and percentage of young adult mean. Among patients with osteoporosis, serum cystatin C was significantly higher even after adjustment for age and sex, whereas no significant difference was noted in creatinine. For patients aged ≥ 65 years, serum cystatin C was significantly higher in subjects with osteoporosis, although there was no significant difference in age between normal subjects and those with osteoporosis. Conclusions. To the best of our knowledge, this is the first study to demonstrate an association between serum cystatin C and osteoporosis. Serum cystatin C is significantly higher in osteoporosis and in particular may be a useful marker for osteoporosis among middle and elderly people aged ≥ 65 years. Measurement of serum cystatin C can be carried out easily and may contribute to early diagnosis and treatment of osteoporosis.
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Ranjan, Rajeev, and Anjana Singh. "Cystatin C is a Better Marker of Renal Dysfunction in Hypertensive Pregnancies." Indian journal of Medical Biochemistry 20, no. 1 (2016): 21–27. http://dx.doi.org/10.5005/jp-journals-10054-0005.
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ABSTRACT Background Glomerular endotheliosis is an essential component in the pathophysiology of gestational hypertension (GH) and preeclampsia (PE) which results in renal dysfunction. This is not always detected by routine renal function tests, such as serum creatinine, urea, and uric acid. Cystatin C, an endogenous cysteine protease inhibitor, is completely absorbed by renal tubules and has been shown to be an ideal marker of glomerular filtration rate (GFR), which needs to be evaluated in assessing renal dysfunction occurring in GH and PE. Aims The present study is designed to evaluate serum cystatin C levels in normal pregnancy, GH, and PE and compare its efficacy with traditional renal function tests. Materials and methods In this prospective cross-sectional study, 75 subjects enrolled, comprised of 25 subjects each of normal pregnancy, GH, and PE. Serum cystatin C, blood urea, serum creatinine, serum uric acid, and urinary protein/creatinine ratio were estimated in all subjects prior to delivery. Results All renal parameters including cystatin C were significantly raised in GH and PE compared with control group. However, only serum cystatin C level (and no other renal parameters) was significantly higher in PE group compared with GH group. Area under the curve for cystatin C was maximum (0.917) compared with other parameters. Cystatin C had a higher sensitivity and specificity than other conventional markers. Conclusion Serum cystatin C is a better marker of renal dysfunction in hypertensive pregnancies. How to cite this article Singh A, Gupta M, Ranjan R, Saini V, Gupta SK. Cystatin C is a Better Marker of Renal Dysfunction in Hypertensive Pregnancies. Indian J Med Biochem 2016; 20(1):21-27.
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Teo, Boon Wee, Charumathi Sabanayagam, Jiemin Liao, Qi Chun Toh, Sharon Saw, Tien Yin Wong, and Sunil Sethi. "Comparison of CKD-EPI Cystatin C and Creatinine Glomerular Filtration Rate Estimation Equations in Asian Indians." International Journal of Nephrology 2014 (2014): 1–8. http://dx.doi.org/10.1155/2014/746497.
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Background. Chronic kidney disease (CKD) is identified in the general population using estimated glomerular filtration rates (eGFR) calculated from a serum creatinine-based equation, the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation. Using serum cystatin C in combination may improve eGFR accuracy. We evaluated the new CKD-EPI equations incorporating cystatin C in a population of Asian Indians in classifying CKD across body mass index, diabetes, and hypertension status.Methods. We retrieved standardized serum creatinine and serum cystatin C data from a cohort of 2877 Asian Indians aged 40–80 years from the Singapore Indian Eye Study and calculated eGFR (in mL/min/1.73 m2) with the new CKD-EPI equations and serum creatinine only equation.Results. The creatinine only equation mean eGFR (88 ± 17) was similar to using spline Log cystatin C (88 ± 22). The lowest mean eGFR (81 ± 21) was obtained with the spline Log cystatin C—age, sex, and weight equation. The creatinine only equation had the fewest participants (7.1%) with eGFR <60 and spline Log cystatin C—age, sex, and weight equation had the most (16.1%).Conclusions. Using serum cystatin C resulted in widely varying eGFR which significantly affected the classification of chronic kidney disease.
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Pan, Junqiang, Xifeng Sun, Pengjie Zhang, Haichao Chen, and Jing Lin. "Relationship between serum cystatin-c and coronary lesion severity in coronary artery disease patients with a normal glomerular filtration rate." Journal of International Medical Research 49, no. 1 (January 2021): 030006052098563. http://dx.doi.org/10.1177/0300060520985639.
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Objective Cardiovascular 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. Methods Nine 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. Results Serum 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. Conclusions Serum cystatin-c was elevated in CAD patients and may be an independent predictor of CAD severity.
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Jenkins, Margaret A., Douglas J. Brown, Francesco L. Ierino, and Sujiva I. Ratnaike. "Cystatin C for estimation of glomerular filtration rate in patients with spinal cord injury." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 40, no. 4 (July 1, 2003): 364–68. http://dx.doi.org/10.1258/000456303766476995.
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Background: Serum creatinine is not a satisfactory marker of glomerular filtration rate (GFR) in patients with spinal cord injury (SCI) who have varying degrees of muscle atrophy. In contrast to serum creatinine, serum cystatin C, a 13-kDa protein, is not affected by muscle mass and is therefore potentially a useful marker of GFR in patients with SCI. In addition, cystatin C is not dependent on sex or age and is not secreted by the renal tubule. Aim: We assessed serum cystatin C as a surrogate marker of GFR in SCI patients. Methods: Cystatin C was analysed using a particle-enhanced immunonephelometric assay (Dade Behring) in serum samples sent for routine measurement of creatinine (64 patients) and creatinine clearance (27 patients) from patients in the Spinal Unit of the Austin Health. We compared these results with serum cystatin C of 57 non-SCI patients who had had a creatinine clearance measurement during the study period. Results: In patients with SCI, the reciprocal of cystatin C had a stronger correlation (r = 0·48, P<0·01) with creatinine clearance than the reciprocal of serum creatinine (r = 0·25, P<0·19). Further, the value of serum creatinine was much lower for a given creatinine clearance in SCI patients than in non-SCI patients; the serum cystatin C concentrations were equivalent. Conclusion: The serum cystatin C is a convenient and more reliable surrogate marker of GFR than serum creatinine and will enable early detection of renal impairment. We need to confirm this finding with a larger study, including comparison with an accepted gold standard for GFR.
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Cabarkapa, Velibor. "Cystatin C - more than the marker of the glomerular filtration rate." Medical review 68, no. 5-6 (2015): 173–79. http://dx.doi.org/10.2298/mpns1506173c.
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Introduction. Cystatin C is one of biomarkers that meet the conditions necessary for an endogenous substance to be a marker of the glomerular filtration rate. Cystatin C - Properties. Cystatin C is produced in the nucleated cells in a constant amount, and its serum concentration does not depend on muscle mass and protein intake. The catabolism of cystatin C is mostly done in the kidneys. Determination of Cystatin C Level. Cystatin C may be determined in the serum, plasma, capillary blood and urine. The laboratory methods which are mainly used to determine its level are nephelometric and turbidimetric immunoassays. Cystatin C as a Marker of Glomerular Filtration Rate. Cystatin C is superior to creatinine as a marker of kidney function, especially in the early stages of chronic kidney disease. Several formulas are available for calculating the glomerular filtration rate from serum cystatin C. Cystatin C in Various Physiological/Pathophysiological Conditions. The level of cystatin C should be interpreted carefully because there are factors that can affect its level regardless of the renal function (thyroid dysfunction, glucocorticoids use, malignancies etc.). Higher cystatin C concentrations in general population are associated with an increased cardiovascular risk, as well as with preeclampsia in pregnant women. Conclusion. The significant advantages of cystatin C as a kidney function marker are its use in the creatinine ?blind? area, in pediatric and the elderly population. In addition, cystatin C could be used as a marker for cardiovascular risk assessment, in predicting and detecting preeclampsia, in patients with malignant diseases, etc.
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Wagner, Carola. "Cystatin C, Renal Function and Cardiovascular Risk." Journal of Medical Biochemistry 27, no. 4 (October 1, 2008): 426–31. http://dx.doi.org/10.2478/v10011-008-0021-4.
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Cystatin C, Renal Function and Cardiovascular RiskCystatin C is a novel serum marker of the glomerular filtration rate (GFR), a critical measure of normal kidney function. Unlike serum creatinine, cystatin C concentrations are independent of gender, age and muscle mass. As cystatin C shown no tubular secretion, it is a much earlier indicator of decreased GFR and allows the detection of mild reductions in GFR, which are not detected by creatinine. Cystatin C has been shown to be associated with future cardiovascular disease and deaths in a dose-dependent relationship that possibly reflects a very early stage of chronic ranal dysfunction. In addition, >sub-clinically< elevated cystatin C concentrations in individuals without chronic kidney disease indicated by creatinine are an independent predictor of progression to chronic kidney disease, heart failure and all-cause mortality.
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Sapkota, Suman, Saroj Khatiwada, Shrijana Shrestha, Nirmal Baral, Robin Maskey, Shankar Majhi, Lal Chandra, and Madhab Lamsal. "Diagnostic Accuracy of Serum Cystatin C for Early Recognition of Nephropathy in Type 2 Diabetes Mellitus." International Journal of Nephrology 2021 (April 26, 2021): 1–7. http://dx.doi.org/10.1155/2021/8884126.
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Objectives. Diabetic nephropathy is one of the major complications that develop over time in type 2 diabetes mellitus (T2DM). This prospective study was conducted to assess the diagnostic accuracy of serum cystatin C in detecting diabetic nephropathy at earlier stages. Materials and Methods. This study was undertaken on 50 cases of T2DM and 50 healthy subjects as controls. Demographic and anthropometric data and blood and urine samples were collected. The concentration of serum cystatin C (index test) and traditional markers of diabetic nephropathy, serum creatinine, and urinary microalbumin (the reference standard) were estimated. Similarly, blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoprotein (HDL) cholesterol, and urinary creatine were measured. Results. The mean ± SD serum cystatin C was significantly higher in T2DM as compared to control (1.07 ± 0.38 and 0.86 ± 0.12 mg/dl, respectively, p < 0.001 ). The mean ± SD bodyweight, BMI, W : H ratio, pulse, SBP, and DBP were 66.4 ± 12.6 kg, 26.2 ± 5.6 kg/m2, 1.03 ± 0.09, 78 ± 7, 125 ± 16 mm of Hg, and 77 ± 9 mm of Hg, respectively, in cases. A significant difference in HDL cholesterol p = 0.018 and serum cystatin C p < 0.001 was observed among different grades of nephropathy. Cystatin C had a significant positive correlation with age (r = 0.323, p = 0.022 ), duration of T2DM (r = 0.326, p = 0.021 ), and UACR (r = 0.528, p < 0.001 ) and a significant negative correlation with eGFR CKD-EPI cystatin C (r = −0.925, p < 0.001 ). The area under ROC curve for serum cystatin C (0.611, 95% CI: 0.450–0.772) was greater than for serum creatinine (0.429, 95% CI: 0.265–0.593) though nonsignificant. Conclusion. Serum cystatin C concentration increases with the progression of nephropathy and duration of diabetes in Nepalese T2DM patients suggesting cystatin C as a potential marker of renal impairment in T2DM patients.
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Permatasari, Pratita Jati, Aumas Pabuti, Eti Yerizel, and Fitrisia Amelin. "Serum Cystatin C dan Kreatinin dalam Mendiagnosis Gangguan Ginjal Akut pada Anak Sakit Kritis." Sari Pediatri 20, no. 2 (October 19, 2018): 95. http://dx.doi.org/10.14238/sp20.2.2018.95-100.
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Latar belakang. Gangguan ginjal akut (GgGA) berhubungan dengan mortalitas dan morbiditas yang tinggi di antara anak sakit kritis. Cystatin C adalah protease inhibitor yang menurut beberapa penelitian merupakan biomarker yang baik untuk mendeteksi gangguan ginjal akut pada anak sakit kritis.Tujuan. Mengetahui sensitivitas, spesifisitas, nilai prediksi positif, dan nilai prediksi negatif cystatin C serum dan kreatinin serum dalam mendiagnosis gangguan ginjal akut pada anak sakit kritis.Metode. Penelitian potong lintang pada 70 subjek di HCU dan PICU RSUP. Dr. M. Djamil Padang dari Mei 2017 – Juni 2017. Subjek penelitian laki-laki 55,71%, median usia 16,50 bulan. Subjek dipilih dengan teknik konsekutif. Dilakukan pemeriksaan cystatin C serum dengan ELISA dan kreatinin dengan kolorimetrik. Baku emas menggunakan estimasi laju filtrasi glomerulus berdasarkan formula Schwartz. Gangguan ginjal akut terjadi bila terjadi penurunan laju filtrasi glomerulus minimal 25% berdasarkan kriteria pRIFLE. Kurva receiver operating characteristic (ROC) digunakan untuk menilai cystatin C dan kreatinin dalam mendiagnosis GgGA.Hasil. Rerata cystatin C dan kreatinin serum pada GgGA 0,88±0,14 mg/L, 1,13±0,59 mg/dL berturut-turut. Tiga puluh tujuh pasien didiagnosis GgGA. Cut off point cystatin C serum 0,56 mg/L, sensitivitas 85,19%, spesifisitas 60,47%, nilai prediksi positif 57,50%, nilai prediksi negatif 13,33%. Cut off point kreatinin serum 0,95 mg/dL, sensitivitas 51,85%, spesifisitas 100%, nilai prediksi positif 100%, nilai prediksi negatif 23,21%.Kesimpulan. Cystatin C serum sensitif untuk mendiagnosis GgGA tetapi kurang spesifik.
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Siddiqua, Hawwa M. S., Mathew John, V. C. Manoj, and Rati Santhakumar. "Cystatin C- an early marker indicative of renal dysfunction in critically ill children: a prospective cohort study." International Journal of Contemporary Pediatrics 6, no. 5 (August 23, 2019): 1981. http://dx.doi.org/10.18203/2349-3291.ijcp20193709.
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Background: Acute kidney injury (AKI) is a sudden onset of kidney failure or kidney damage that happens within a few hours or a few days and can also affect other organs such as brain, heart and the lungs. Hence early diagnosis and intervention is needed to improve the outcome of the children. In these studies this objective was to determine if cystatin C is an early marker indicative of renal dysfunction in critically ill children and to determine if Cystatin C can detect Acute kidney injury earlier than serum creatinine.Methods: This prospective cohort study was undertaken in PICU at Jubilee Mission Medical College from December 2016- May 2018. Blood samples were collected from 34 critically ill children for serum creatinine estimation at 0,24 and 48 hours of admission and serum and urine were collected for cystatin C estimation at admission. Children were categorized into AKI and NON-AKI based on pRIFLE criteria. Comparison of cystatin C values with serum creatinine was performed and Statistical analysis was done using IBM SPSS version 20.Results: A total of 34 critically ill children were enrolled in this study, out of which 12 children progressed to AKI during the course of illness according to modified Pediatric Risk, Injury, Failure, Loss, End Stage Renal Disease (pRIFLE) criteria. We found a strong positive correlation between cystatin C at 0 hours and serum creatinine at 48 hours among AKI groups.Conclusions: Serum and Urine cystatin C are early markers to diagnose AKI in critically ill children. Serum cystatin C is more sensitive than urine cystatin C for the diagnosis of AKI.
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Shelke, Sudarshan N., and Jyoti S. Tele. "Cystatin C based eGFR - for early detection of diabetic kidney disease." International Journal of Research in Medical Sciences 7, no. 9 (August 27, 2019): 3402. http://dx.doi.org/10.18203/2320-6012.ijrms20193921.
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Background: Diabetic kidney disease is the leading cause of premature death in young diabetic patients. Detection of diabetic kidney disease as early as possible in the disease process currently offers the best chance of delaying or possibly preventing progression to end-stage renal disease. The present study was aimed to evaluate utility of serum cystatin C based eGFR for early diagnosis of diabetic kidney disease.Methods: Diagnosed patients of type 2 diabetes mellitus having frank proteinuria were excluded. Patients without proteinuria were tested for microalbuminuria. 50 patients having microalbuminuria were tested for 24 hour urine creatinine, serum creatinine and serum cystatin C. Both cystatin C based eGFR and eGFR by Cockcroft and Gault equation were compared with standard GFR by 24 hour urine Creatinine clearance respectively.Results: There was statistically significant positive correlation between cystatin C based eGFR and standard GFR by 24 hr Creatinine clearance (r=0.87). For eGFR by Cockcroft-Gault equation, it was 0.36 (r=0.36).Conclusions: The results of this study suggest that serum cystatin C based eGFR measurement is a useful, practical tool for the evaluation of renal involvement in the course of diabetes. As serum creatinine values are affected by many factors like age, sex, muscle mass and diet, serum cystatin C based eGFR estimation offers a hope that diabetic kidney disease can be well prevented with appropriate interventions.
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Chen, Dan, Wenwu Sun, Jia Li, Bohua Wei, Wei Liu, Xiaopin Wang, Fan Song, Liangkai Chen, Junhui Yang, and Li Yu. "Serum Cystatin C and Coronavirus Disease 2019: A Potential Inflammatory Biomarker in Predicting Critical Illness and Mortality for Adult Patients." Mediators of Inflammation 2020 (October 8, 2020): 1–10. http://dx.doi.org/10.1155/2020/3764515.
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This study aimed at determining the relationship between baseline cystatin C levels and coronavirus disease 2019 (COVID-19) and investigating the potential prognostic value of serum cystatin C in adult patients with COVID-19. 481 patients with COVID-19 were consecutively included in this study from January 2, 2020, and followed up to April 15, 2020. All clinical and laboratory data of COVID-19 patients with definite outcomes were reviewed. For every measure, COVID-19 patients were grouped into quartiles according to the baseline levels of serum cystatin C. The highest cystatin C level was significantly related to more severe inflammatory conditions, worse organ dysfunction, and worse outcomes among patients with COVID-19 (P values < 0.05). In the adjusted logistic regression analyses, the highest cystatin C level and ln-transformed cystatin C levels were independently associated with the risks of developing critically ill COVID-19 and all-cause death either in overall patients or in patients without chronic kidney disease (P values < 0.05). As a potential inflammatory marker, increasing baseline levels of serum cystatin C might independently predict adverse outcomes for COVID-19 patients. Serum cystatin C could be routinely monitored during hospitalization, which showed clinical importance in prognosticating for adult patients with COVID-19.
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Finney, Hazel, Alan H. Williams, and Christopher P. Price. "Serum cystatin C in patients with myeloma." Clinica Chimica Acta 309, no. 1 (July 2001): 1–6. http://dx.doi.org/10.1016/s0009-8981(01)00415-6.
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Paskalev, E., L. Lambreva, P. Simeonov, N. Koicheva, B. Beleva, M. Genova, R. Marcovska, and A. Nashkov. "Serum cystatin C in renal transplant patients." Clinica Chimica Acta 310, no. 1 (August 2001): 53–56. http://dx.doi.org/10.1016/s0009-8981(01)00522-8.
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Risch, Lorenz, and Andreas R. Huber. "Glucocorticoids and increased serum cystatin C concentrations." Clinica Chimica Acta 320, no. 1-2 (June 2002): 133–34. http://dx.doi.org/10.1016/s0009-8981(02)00044-x.
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Saka, Yosuke, Akihisa Kato, Naoto Tawada, Yuhei Noda, Syunsuke Niwa, Tetsusi Mimura, Tomohiko Naruse, and Yuzo Watanabe. "Acute azotaemia without serum cystatin C elevation." Nephrology 24, no. 7 (April 29, 2019): 775. http://dx.doi.org/10.1111/nep.13540.
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Obrenovic, R., D. Petrovic, N. Majkic-Singh, J. Trbojevic-Stankovic, and B. Stojimirovic. "Serum cystatin c levels in normal pregnancy." Clinical Nephrology 76, no. 09 (September 1, 2011): 174–79. http://dx.doi.org/10.5414/cn106792.
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Koyama, Hidenori, and Manabu Kadoya. "Serum cystatin C level in chronic hypercortisolism." Endocrine Journal 67, no. 8 (2020): 891–92. http://dx.doi.org/10.1507/endocrj.ej20-0370.
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Gruev, Todor, Koco Chakalarovski, Olivera Stojceva-Taneva, Ani Grueva, and Katerina Trenceva. "Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels." Journal of Medical Biochemistry 28, no. 3 (July 1, 2009): 191–96. http://dx.doi.org/10.2478/v10011-009-0014-y.
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Effects of Glucocorticoid Immunosuppression on Serum Cystatin C LevelsThe aim of the present study is to describe the influence of glucocorticoid immunosuppression on serum cystatin C concentration in renal transplant patients. To evaluate the influence of immunosuppressive regimens, especially glucocorticoids, on serum cystatin C level, 38 clinically 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 methylprednisolone 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 administration of high-dose methylprednisolone led to significant differences in cystatin C levels at different time points (before administration, after three doses, and 8 days after discontinuation). Glucocorticoid medication in adult renal transplant patients is associated in a dose-de pendent manner with increased cystatin C, leading to systematic under estimation of GFR. Moreover, our data illustrate the need for specific reference intervals in patients on glucocorticoid therapy. In clinical routine settings, as well as in future clinical studies, it is important to take glucocorticoid medication into account when interpreting serum cystatin C concentrations in renal transplant patients presumably, as well as in other patient groups.
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Shi, Jijun, Chunyuan Zhang, Yongjun Cao, Xinyuan Qu, Huihui Liu, and Shoujiang You. "Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis." Current Neurovascular Research 16, no. 4 (December 23, 2019): 301–9. http://dx.doi.org/10.2174/1567202616666190906110204.
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Background: Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT. Methods: Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up. Results: During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events. Conclusions: Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.
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John, George T., Jude Joseph Fleming, Girish S. Talaulikar, R. Selvakumar, Paaulose P. Thomas, and Chakko K. Jacob. "Measurement of renal function in kidney donors using serum cystatin C and β2-microglobulin." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 40, no. 6 (November 1, 2003): 656–58. http://dx.doi.org/10.1258/000456303770367252.
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Background: The usefulness of serum cystatin C and serum β2-microglobulin (B2M) as markers of glomerular filtration rate (GFR) were compared in kidney donors before and after nephrectomy. Methods: Blood samples were taken from 28 donors (15 women and 13 men) for serum creatinine, urea, cystatin C and B2M estimation a median of 7 days before and 10 days after nephrectomy. Results: Estimated GFR decreased from a median of 86.2 mL/min/1.73 m2 to 60.3 mL/min/1.73 m2, a median decrease of 28.6%. Serum creatinine increased by 40% and urea by 30.4%; serum cystatin C increased by 31.2% and serum B2M increased by 65.6%. Using published data on biological variation, critical values were calculated. An increase in serum creatinine above 18 µmol/L detected the decline in renal function in 26/28 (92.9%) subjects. Increases in serum B2M greater than a critical value of 0.94 mg/L detected 24/28 (85.7%) of these subjects, but the critical value of 0.59 mg/L for cystatin C detected only 8/28 (28.6%). Conclusion: Using critical values, serial measurement of serum creatinine was better than serum B2M in detecting reduced renal function. Because of its large intraindividual variation, serial serum cystatin C estimation was very poor in detecting reduced renal function.
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Zhu, Hong, and Yuying Qian. "Serum neutrophil gelatinase-associated lipocalin and cystatin C are diagnostic markers of renal dysfunction in older patients with coronary artery disease." Journal of International Medical Research 46, no. 6 (March 29, 2018): 2177–85. http://dx.doi.org/10.1177/0300060517748842.
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Objective This study aimed to assess the diagnostic value of serum neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C for renal dysfunction in older patients with coronary disease. Methods A total of 84 older patients with coronary artery disease were included in this study. Serum NGAL and cystatin C levels were analysed using commercially available kits. Medical data of all patients were recorded and analysed. Results NGAL and cystatin C levels were significantly positively correlated with N-terminal prohormone of brain natriuretic peptide levels and negatively correlated with the estimated glomerular filtration rate. The areas under the receiver operating characteristic curves of serum NGAL and cystatin C levels for diagnosing early renal dysfunction were 0.884 and 0.744, respectively. Conclusion Serum NGAL and cystatin C are potential early and sensitive markers of renal dysfunction in older patients with coronary artery disease.
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Hartati, Ackni, Nanan Sekarwana, and Dzulfikar DLH. "Perbedaan Laju Filtrasi Glomerulus Berdasarkan Kadar Kreatinin dan Cystatin C Serum pada Sindrom Nefrotik Anak." Sari Pediatri 16, no. 5 (November 9, 2016): 325. http://dx.doi.org/10.14238/sp16.5.2015.325-9.
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Latar belakang. Komplikasi sindrom nefrotik (SN) yang sering telambat terdeteksi adalah gangguan ginjalakut (GnGA). Cystatin C serum dipertimbangkan menjadi pemeriksaan potensial pengganti kreatinin sebagaipenanda fungsi ginjal. Kadar cystatin C lebih mendekati nilai laju filtrasi glomerulus (LFG) dibandingkandengan kreatinin serum.Tujuan. Menentukan perbedaan LFG berdasarkan kadar kreatinin dan cystatin C serum pada SN anak.Metode. Penelitian potong lintang dilakukan dari Februari–Maret 2014 di unit rawat jalan dan rawat inapRSUP Dr. Hasan Sadikin Bandung, RSUD Kota Bandung, dan RSUD Cibabat Kota Cimahi. Subjek SNusia 1–14 tahun. Pemeriksaan kadar kreatinin dengan metode Jaffe dan cystatin C serum dengan particleenhancedturbidimetric immunoassay (PETIA). Uji statistik menggunakan McNemar dan uji t berpasangandan kemaknaan berdasarkan nilai p<0,05.Hasil. Terdapat 21 kasus SN yang terdiri atas 18 laki-laki dan 3 perempuan dengan rerata usia 6 tahun 3bulan. Nilai LFG berdasarkan kreatinin 137,86±27,07 ml/min/1,73 m2 dan LFG berdasarkan cystatin C73,59±12,49 ml/min/1,73 m2. Terdapat perbedaan signifikan antara LFG berdasarkan kadar kreatinin dancystatin C serum (p<0,01).Kesimpulan. Proporsi LFG cystatin C berdasarkan formula Filler lebih rendah dibandingkan kreatininberdasarkan formula Schwartz
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Mohammed, Mahmoud Moustafa. "Correlation of Serum Cystatin C level with Coronary Artery Disease and Its Severity." Journal of Medical Research 7, no. 3 (June 10, 2021): 65–69. http://dx.doi.org/10.31254/jmr.2021.7302.
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Background: Atherosclerosis is an important cause of cardiovascular mortality and morbidity in the world and its progression might be slowed in many people with appropriate lifestyle and drug interventions. Hence a lot of researches are targeting the atherosclerotic process and its mediators. Cystatin C is considered to be an active cysteine protease inhibitor found in all body fluids and expressed in all nucleated cells in the body and is a better marker of renal function when compared to creatinine. Elevated plasma levels of cystatin C is thought to be associated with increased risk of cardiovascular disease (CVD) and mortality in different populations. This may be due to the fact that it represents occult impaired renal function, which is associated with increased risk of CVD. However, in several studies, cystatin C has been associated with CVD even within normal ranges of eGFR. Aim: To evaluate the relation of the serum cystatin C level and atherosclerotic burden in coronary arteries Methods: Our study included 80 patients of both sexes with known or suspected ischemic heart disease who were candidates for coronary angiography. Their serum Cystatin C level was measured using ELISA technique and correlated with coronary atherosclerosis using Gensini score. Results: No association was found between coronary atherosclerosis severity and serum cystatin C level. There was also no difference in serum cystatin C level between patients presenting with acute coronary syndrome and those presenting with stable ischaemic heart disease. Conclusion: The relation between serum cystatin C level and coronary atherosclerosis is still unclear
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Čabarkapa, Velibor, Romana Mijović, Zoran Stošić, Nikola Ćurić, Radmila Žeravica, and Branislava Ilinčić. "Estimation of Glomerular Filtration Rate From Serum Cystatin C and Creatinine in Patients with Thyroid Dysfunction." Journal of Medical Biochemistry 31, no. 2 (April 1, 2012): 88–93. http://dx.doi.org/10.2478/v10011-011-0044-0.
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Estimation of Glomerular Filtration Rate From Serum Cystatin C and Creatinine in Patients with Thyroid DysfunctionGiven that thyroid function influences serum cystatin C and creatinine levels, the question arises as to whether it is possible to accurately estimate glomerular filtration rate (GFR) in patients with thyroid dysfunction. The objective of the study was to determine serum cystatin C and creatinine levels and estimate GFR in patients with thyroid dysfunction. The study included 32 cases with newly diagnosed hyperthyroidism and 27 cases with newly diagnosed hypothyroidism, as well as 20 healthy controls matched for sex and age with the cases. Serum concentrations of thyroid stimulating hormone (TSH), free triiodothyronine (fT3) and free thyroxine (fT4), creatinine and cystatin C were measured in all study subjects. GFR was estimated using the Modification of Diet in Renal Disease (MDRD), the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and cystatin C-based equations. Serum cystatin C levels were significantly higher in hyperthyroid subjects compared to controls (1.32±0.31 vs. 0.89±0.15; p<0.01). Serum creatinine levels were significantly lower in hyperthyroid subjects compared to controls (60.6±10.2 vs. 76.4±8.6; p<0.01), and significantly higher in hypothyroid subjects compared to controls (94.5±13.2 vs. 76.4±8.6; p<0.01). GFR estimated with the MDRD equations was significantly higher in hyperthyroid subjects compared to hypothyroid subjects (101.6±20.7 vs. 64.1±11.6 mL/min/1.73m2; p<0.01). GFR estimated with the equation based on serum cystatin C was significantly lower in hyperthyroid subjects compared to hypothyroid subjects (59.2±22.1 vs. 92.1±16.0 mL/min/1.73m2; p<0.01). Although serum cystatin C is regarded a reliable marker of GFR and more sensitive than serum creatinine, it has limitations in patients with thyroid dysfunction, due to significant changes in its serum concentrations regardless of renal function. In patients with thyroid dysfunction GFR should therefore be estimated using the equations based on serum creatinine.
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Jonkisz, Paweł, Krisztina Kungl, Agnieszka Sikorska, Agnieszka Kurosad, and Józef Nicpoń. "Cystatin C analysis in the dog: A comparison of turbidimetric and nephelometric assay results." Acta Veterinaria Hungarica 58, no. 1 (March 1, 2010): 59–67. http://dx.doi.org/10.1556/avet.58.2010.1.6.
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Cystatin C is a serum protein with low molecular mass, which has been suggested as a marker to assess renal function in the dog. This protein is regularly assessed using particle-enhanced turbidimetric immunoassay (PETIA) and particle-enhanced nephelometric immunoassay (PENIA), in which rabbit anti-human cystatin C antibodies are used. The purpose of this work was to compare the results of cystatin C analysis obtained by PETIA and PENIA assays in the dog. Forty dogs of different genders and breeds were classified into four groups of 10 animals each based on serum creatinine concentrations (4 stages of chronic kidney disease). Serum cystatin C concentration was measured using PETIA and PENIA assays, the results were compared, and correlation with serum urea and creatinine concentrations was established. The correlation coefficient for results obtained using PETIA and PENIA assays was r = 0.706. Serum cystatin C concentrations obtained in PETIA had a lower correlation coefficient with creatinine concentrations than those found in PENIA (r = 0.614 and r = 0.904, respectively); similarly, serum cystatin C was less correlated with serum urea concentration in PETIA than in PENIA (r = 0.463 and r = 0.636, respectively). The results obtained in this study suggest that the nephelometric assay is more sensitive and was shown to be more closely correlated with other renal function indicators than the PETIA assay.
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Stejskal, David, Bořek Lačňák, Pavlína Solichová, Libor Jedelský, František Všianský, Božena Hausnerová, and Michal Karpíšek. "Serum cystatin C as a long-term predictor of overall mortality." Cor et Vasa 48, no. 10 (October 1, 2006): 340–44. http://dx.doi.org/10.33678/cor.2006.111.
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O'Riordan, Shelagh E., Michelle C. Webb, Helen J. Stowe, David E. Simpson, Madhu Kandarpa, Anthony J. Coakley, David J. Newman, Jean A. Saunders, and Edmund J. Lamb. "Cystatin C improves the detection of mild renal dysfunction in older patients." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 40, no. 6 (November 1, 2003): 648–55. http://dx.doi.org/10.1258/000456303770367243.
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Background: Conventional estimates of glomerular dysfunction, including serum creatinine and creatinine clearance, are inadequate in older people. In this study we have compared the diagnostic accuracy of a novel test of kidney disease, cystatin C, against these markers in older patients with a range of renal function. Methods: Fifty-three patients (mean age 79.6 years, range 69-92 years) with a variety of medical diagnoses were recruited via outpatient clinics. Exclusion criteria included active rheumatoid disease, known current malignancy, renal replacement therapy/renal transplantation and cognitive impairment. 51Cr-EDTA was used as the reference method against which the other markers of glomerular filtration rate were compared using regression analyses. Results: The best fit with glomerular filtration rate was given by Cockcroft and Gault calculated clearance ( R2 = 0.83), followed by serum cystatin C ( R2 = 0.79), serum creatinine ( R2 = 0.76) and creatinine clearance ( R2 = 0.73). The accuracy for glomerular filtration rate prediction was poor for all markers. Serum cystatin C detected nearly all patients with mild renal impairment whereas serum creatinine only detected half of these cases. Regression modelling predicted that the upper limit of normal for serum cystatin C would be exceeded as glomerular filtration rate fell below 64 mL/min/1.73 m2, compared with 44 mL/min/1.73 m2 for serum creatinine. Conclusion: Serum cystatin C is a simple and sensitive screening test for kidney dysfunction in older people.
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Keevil, Brian G., Eric S. Kilpatrick, Simon P. Nichols, and Paul W. Maylor. "Biological variation of cystatin C: implications for the assessment of glomerular filtration rate." Clinical Chemistry 44, no. 7 (July 1, 1998): 1535–39. http://dx.doi.org/10.1093/clinchem/44.7.1535.
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Abstract To assess the inherent potential for detecting mild to moderate reductions in glomerular filtration rate, this study determined the biological variability of serum cystatin C and creatinine in 12 healthy subjects. After accounting for analytical variation, interindividual variance accounted for 93% and intraindividual variance accounted for 7% of serum creatinine biological variation. As such, to lie outside the assay reference interval, some subjects must exceed 13 SD from their usual mean value, whereas in others, a change of only 2 SD would be sufficient. For cystatin C, interindividual variation explained 25% and intraindividual variance explained 75% of biological variability. Therefore, the upper limit of the population reference interval for cystatin C is seldom more than 3–4 SD from the mean value of any healthy individual. The critical difference for sequential values significant at P ≤0.05 was calculated as 37% for serum cystatin C and 14% for serum creatinine. We conclude that cystatin C is potentially a better marker for detecting impaired renal function than serum creatinine, but serum creatinine is probably still the better marker for detecting temporal changes of renal function in individuals with established renal disease.
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Faraji, Md Anwarul Haque, Mohammed Rashed Anwar, Dilip Kumar Debnath, Md Babrul Alam, Syed Mahbub Morshed, and KAM Mahbub Hasan. "Serum Cystatin C as an Endogenous Marker of Renal Function in Patients with Chronic Kidney Disease (CKD)." Journal of Current and Advance Medical Research 4, no. 1 (April 5, 2018): 3–12. http://dx.doi.org/10.3329/jcamr.v4i1.36168.
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Background: Cystatin C is being considered as a potential replacement for serum creatinine as a filtration marker.Objectives: This present study was conducted to determine the validity of Cystatin C as a renal function test and to compare the Cystatin C and serum creatinine level between the CKD cases and person not having CKD.Methodology: The present case control study was conducted in the department of Nephrology of Dhaka Medical College Hospital during the period of January 2009 to December 2009 with the aim to find out the serum Cystatin C as diagnostic markers of chronic kidney disease. In the present study total 100 respondents were included. Among them 50 were CKD patients and another 50 were without CKD. Results: It was an age and sex matched study. Out of 50 patients with CKD, 29 (58.0%) were in the stage IV followed by 15 (30.0%) were in the stage III and rest 6 (12.0%) were in the stage V. In CKD group 31 (62.0%) had glomerulonephritis, 18 (36.0%) had HTN, 11 (22.0%) had DM and 3 (6.0%) had obstructive uropathy. In without CKD group 9 (18.0%) had HTN, 6 (12.0%) had DM. Mean±SD of Serum Creatinine in CKD and without CKD groups were 5.73±2.69 and 0.85±0.11mg/dl respectively. Mean±SD of Serum Cystatin C in CKD and without CKD groups were 3.59±1.21 and 0.71±0.09 mg/dl respectively. In all patients sensitivity of Cystatin C to diagnose CKD was 100.0% and specificity also100.0%. Sensitivity of serum creatinine to diagnose CKD was 88.0% and specificity was 100.0%.Conclusions: Cystatin C proved more reliable than creatinine and was comparable to plasma creatinine and Cockcroft-Gault estimation. Serum Cystatin C had higher diagnostic accuracy with high sensitivity and specificity to detect renal function and is a reliable marker of renal function. Journal of Current and Advance Medical Research 2017;4(1):3-12
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BOSTOM, ANDREW G., REGINALD Y. GOHH, LINDA BAUSSERMAN, DAVID HAKAS, PAUL F. JACQUES, JACOB SELHUB, LANCE DWORKIN, and IRWIN H. ROSENBERG. "Serum Cystatin C as a Determinant of Fasting Total Homocysteine Levels in Renal Transplant Recipients with a Normal Serum Creatinine." Journal of the American Society of Nephrology 10, no. 1 (January 1999): 164–66. http://dx.doi.org/10.1681/asn.v101164.
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Abstract. Serum creatinine, a surrogate for both renal function and homocysteine generation, is an important determinant of fasting plasma total homocysteine levels in stable renal transplant recipients. In this study, it is hypothesized that among stable renal transplant recipients with normal creatinine levels (i.e., ≤ 1.5 mg/dl), serum cystatin C, a more sensitive indicator of GFR, would better predict fasting total homocysteine levels compared with serum creatinine. Fasting plasma total homocysteine, folate, vitamin B12, and pyridoxal 5′-phosphate levels, along with serum cystatin C, creatinine, and albumin levels, were determined in 28 consecutive renal transplant recipients (mean age 47 ± 14 yr; 60.7% men) with stable allograft function, whose serum creatinine was ≤1.5 mg/dl. General linear modeling with analysis of covariance revealed that serum cystatin C was independently predictive (partial R = 0.494; P = 0.023) of fasting total homocysteine levels after adjustment for age, gender, vitamin status, albumin, and creatinine levels. In contrast, creatinine levels were not predictive of fasting total homocysteine levels in this model (P = 0.110) or an identical model that excluded cystatin C (P = 0.131). Serum cystatin C levels may reflect subtle decreases in renal function that independently predict fasting total homocysteine levels among stable renal transplant recipients with a normal serum creatinine.