Analysis of glomerular filtration rate, serum cystatin C levels, and renal resistive index values in cirrhosis patients

Üstündağ, Yücel | Samsar, Ufuk | Açıkgöz, Şereften | Çabuk, Mehmet | Kıran, Sibel | Külah, Eyüp | Aydemir, Selim

Article | 2007 | Clinical Chemistry and Laboratory Medicine45 ( 7 ) , pp.890 - 894

Background: The aim of this study was to evaluate the relation of glomerular filtration rate (GFR) to serum cystatin C levels, renal resistive index (RRI), serum creatinine and creatinine clearance in patients with different stages of cirrhosis. Methods: The study sample was 25 cirrhotic patients (10 females and 15 males; mean age 57.3±2.04 years), 10 in the compensated stage without ascites and 15 in the decompensated stage with new-onset ascites. None had azotemia nor were on diuretic treatment. The control group comprised 25 healthy adults (11 female and 14 men; mean age 56.56±1.91 years). Serum cystatin C, RRI, serum creatinine . . .and creatinine clearance were measured. GFR was determined by technetium99m- diethylene triamine pentaacetic acid renal scintigraphy. Results: Cirrhosis cases had lower mean scintigraphic GFR than controls (64.5±4.03 vs. 87.96±4.16 mL/min, p<0.05). Serum cystatin C and RRI were significantly higher in the cirrhotic group compared to controls (1.16±0.09 mg/L and 0.68±0.01 vs. 0.86±0.03 mg/L and 0.64±0.01, respectively; p<0.05). Subgroup comparative analysis showed that only two parameters, scintigraphic GFR and serum cystatin C, were significantly different between compensated and decompensated cirrhotics (75.62±4.9 mL/min and 0.89±0.07 mg/L vs. 57.23±5.14 mL/min and 1.34±0.13mg/L, respectively; p<0.05). Scintigraphic GFR showed significant correlation with cystatin C, but not with serum creatinine or creatinine clearance (r=-0.877, p<0.05) in decompensated patients. No correlation was observed between scintigraphic GFR and RRI or between serum cystatin C and RRI in all subjects. A receiver operator characteristics curve showed that cystatin C at a cutoff value of 1.01 mg/L can significantly differentiate patients with GFR <70 mL/min with 80% sensitivity and 80% specificity. Conclusions: Serum cystatin C, but not serum creatinine or RRI measurement, correlates with GFR in each stage of liver failure and has a significant diagnostic advantage in detecting lower GFR in such cases. © 2007 by Walter de Gruyter Daha fazlası Daha az

Serum cystatin C levels in gastric cancer patients: Scientific letter

Demirtaş S. | Uzunoglu N. | Can M. | Karaca L.

Article | 2007 | Turkiye Klinikleri Journal of Medical Sciences27 ( 3 ) , pp.442 - 444

Elevated activities of cysteine proteinases in cancers are attributed to impaired regulation by the endogenous cysteine proteinase inhibitors (cystatins). Cystatin C is suggested to be a reliable marker of glomerular filtration rate (GFR). The purpose of this study was to evaluate whether cystatin C concentration was influenced by gastric malignancy, which is a common cancer type and the availability of this parameter safely for screening renal dysfunction in these patients. Since there is inadequate information on the clinical significance of cystatin C expression in human gastric cancers, we studied the differences in levels of se . . .rum cystatin C in this type of cancer and also evaluated them with respect to cancer stages. The levels of cystatin C in patients with gastric adenocancer were similar to those in the control group. Similarly, the values of serum creatinine and GFR in the patients were comparable to those of the controls. Serum creatinine values in controls and in patients did not show a statistically significant difference 0.8 ± 0.16 and 0.9 ± 0.35 respectively (p> 0.05). Serum cystatin C values in controls and patients were 0.74 ± 0.32 and 0.72 ± 0.6 respectively, which was also not different statistically (p> 0.05). When the patients were evaluated with respect to the stages of the cancer, the cystatin C values did not differ significantly. The mean ± SD levels of the patients in low and advanced stages were 0.79 ± 0.51 and 0.69 ± 0.64 respectively (p> 0.05). Our study clearly demonstrates that serum cystatin C has valuable potential for the detection and monitoring of GFR and may be safely used in gastric cancer patients. Copyright © 2007 by Türkiye Klinikleri Daha fazlası Daha az

Glomerular filtration rate: Which method should we measure in daily clinical practice?

Yildiz G. | Magden K. | Abdulkerim Y. | Ozcicek F. | Hür E. | Candan F.

Article | 2013 | Minerva Medica104 ( 6 ) , pp.613 - 623

Aim. In this study, we compared estimated glomerular filtration rate (eGFR) calculated with the formulas of Cockcroft-Gault (C&G), Modification of Diet in Renal Disease (MDRD), Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) and Mayo Clinic Quadratic (Mayo Q) and, GFR (mGFR) that was scintigraphically measured with creatinine clearance (CrC1) and technetium-99m di-ethylene triamine penta-acetic acid (99mTc-DTPA). Objective of this study was to define the correlations between the formulas, provide a reliable method for measurement and estimation of GFR in daily clinical practice and demonstrate the potential errors. M . . .ethods. C&G, CKD-EPI, Mayo Q and MDRD eGFR of 84(37 males, 47 females) patients diagnosed with chronic kidney disease were calculated. Values of 99mTc-DTPA based on mGFR were compared with eGFR values of the formulas. Results. Significant correlations were found with the values of 99mTc-DTPA mGFR, CrCl, MDRD, CKD-EPI, Mayo Q and C&G eGFR. The highest correlation was found between LBM (lean body mass) corrected C&G, MDRD-6, Mayo Q and CKD-EPI eGFR. The best estimate was made with MDRD-6 in the cases with 99mTc-DTPA mGFR<30 mL/min/1.73 m2 and with MDRD-4 in the cases with 99mTc-DTPA mGFR?30 mL/min/1.73 m2, while the worst estimate was made with uncorrected C&G formula in both groups. Conclusion. All eGFR formulas can be used in daily clinical practice. However, using MDRD-6 in the cases with GFR<30 mL/min/1.73 nil and MDRD-4 in the cases with GFR?30 mL/min/1.73m2 as well as using LBM for C&G eGFR or correction according to LBM when AW (actual weight) is used, might provide a more accurate estimation Daha fazlası Daha az

The independent relationship between creatinine clearance, microalbuminuria and circadian blood pressure levels in newly diagnosed essential hypertensive and type 2 diabetic patients

Afsar, Bans | Elsurer, Rengin

Article | 2012 | JOURNAL OF DIABETES AND ITS COMPLICATIONS26 ( 6 ) , pp.531 - 535

Background and Objectives: Increased evidence suggests that apart from patients with increased albumin excretion and decreased glomerular filtration rate (GFR); there are also patients with type 2 diabetes with decreased GFR but without albuminuria. The exact pathophysiologic mechanisms regarding these clinical conditions are not known. We suggest that different blood pressure (BP) levels may be one the factors for these different clinical conditions. However, before labeling BP as a causative factor: one must show whether BP levels are different in these patients. Thus the current study was performed to analyze the relationship bet . . .ween creatinine clearance, microalbuminuria and circadian blood pressure levels in newly diagnosed essential hypertensive and type 2 diabetic patients. Methods: Medical history, physical examination, laboratory analysis and ambulatory blood pressure measurements (ABPMs) were analyzed. 24-h urine specimens were collected to measure creatinine clearance and albumin excretion Results: In total 216 patients were included which were divided into 4 groups: group 1 composed of 90 patients with normal GFR and without microalbuminuria (MA), group 2 composed of 50 patients with normal GFR and with MA, group 3 composed of 36 patients with decreased GFR and without MA and group 4 composed of 40 patients with both decreased GFR and MA. The ratio of dippers vs. non dippers was not different between group 1, group 2 and group 3 patients. However ratio of dippers was higher in group 1 when compared to group 4 (P: 0.003) and group 4 patients have an odds of 7.678 (CI: 1.657-35.576, P: 0.009) for non-dapping status when compared to patients in group 1. Conclusion: In conclusion, ABPM measurements were highest in patients with both decreased GFR and MA, whereas they are lowest in patients with normal GFR and normal UAE. (C) 2012 Elsevier Inc. All rights reserved Daha fazlası Daha az

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