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Abstract Fall is common in the elderly, and chronic kidney disease is considered a major risk factor. Serum creatinine (Cre) and cystatin C (Cys C) are commonly used biomarkers for renal function, while the ratio of Cre to Cys C, known as the sarcopenia index (SI), provides insights into muscle health. This study investigates the relationships between Cre, Cys C, estimated glomerular filtration rates (eGFR), SI, and self-reported falls using National Health and Nutrition Examination Survey (NHANES) data. We included 4,272 older adults with eGFR > 30mL/min/1.73m2 from NHANES (1999 to 2004) and divided them into the fall and non-fall groups based on the questionnaires. Correlations were assessed using restricted cubic spline, weighted generalized linear regression models. Multi-factor logistic regression analysis identified serum Cys C as significantly associated with falls (all participants: OR 1.16, 95% CI: 1.09 to 1.23, p 75 mL/min/1.73m2: OR 1.17, 95% CI: 1.05 to 1.30, p

INTRODUCTION: In India, hypertensive renal disease, the second leading cause of chronic kidney failure, necessitates dialysis or renal transplantation. Most traditional renal function indicators, such as serum urea and creatinine, track disease progression and therapy response. Cystatin C, an excellent glomerular filtration rate (GFR) indicator, is freely filtered through the glomerular membrane, and its concentration is solely dictated by GFR. About 25%–40% of untreated hypertensives develop hyperuricemia. Microalbuminuria is a traditional renal function biomarker and outcome predictor in renal disease patients. This research compared blood cystatin C to standard renal function indicators (serum urea, serum creatinine [Scr], serum uric acid, urine microalbumin, and urinary total protein) in essential hypertension patients in a Kumaun tertiary care institution. MATERIAL AND METHODS: One hundred hypertensive individuals aged 30–60 years and 50 age- and sex-matched normotensive controls were studied. The fully computerized Roche Cobas C501 Analyzer assessed Scr and urea. Estimation of serum cystatin C was done by turbidimetric method using semiautomatic analyzer (MERCK Microlab 300). A urine sample taken over a 24-h period for total protein concentration and urinary microalbumin was taken in a clean plastic container. The preservative was 10% HCL. Using pyrogallol red and turbidimetric immunoassay, urine total protein and microalbumin were measured. RESULTS: In comparison to the control group and Stage II hypertension participants, hypertensive people exhibited substantially greater mean blood urea, creatinine, urine total protein, and urinary microalbumin levels. The difference was statistically significant (P < 0.0007). Only Stage II hypertensives had substantially lower mean estimated GFR (eGFR) and eGFR (Scr) levels than controls. These differences were statistically significant (P < 0.0001). Cases and Stage II hypertensives had considerably higher mean blood cystatin C levels than controls and Stage I hypertensives. Serum cystatin C correlated positively with urea, creatinine, and urine microalbumin, but negatively with uric acid (r = 0.004; P > 0.05). Linear connections were found between parameters. CONCLUSION: Our investigation found that cystatin C-based GFR equations beat Scr ones. Serum cystatin C is more sensitive than Scr for detecting early renal function deterioration in hypertensive individuals.

Chronic kidney disease (CKD) is a microvascular complication that frequently affects numerous patients diagnosed with diabetes. For the diagnosis of CKD, the guidelines recommend the identification of the urinary albumin/creatinine ratio and the determination of serum creatinine, based on which the estimated rate of glomerular filtration (eGFR) is calculated. Serum creatinine is routinely measured in clinical practice and reported as creatinine-based estimated glomerular filtration rate (eGFRcr). It has enormous importance in numerous clinical decisions, including the detection and management of CKD, the interpretation of symptoms potentially related to this pathology and the determination of drug dosage. The equations based on cystatin C involve smaller differences between race groups compared to GFR estimates based solely on creatinine. The cystatin C-based estimated glomerular filtration rate (eGFRcys) or its combination with creatinine (eGFRcr-cys) are suggested as confirmatory tests in cases where creatinine is known to be less precise or where a more valid GFR estimate is necessary for medical decisions. Serum creatinine is influenced by numerous factors: age, gender, race, muscle mass, high-protein diet, including protein supplements, and the use of medications that decrease tubular creatinine excretion (H2 blockers, trimethoprim, fenofibrate, ritonavir, and other HIV drugs). The low levels of creatinine stemming from a vegetarian diet, limb amputation, and conditions associated with sarcopenia such as cirrhosis, malnutrition, and malignancies may lead to inaccurately lower eGFRcr values. Therefore, determining the GFR based on serum creatinine is not very precise. This review aims to identify a new perspective in monitoring renal function, considering the disadvantages of determining the GFR based exclusively on serum creatinine. [ABSTRACT FROM AUTHOR]

Background: At present, estimated glomerular filtration rate (eGFR) remains the most frequently utilized parameter in the evaluation of kidney injury severity. Numerous equations have been formulated based on serum creatinine (Scr) or serum cystatin C (Cysc) levels. However, there is a lack of consensus regarding the efficacy of these equations in assessing eGFR, particularly for elderly individuals in China. This study aimed to evaluate the applicability of the MDRD, MDRDc, CKD-EPI series, BIS1, and FAS equations within the Chinese elderly population. Methods: A cohort of 298 elderly patients with measured GFR (mGFR) was enrolled. The patients were categorized into three subgroups based on their mGFR levels. The eGFR performance was examined, taking into account bias, interquartile range (IQR), accuracy P30, and root-mean-square error (RMSE). Bland–Altman plots were employed to verify the validity of eGFR. Results: The participants had a median age of 71 years, with 167 (56.0%) being male. Overall, no significant differences in bias were observed among the seven equations (P > 0.05). In terms of IQR, P30, and RMSE, the BIS1 equation demonstrated superior accuracy (14.61, 72.1%, and 13.53, respectively). When mGFR < 30 ml/min/1.73 m2, all equations underestimated the true GFR, with the highest accuracy reaching only 59%. Bland–Altman plots indicated that the BIS1 equation exhibited the highest accuracy, featuring a 95% confidence interval (CI) width of 52.37. Conclusions: This study suggested that the BIS1 equation stands out as the most applicable for estimating GFR in Chinese elderly patients with normal renal function or only moderate decline. 2020NL-085-03, 2020.08.10, retrospectively registered. [ABSTRACT FROM AUTHOR]

Increased serum cystatin C may play a role in the pathogenesis of idiopathic epiretinal membrane (IERM). Physicians should be aware of this relationship and should refer patients to the ophthalmology clinic for screening. To evaluate the serum cystatin C level in patients with IERM, and its associations with visual acuity. Sixty-eight patients with IERM and sixty-nine controls were enrolled in this cross-sectional study. Based on the results of optical coherence tomography, patients with IERM were divided into four stages (I, II, III and IV). Serum cystatin C was measured in all participants. Serum cystatin C levels were compared between the control group and IERM group and between the IERM group with different optical coherence tomography stages. Multiple linear regression was used to evaluate the relationship between serum cystatin C and IERM stages and best corrected visual acuity. Serum cystatin C level was higher in the IERM group than in the control group (P < 0.001). There were statistically significant differences in serum cystatin C among different stages of IERM (PI vs II = 0.011, PI vs IV < 0.001 and PIII vs IV = 0.040, respectively). There were significant differences in best corrected visual acuity among different stages of IERM (PI vs III = 0.018, PI vs IV < 0.001, PII vs IV < 0.001 and PIII vs IV < 0.001, respectively). Regression analysis showed a positive correlation between serum cystatin C and best corrected visual acuity (t = 2.238 P = 0.029). The cut-off value of receiver operation characteristic curve of serum cystatin C for IERM was 0.775. This study revealed that serum cystatin C may be involved in the pathogenesis of IERM and can predict its occurrence. Elevated serum cystatin C appears to be associated with the severity of the disease and relatively poor vision acuity in IERM patients. [ABSTRACT FROM AUTHOR]

Background: The estimation of Serum Cystatin C has become widely available in clinical practice. Though Cystatin C is an approved marker of renal dysfunction in diabetic population, its role is evolving as a marker of cardiovascular mortality as well as neuro-degenerative disorders like Alzheimer's disease. Aim: The present study aims to establish the predictive role of Cystatin C in cardiovascular complications and hence its role in as a marker of cardiovascular mortality in a diabetic population. Methods: 144 patients fulfilling inclusion and exclusion criteria were enrolled in the study over a period of 3 months. Details of socio-demographic data, clinical variables and biochemical parameters were collected using a semi-structured proforma specifically designed for this study. Relevant clinical tests were done and data thus collected was tabulated and analysed using SPSS. Conclusion: There is a significant correlation of elevated Serum Cystatin C and cardiovascular complications. It has a strong positive predictive value for cardiovascular mortality in diabetic population. [ABSTRACT FROM AUTHOR]

Background: Serum Cystatin C is elevated in diabetic patients even before the appearance of microalbuminuria and hence, it can be used as an early marker for detecting diabetic nephropathy. Aims and Objectives: The aim of the study was to compare serum Cystatin C levels in Type 2 diabetes mellitus (DM) patients with microalbuminuria and without microalbuminuria. Materials and Methods: A hospital-based and cross-sectional study conducted among 40 patients with Type 2 diabetic mellitus attending the Endocrinology OPD Medical College, Thiruvananthapuram. Informed consent was obtained. Biochemical parameters like blood glucose was estimated by hexokinase method and serum creatinine by modified Jaffe’s method using fully automated analyzer. HbA1c was determined by turbidimetric immunoinhibition method. Serum Cystatin C and microalbumin was evaluated by ELISA method. Statistical analysis of data was performed using SPSS windows version 26. Statistical tests like unpaired t-test were done to compare the study subjects and Pearson correlation was done to know the correlation between variables and P6.5%. Serum creatinine value

Chronic kidney disease (CKD) is a microvascular complication that frequently affects numerous patients diagnosed with diabetes. For the diagnosis of CKD, the guidelines recommend the identification of the urinary albumin/creatinine ratio and the determination of serum creatinine, based on which the estimated rate of glomerular filtration (eGFR) is calculated. Serum creatinine is routinely measured in clinical practice and reported as creatinine-based estimated glomerular filtration rate (eGFRcr). It has enormous importance in numerous clinical decisions, including the detection and management of CKD, the interpretation of symptoms potentially related to this pathology and the determination of drug dosage. The equations based on cystatin C involve smaller differences between race groups compared to GFR estimates based solely on creatinine. The cystatin C-based estimated glomerular filtration rate (eGFRcys) or its combination with creatinine (eGFRcr-cys) are suggested as confirmatory tests in cases where creatinine is known to be less precise or where a more valid GFR estimate is necessary for medical decisions. Serum creatinine is influenced by numerous factors: age, gender, race, muscle mass, high-protein diet, including protein supplements, and the use of medications that decrease tubular creatinine excretion (H2 blockers, trimethoprim, fenofibrate, ritonavir, and other HIV drugs). The low levels of creatinine stemming from a vegetarian diet, limb amputation, and conditions associated with sarcopenia such as cirrhosis, malnutrition, and malignancies may lead to inaccurately lower eGFRcr values. Therefore, determining the GFR based on serum creatinine is not very precise. This review aims to identify a new perspective in monitoring renal function, considering the disadvantages of determining the GFR based exclusively on serum creatinine.

Abstract Background Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. Case presentation We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient’s kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. Conclusions This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury.

Abstract Background Tubulointerstitial lesions play a pivotal role in the progression of IgA nephropathy (IgAN). Elevated N-acetyl-beta-D-glucosaminidase (NAG) in urine is released from damaged proximal tubular epithelial cells (PTEC) and may serve as a biomarker of renal progression in diseases with tubulointerstitial involvement. Methods We evaluated the predictive value of urinary NAG (uNAG) for disease progression in 213 biopsy-proven primary IgAN patients from January 2018 to December 2019 at Zhongshan Hospital, Fudan University. We compared the results with those of serum cystatin C (sCysC). Results Increased uNAG and sCysC levels were associated with worse clinical and histological manifestations. Only uNAG level was independently associated with remission status after adjustment. Patients with high uNAG levels (> 22.32 U/g Cr) had a 4.32-fold greater risk of disease progression. The combination of baseline uNAG and clinical data may achieve satisfactory risk prediction in IgAN patients with relatively preserved renal function (eGFR ≥ 60 ml/min/1.73 m2, area under the curve [AUC] 0.760). Conclusion Our results suggest that uNAG is a promising biomarker for predicting IgAN remission status.

Background: Serum Cystatin C is elevated in diabetic patients even before the appearance of microalbuminuria and hence, it can be used as an early marker for detecting diabetic nephropathy. Aims and Objectives: The aim of the study was to compare serum Cystatin C levels in Type 2 diabetes mellitus (DM) patients with microalbuminuria and without microalbuminuria. Materials and Methods: A hospital-based and cross-sectional study conducted among 40 patients with Type 2 diabetic mellitus attending the Endocrinology OPD Medical College, Thiruvananthapuram. Informed consent was obtained. Biochemical parameters like blood glucose was estimated by hexokinase method and serum creatinine by modified Jaffe's method using fully automated analyzer. HbA1c was determined by turbidimetric immunoinhibition method. Serum Cystatin C and microalbumin was evaluated by ELISA method. Statistical analysis of data was performed using SPSS windows version 26. Statistical tests like unpaired t-test were done to compare the study subjects and Pearson correlation was done to know the correlation between variables and P<0.05 was considered as significant. Results: In this study, all the study group had fasting blood level above 126 mg/dL with HbA1c value >6.5%. Serum creatinine value <1.4 mg/dL is considered normal. In this study group subjects, 34 (85%) had normal level of serum creatinine, while 6 (15%) 6 patients had creatinine level more than 1.4 mg/dL. Mean±SD for serum cystatin C levels in Type 2 DM patients with microalbuminuria and without microalbuminuria was 22.7±4.9 and 4.79±3.55, respectively. The serum cystatin C levels were significantly (P<0.01) higher in the microalbuminuria group than in the normoalbuminuric patients. In the present study, there was highly significant positive correlation between serum cystatin C and microalbumin (r=0.93, P<0.001. In the present study, there was highly significant positive correlation between serum cystatin C and fasting blood sugar, serum creatinine, and glycated hemoglobin in patients with microalbuminuria) than without microalbuminuria. Conclusion: Serum cystatin C levels were found to be increased in patients with Type 2 DM with microalbuminuria and can be considered as a valuable early marker of renal damage. [ABSTRACT FROM AUTHOR]

Background: Urinary ascites represents a scarcely observed pseudo-acute kidney injury in clinical settings. Protracted or missed diagnosis may hold grave ramifications for patient outcomes. Case presentation: We reported a case involving an elderly female patient experiencing pseudo-acute kidney injury accompanied by ascites, wherein her renal dysfunction persisted despite medical intervention and hemodialysis. Urinary ascites was identified via a methylene blue test and by contrasting creatinine levels in serum and ascites. This patient's kidney function was multiple typified by a marked elevation in serum creatinine/Cystatin C ratio (> 2 L/dL), potentially serving as a clue for the clinical diagnosis of pseudo-acute kidney injury engendered by urinary ascites. Conclusions: This case suggested the potential diagnostic value of an asynchronous increase in serum creatinine and serum CysC (or an increased ratio of blood creatinine to blood CysC) in patients with pseudo-acute kidney injury. [ABSTRACT FROM AUTHOR]

Background: Tubulointerstitial lesions play a pivotal role in the progression of IgA nephropathy (IgAN). Elevated N-acetyl-beta-D-glucosaminidase (NAG) in urine is released from damaged proximal tubular epithelial cells (PTEC) and may serve as a biomarker of renal progression in diseases with tubulointerstitial involvement. Methods: We evaluated the predictive value of urinary NAG (uNAG) for disease progression in 213 biopsy-proven primary IgAN patients from January 2018 to December 2019 at Zhongshan Hospital, Fudan University. We compared the results with those of serum cystatin C (sCysC). Results: Increased uNAG and sCysC levels were associated with worse clinical and histological manifestations. Only uNAG level was independently associated with remission status after adjustment. Patients with high uNAG levels (> 22.32 U/g Cr) had a 4.32-fold greater risk of disease progression. The combination of baseline uNAG and clinical data may achieve satisfactory risk prediction in IgAN patients with relatively preserved renal function (eGFR ≥ 60 ml/min/1.73 m2, area under the curve [AUC] 0.760). Conclusion: Our results suggest that uNAG is a promising biomarker for predicting IgAN remission status. [ABSTRACT FROM AUTHOR]

AIM: To prepare the model of diabetic retinopathy(DR)on the basis of the model of type 2 diabetes mellitus(T2DM)in rats, observe the preventive and protective effect of metformin on DR in T2DM rats and the effect on serum Cystatin C(Cys C), and discuss its mechanism.METHODS: A total of 120 male SD rats were selected and 30 rats were randomly divided into blank control group A(10 rats), T2DM group(10 rats)and metformin intervention group A(10 rats). The remaining 90 rats were randomly divided into three groups: blank control group B(30 rats), DR group(30 rats)and metformin intervention group B(30 rats). Except for blank control groups A and B, T2DM models were constructed in all other groups. After modeling, rats in metformin intervention group A were given metformin by gavage, and rats in blank control group A and T2DM group were given normal saline by gavage. After 3mo of intervention, fasting blood glucose(FBG)and fasting serum insulin(FINS)indexes of the three groups were measured respectively, and the homeostasis model assessment of insulin resistance(HOMA-IR)was calculated and analyzed; The serum Cys C, tumor necrosis factor-α(TNF-α), the levels of Interleukin-8(IL-8), vascular endothelial growth factor(VEGF)and reactive oxygen species(ROS)were measured, and we observed the retinal tissue and vascular morphology of rats by FFA, HE staining and transmission electron microscopy; rats in metformin intervention group B began to give metformin by gavage 3mo after the course of T2DM, and other rats were given normal saline. According to the length of intervention, 10 rats were taken from each group and observed at 4, 5 and 6mo respectively. Serum levels of Cys C, TNF-α, IL-8, VEGF and ROS were measured in each group. We observed the retinal tissue and vascular morphology of rats by FFA, HE staining and transmission electron microscopy.RESULTS: The expressions of serum FBG, FINS, HOMA-IR, Cys C, TNF-α, IL-8, VEGF and ROS were statistically significant among the blank control group A, T2DM group and metformin intervention group A(P

Clinically type 2 diabetes mellitus (T2DM) without serum creatinine microalbuminuria, macroalbuminuria lacks predictors for diabetic nephropathy (DN). We utilized a meta-analysis technique to review the literature to evaluate whether serum cystatin C may be used as an early marker of diabetic nephropathy in light of the differing opinions regarding the utility of serum cystatin C as such. PubMed, Google Scholar, Web of Science, EMBASE, and Scopus Database were searched using various key search terms. Studies involving T2DM patients and containing serum cystatin C levels and the estimated glomerular filtration rate (eGFR) data were included. Pooled sensitivity, specificity, positive predictive value, and negative predictive value were also calculated. The pooled sensitivity and specificity of serum cystatin C for predicting DN were 0.87 (95% CI 0.84 - 0.91) and 0.84 (95% CI 0.83 - 0.88) respectively. The pooled positive and negative predictive values of serum cystatin C for predicting DN were 7.035 (95 % CI 4.30 – 11.43) and 0.15 (95% CI 0.09 - 0.21) respectively. The area under the summary receiver operating characteristic (SROC) curve was 0.9548 and the diagnostic odds ratio was 67.10 (95% CI 28.12 - 156.84). Serum cystatin C is a significant biomarker of DN among patients with T2DM. It can also positively monitor kidney function progression and prediction of adverse outcomes among T2DM patients.

Background: Hepatorenal syndrome is a part of the prerenal acute kidney injury (AKI) characterized by kidney dysfunction which is secondary to the decreased renal blood flow that occurs in liver cirrhosis with portal hypertension and is a fatal complication. Hepatorenal syndrome (HRS) occurs in about 20% of liver cirrhosis patients with refractory ascites. Method: This study was conducted on 24 liver cirrhosis patients with ascites who visited Gastroenterohepatology Outpatient Ward and Internal Medicine Inpatient Unit, Dr. M. Djamil Padang. Samples were collected and data analyses were conducted in December 2019 to March 2020. Results: In this study, the model for end-stage liver disease (MELD)-Na score was used to determine the risk of HRS in liver cirrhosis patients with ascites, in which patients with a MELD-Na score 22 belonged to the group at risk of developing HRS. From 24 patients, the mean MELD-Na score was 24.58 ± 3.5. The lowest MELD-Na score was 22 in 8 patients (33.3%), while 1 patient (4.2%) had the highest MELD-Na score of 35. In this study, serum CysC levels were measured in patients with normal creatinine, and the mean serum CysC level was 2.69 ± 0.46 mg/L. The minimum value of CysC was 2.03 mg/L, while the maximum value was 3.9 mg/L. Serum CysC levels in all 24 patients were increased compared to the normal values. Conclusion: Liver cirrhosis patients who were at risk to develop HRS based on the MELD-Na score have increased serum Cystatin C levels, although serum creatinine levels were still normal.

Background: Diabetic nephropathy is a leading cause of end-stage renal disease. The diagnostic markers of nephropathy, including the presence of albuminuria and/or a reduced estimated glomerular filtration rate, are not clinically ideal, and most of them are raised after a significant reduction in renal function. Therefore, it is crucial to seek more sensitive and non-invasive biomarkers for the diagnosis of diabetic nephropathy. Objective of the study: This study aimed to investigate the serum cystatin C levels and dyslipidemia for the detection of diabetic nephropathy in patients with type 2 diabetes mellitus. Methodology: A hospital-based comparative cross-sectional study was conducted from December 2021 to August 2022 in Tikur, Anbessa specialized teaching hospital with a sample size of 140 patients with type2 diabetes mellitus. Socio-demographic data was collected using a structured questionnaire, and 5mL of blood was collected from each participant following overnight fasting for biochemical analyses. Results: In type 2 diabetes patients with nephropathy, we found significant lipoprotein abnormalities and an increase in serum cystatin C (P < 0.001) compared to those without nephropathy. Serum cystatin C, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, very low-density lipoprotein, high density lipoprotein, and duration of diabetes were identified as being significantly associated with diabetic nephropathy (P < 0.05) in multivariable logistic regression analysis. The mean values of total cholesterol levels, triglyceride levels, and high-density lipoprotein cholesterol levels were also found to be significantly higher (P < 0.05) in females as compared to male type-2 diabetic patients. The fasting blood glucose levels and lipid profiles of the participants were found to be significantly associated with serum cystatin C levels. Conclusion: The present study found significant serum cystatin C and lipoprotein abnormalities in T2DM patients with diabetic nephropathy when compared with those without diabetic nephropathy, and these lipoprotein abnormalities were significantly associated with serum cystatin C levels. [ABSTRACT FROM AUTHOR]

Introduction: Type 2 Diabetes mellitus is the most common metabolic disorder in India. It is assuming epidemic proportions with the Asian-Indian phenotype being more susceptible for the development of the disease. Among Indians, the onset of type 2 diabetes occurs at a younger age making them more vulnerable to develop all the complications of diabetes due to longer duration of the disease. Aims: To study the utility of serum Cystatin C as a marker for early detection of renal dysfunction in type 2 Diabetes Mellitus. Materials and Methods: The study included 50 diabetic patients admitted to/treated on outpatient basis at the Patna Medical College and Hospitals, Patna during the study period extending from May 2021-April 2023. Result: Glycemic control was assessed by HbA1c. 14 patients (28%) had HbA1c <7% indicating adequate control and 36 (82%) had poorly controlled sugars and 41 patients (82%) all of whom had normal serum creatinine values were found to have 24 hr urine creatinine clearance < 90 mL/min indicating renal dysfunction. Conclusion: Serum Cystatin C appears to hold promise in predicting early renal dysfunction and more so as an indicator of overt nephropathy. The equation of Rule et al seemed to perform better than Grubb's equation in our study population in estimating GFR. [ABSTRACT FROM AUTHOR]

BackgroundDiabetic nephropathy is a leading cause of end-stage renal disease. The diagnostic markers of nephropathy, including the presence of albuminuria and/or a reduced estimated glomerular filtration rate, are not clinically ideal, and most of them are raised after a significant reduction in renal function. Therefore, it is crucial to seek more sensitive and non-invasive biomarkers for the diagnosis of diabetic nephropathy.Objective of the studyThis study aimed to investigate the serum cystatin C levels and dyslipidemia for the detection of diabetic nephropathy in patients with type 2 diabetes mellitus.MethodologyA hospital-based comparative cross-sectional study was conducted from December 2021 to August 2022 in Tikur, Anbessa specialized teaching hospital with a sample size of 140 patients with type2 diabetes mellitus. Socio-demographic data was collected using a structured questionnaire, and 5 mL of blood was collected from each participant following overnight fasting for biochemical analyses.ResultsIn type 2 diabetes patients with nephropathy, we found significant lipoprotein abnormalities and an increase in serum cystatin C (P < 0.001) compared to those without nephropathy. Serum cystatin C, systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low density lipoprotein, very low-density lipoprotein, high density lipoprotein, and duration of diabetes were identified as being significantly associated with diabetic nephropathy (P < 0.05) in multivariable logistic regression analysis. The mean values of total cholesterol levels, triglyceride levels, and high-density lipoprotein cholesterol levels were also found to be significantly higher (P < 0.05) in females as compared to male type-2 diabetic patients. The fasting blood glucose levels and lipid profiles of the participants were found to be significantly associated with serum cystatin C levels.ConclusionThe present study found significant serum cystatin C and lipoprotein abnormalities in T2DM patients with diabetic nephropathy when compared with those without diabetic nephropathy, and these lipoprotein abnormalities were significantly associated with serum cystatin C levels.

Introduction: Acute kidney injury (AKI) caused by cisplatin is common and has a higher incidence of multiple use, resulting in a poor short- and long-term prognosis for patients. There is currently no good premedication AKI risk assessment tool. The aim of this study was to establish an AKI risk assessment nomogram for patients with multiple cisplatin applications. Methods: This study was a retrospective analysis of patients who were treated with non-first-time cisplatin chemotherapy regimen at Changzhou Second People's Hospital affiliated to Nanjing Medical University from January 2016 to January 2022. All data from the development group were used to screen the impact factors of AKI via univariate and multivariate analyses. A nomogram was developed based on these impact factors and verified with verification group. The area under the curve (AUC) of receiver operating characteristic (ROC) curve, calibration curves, and decision curve analyses (DCAs) were used to evaluate the nomogram. Results: Among the 256 patients enrolled in 450 cycles of chemotherapy, 282 were in the development cohort (97 AKI), and 168 were in the validation cohort (61 AKI). Multivariate logistic regression revealed that age, hypertension, diabetes, serum cystatin C (sCysC), urinary kidney injury molecule-1 (uKim1), and a single dose of cisplatin were independently associated with AKI. The results showed that our model yielded satisfied diagnostic performance with an AUC value of 0.887 and 0.906 using the development group and on verification group. The calibration plots and DCA showed the superior clinical applicability of the nomogram. These results were verified in the validation cohort. Conclusion: A nomogram combining functional (sCysC) and tubular (uKim1) injury biomarkers with conventional clinical factors might assess the risk of AKI after multiple cycles of cisplatin chemotherapy. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) in critically ill patients is associated with a significant increase in mortality as well as long-term renal dysfunction and chronic kidney disease (CKD). Serum creatinine (SCr), the most widely used biomarker to evaluate kidney function, does not always accurately predict the glomerular filtration rate (GFR), since it is affected by some non-GFR determinants such as muscle mass and recent meat ingestion. Researchers and clinicians have gained interest in cystatin C (CysC), another biomarker of kidney function. The study objective was to compare GFR estimation using SCr and CysC in detecting CKD over a 1-year follow-up after an AKI stage-3 event in the ICU, as well as to analyze the association between eGFR (using SCr and CysC) and mortality after the AKI event. Method: This prospective observational study used the medical records of ICU patients diagnosed with AKI stage 3. SCr and CysC were measured twice during the ICU stay and four times following diagnosis of AKI. The eGFR was calculated using the EKFC equation for SCr and FAS equation for CysC in order to check the prevalence of CKD (defined as eGFR < 60 mL/min/1.73 m2). Results: The study enrolled 101 patients, 36.6% of whom were female, with a median age of 74 years (30–92), and a median length of stay of 14.5 days in intensive care. A significant difference was observed in the estimation of GFR when comparing formulas based on SCrand CysC, resulting in large differences in the prediction of CKD. Three months after the AKI event, eGFRCysC < 25 mL/min/1.73 m2 was a predictive factor of mortality later on; however, this was not the case for eGFRSCr. Conclusion: The incidence of CKD was highly discrepant with eGFRCysC versus eGFRSCr during the follow-up period. CysC detects more CKD events compared to SCr in the follow-up phase and eGFRCysC is a predictor for mortality in follow-up but not eGFRSCr. Determining the proper marker to estimate GFR in the post-ICU period in AKI stage-3 populations needs further study to improve risk stratification. [ABSTRACT FROM AUTHOR]

Abstract Objective Our study aimed to assess the association between serum cystatin C levels and prognosis in acute myocardial infarction (AMI) patients after coronary reconstructive surgery. Methods We searched PubMed, Embase, and Cochrane Library up to January 21, 2022 without language restriction. Outcomes were major cardiovascular events (MACEs) and mortality. The risk ratio (RR) and 95% confidence interval (CI) were merged by random-effect models. Results We included 8 studies with a total of 7,394 subjects in our meta-analysis. Our meta-analysis showed that higher-level of serum cystatin C levels were associated with higher risk of MACEs (RR = 2.52, 95% CI 1.63–3.89, P

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Background Diabetic nephropathy is a syndrome characterized by a secondary renal disease in patients with diabetes mellitus (DM). It is a serious complication of DM and is the most common cause of the end-stage renal disease. Aim To evaluate the diagnostic value of serum cystatin C level as an early biomarker of nephropathy in children with type 1 diabetes mellitus (T1DM) attending Suez Canal University Hospital. Patients and methods This was a descriptive cross-sectional study that included 49 children with T1DM attending the pediatric endocrinology outpatient clinic of at Suez Canal University Hospital, Ismailia, Egypt, and 49 matched healthy controls during the period from 1/12/2020 to 1/3/2021. The target population was children with T1DM aged between 6 and 18 years of both sexes who were attending the pediatric endocrinology outpatient clinic of Suez Canal University Hospital, Ismailia, Egypt. All studied patients and healthy controls were subjected to history taking and general and systemic examination. The following investigations were done: fasting blood sugar, serum creatinine, estimated glomerular filtration rate, albumin/creatinine ratio (ACR), urine analysis, hemoglobin A1C, and serum cystatin C level). Results ACR and cystatin C levels were significantly higher in albuminuric than nonalbuminuric diabetic patients. There was a significant positive correlation between serum cystatin C and duration of diabetes, hemoglobin A1C, and ACR. For serum cystatin C, regarding detection of microalbuminuria, the sensitivity was 66.7%, specificity was 75%, the positive predictive value was 49%, and the negative predictive value was 0.52%, with the best cut-off value of 0.98 (mg/l). Conclusion Microalbuminuric diabetic patients showed an increased serum cystatin C levels, whereas their creatinine levels were still within normal. Serum cystatin C levels well reflect the severity of renal damage caused by DM. The serum cystatin C measurement might become a useful, practical, noninvasive, and accurate tool for early detection of microalbuminuria and renal insufficiency in T1DM. [ABSTRACT FROM AUTHOR]

BackgroundIt is well known that sarcopenia is a common risk factor in patients with gastrointestinal tumours, which may negatively affect the clinical outcome and prognosis. Recent studies suggest that serum creatinine-cystatin C (Cr/CysC) ratio may be associated with sarcopenia, but this association lacks sufficient evidence in patients with gastrointestinal stromal tumours (GIST). Therefore, this study aimed to investigate whether the Cr/CysC ratio was associated with sarcopenia and recurrence-free survival (RFS) in patients with GIST.Materials and methodsThe study retrospectively analysed 413 patients with GIST who underwent surgical resection from January 2016 to January 2020. The serum Cr/CysC ratio was determined as a proxy for sarcopenia by comparing it with various biomarkers and Cox multifactorial analysis was used to determine the relationship between Cr/CysC ratio and prognosis.ResultsSerum Cr/CysC was positively correlated with skeletal muscle area (SMA) (r = 0.256, p < 0.001), skeletal muscle index (SMI) (r = 0.300, p < 0.001), and hand grip strength (HGS) (r = 0.251, p < 0.001). The area under the receiver operator characteristic curve for sarcopenic subjects with serum Cr/CysC ratio was significantly greater than other biomarkers (Cr/CysC: 0.840, CysC: 0.732, Cr: 0.518). The optimal cut-off value for Cr/CysC was 0.65, and patients in the high Cr/CysC group had a higher 3-year recurrence-free survival (RFS) than those in the low Cr/CysC group (92.72 vs. 72.46%, p < 0.001). Cox multifactorial analysis found that the Cr/CysC ratio was an independent risk factor for RFS in GIST patients (HR = 2.143, 95% CI: 1.431–5.459, p = 0.011).ConclusionSerum Cr/CysC ratio has satisfactory and comparable diagnostic accuracy, and prognostic value for sarcopenia in patients with GIST. Therefore, it can be a simple and practical clinical tool to screen sarcopenia in GIST patients. However, further studies are required to validate these findings.

Background: The COVID-19 pandemic has claimed millions of lives. A tool for early prediction of severity and mortality risk is desirable for better utilization of health care facilities. Several biomarkers like D-dimer, lactate dehydrogenase (LDH), C-reactive protein (CRP) and some recently explored biomarkers like serum cystatin C and serum calprotectin have been proposed as prognostic markers of COVID-19, but their role as prognostic markers is so far undefined. The present work attempted to investigate the possible role of serum cystatin C and serum calprotectin as prognostic tools to predict severity and outcome ahead of time. Material and Methods: This observational cohort study was carried out on 95 COVID-19 patients admitted to a dedicated COVID care facility from mid-October 2020 to January 2021. Serial estimations of serum cystatin C and serum calprotectin levels were done and assessed for significant difference between severe (NEWS 2 score ≥5) and non-severe (NEWS 2 score <5) groups, survivors and deceased and on the basis of comorbidities at each time points. Survival analysis was done based on the optimal thresholds for severity and mortality, calculated from the receiver operating characteristic (ROC). Result: The results showed that median cystatin C levels were significantly higher on the first day in the severe group (P < 0.001) and in patients with cardiovascular disease (P < 0.05), chronic lung disease (P = 0.009) and among patients who died (P < 0.05). It remained raised on day 3 in severe (P < 0.05) and deceased (P < 0.05) group. Serum calprotectin levels were significantly higher in patients with chronic lung disease (P = 0.008) and in those who died (P < 0.05). Conclusion: Serum cystatin C could be used as a tool for early prognosis and therapeutic decision-making for COVID-19 patients. Serum calprotectin seems to be a better marker of critical illness. [ABSTRACT FROM AUTHOR]

Background: The burden of depression in the elderly is increasing worldwide with global aging. However, there is still a lack of research on the relationship between depressive symptoms and the progression of renal function. Our aim is to evaluate the longitudinal association between baseline depressive symptoms and the changes in serum cystatin C levels over 10 years' follow-up period. Methods: We used longitudinal data from the Health and Retirement Study (HRS), an existing community based nationally representative aging cohort study which enrolled individuals over age 50 in the USA. Depressive symptoms were determined using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD) at wave 7 (2004) and wave 8 (2006). Persistent depressive symptoms were defined as both CESD scores measured at waves 7 and 8 were ≥3; episodic depressive symptoms were defined as CESD scores ≥3 at wave 7 or wave 8. A linear mixed model was used to evaluate the correlation between baseline depressive symptoms and future changes in cystatin C levels. Results: The mean age of the 7,642 participants was 63.8 ± 10.8 years, and 60.9% were women. Among the participants, 1,240 (16.2%) had episodic depressive symptoms and 778 (10.2%) had persistent depressive symptoms. Compared with participants with no depressive symptoms at both waves, a significant increase in serum cystatin C levels was found among those with persistent depressive symptoms. Conclusions: Our results showed that baseline persistent depressive symptoms were significantly associated with an increased rate of serum cystatin C levels. The level of serum cystatin C should be monitored in the elderly with persistent depressive symptoms. [ABSTRACT FROM AUTHOR]

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.

BackgroundThe burden of depression in the elderly is increasing worldwide with global aging. However, there is still a lack of research on the relationship between depressive symptoms and the progression of renal function. Our aim is to evaluate the longitudinal association between baseline depressive symptoms and the changes in serum cystatin C levels over 10 years' follow-up period.MethodsWe used longitudinal data from the Health and Retirement Study (HRS), an existing community based nationally representative aging cohort study which enrolled individuals over age 50 in the USA. Depressive symptoms were determined using an eight-item version of the Center for Epidemiologic Studies Depression Scale (CESD) at wave 7 (2004) and wave 8 (2006). Persistent depressive symptoms were defined as both CESD scores measured at waves 7 and 8 were ≥3; episodic depressive symptoms were defined as CESD scores ≥3 at wave 7 or wave 8. A linear mixed model was used to evaluate the correlation between baseline depressive symptoms and future changes in cystatin C levels.ResultsThe mean age of the 7,642 participants was 63.8 ± 10.8 years, and 60.9% were women. Among the participants, 1,240 (16.2%) had episodic depressive symptoms and 778 (10.2%) had persistent depressive symptoms. Compared with participants with no depressive symptoms at both waves, a significant increase in serum cystatin C levels was found among those with persistent depressive symptoms.ConclusionsOur results showed that baseline persistent depressive symptoms were significantly associated with an increased rate of serum cystatin C levels. The level of serum cystatin C should be monitored in the elderly with persistent depressive symptoms.

Abstract Background Combining tubular damage and functional biomarkers may improve prediction precision of acute kidney injury (AKI). Serum cystatin C (sCysC) represents functional damage of kidney, while urinary N-acetyl-β-D-glucosaminidase (uNAG) is considered as a tubular damage biomarker. So far, there is no nomogram containing this combination to predict AKI in septic cohort. We aimed to compare the performance of AKI prediction models with or without incorporating these two biomarkers and develop an effective nomogram for septic patients in intensive care unit (ICU). Methods This was a prospective study conducted in the mixed medical-surgical ICU of a tertiary care hospital. Adults with sepsis were enrolled. The patients were divided into development and validation cohorts in chronological order of ICU admission. A logistic regression model for AKI prediction was first constructed in the development cohort. The contribution of the biomarkers (sCysC, uNAG) to this model for AKI prediction was assessed with the area under the receiver operator characteristic curve (AUC), continuous net reclassification index (cNRI), and incremental discrimination improvement (IDI). Then nomogram was established based on the model with the best performance. This nomogram was validated in the validation cohort in terms of discrimination and calibration. The decision curve analysis (DCA) was performed to evaluate the nomogram’s clinical utility. Results Of 358 enrolled patients, 232 were in the development cohort (69 AKI), while 126 in the validation cohort (52 AKI). The first clinical model included the APACHE II score, serum creatinine, and vasopressor used at ICU admission. Adding sCysC and uNAG to this model improved the AUC to 0.831. Furthermore, incorporating them significantly improved risk reclassification over the predictive model alone, with cNRI (0.575) and IDI (0.085). A nomogram was then established based on the new model including sCysC and uNAG. Application of this nomogram in the validation cohort yielded fair discrimination with an AUC of 0.784 and good calibration. The DCA revealed good clinical utility of this nomogram. Conclusions A nomogram that incorporates functional marker (sCysC) and tubular damage marker (uNAG), together with routine clinical factors may be a useful prognostic tool for individualized prediction of AKI in septic patients.

Abstract Background and Aim Systemic inflammation and organ dysfunction/failure can complicate acute decompensation (AD) of cirrhosis with progression to acute‐on‐chronic liver failure (ACLF), leading to increased mortality. There are few studies on serum biomarkers predicting renal dysfunction (RD) or ACLF in AD. Serum cystatin C (CysC) and interleukin‐6 (IL‐6) were evaluated for predicting RD, ACLF, and mortality in AD patients. Methods Consecutive AD patients seen from January 2018 to June 2019 were included. IL‐6 and CysC were measured in serum at the time of index presentation. Patients were followed for 90 days or until primary (development of RD) or secondary outcomes (development of ACLF or mortality). Multivariate analysis was performed to find whether CysC and IL‐6 can independently predict primary and secondary outcomes. Results A total of 124 patients were screened; 88 patients were included. On follow up, 22 (27.3%) developed RD, 11 (11/57, 19.3%) developed ACLF, and 21 (24%) died. The CysC predicted RD (odds ratio [OR] 7.97, 95% confidence interval [CI] 2.70–23.53, P = 0.001) and ACLF (OR 5.486, 95% CI 1.456–20.6, P = 0.012) development. IL‐6 was not an independent predictor of RD (P = 0.315), ACLF (P = 0.168), and mortality (P = 0.225). Conclusion Serum CysC can predict the development of RD and ACLF in patients of cirrhosis with AD.

Introduction: Hypertension is known to impact the structure and function of the ocular vascular system and is an established risk factor for many eye diseases. This study aimed to detect the blood flow in the optic disc and macula in patients with essential hypertension and to analyze its correlation with serum cystatin C (Cys-C) levels. Methods: This single center, cross-sectional study included 100 patients with primary hypertension without hypertensive retinopathy, who were divided into an experimental group (50 cases, 50 eyes) with elevated serum Cys-C levels and a control group (50 cases, 50 eyes) with normal serum Cys-C. The optic disc and macular vessel density (VD) and vascular perfusion density (PD) were assessed using optical coherence tomography angiography. Data such as the area, perimeter, and circularity of the foveal avascular zone (FAZ) were analyzed. Results: There were statistically significant between-group differences in the VD and PD of the optic disc (p < 0.05). Spearman correlation analysis of related indicators revealed that serum Cys-C was positively correlated with creatinine, uric acid, and FAZ circularity (p < 0.05). Furthermore, serum Cys-C was negatively correlated with optic disc VD and PD in some regions (p < 0.05). Conclusion: In patients with essential hypertension, serum Cys-C is negatively correlated with VD and PD in the inner layer of the optic disc (zone 10). [ABSTRACT FROM AUTHOR]

Objective: Our study aimed to assess the association between serum cystatin C levels and prognosis in acute myocardial infarction (AMI) patients after coronary reconstructive surgery.Methods: We searched PubMed, Embase, and Cochrane Library up to January 21, 2022 without language restriction. Outcomes were major cardiovascular events (MACEs) and mortality. The risk ratio (RR) and 95% confidence interval (CI) were merged by random-effect models.Results: We included 8 studies with a total of 7,394 subjects in our meta-analysis. Our meta-analysis showed that higher-level of serum cystatin C levels were associated with higher risk of MACEs (RR = 2.52, 95% CI 1.63-3.89, P < 0.001) and mortality (RR = 2.64, 95% CI 1.66-4.19, P < 0.001) in AMI patients after coronary revascularization. Subgroup analysis showed that the serum cystatin C levels were associated with significantly higher risk of MACEs (RR = 2.72, 95% CI 1.32-5.60, P = 0.006) and mortality (RR = 2.98, 95% CI 1.21-7.37, P = 0.020) in AMI patients after percutaneous coronary intervention (PCI). However, in AMI patients after coronary artery bypass surgery, there were no significantly higher risk of MACEs (RR = 2.41, 95% CI 0.98-5.93, P = 0.05) and mortality (RR = 3.15, 95% CI 0.76-13.03, P = 0.10). Further subgroup analysis showed that this significantly higher risk of MACEs and mortality did not change with the study sample size, study population area or study follow-up time.Conclusion: The meta-analysis demonstrated that higher serum cystatin C levels were associated with significantly higher risk of MACEs and mortality in AMI patients after PCI. It is a biomarker for risk stratification for predicting the prognosis in AMI patients after PCI. [ABSTRACT FROM AUTHOR]

Introduction: N-acetylcysteine (NAC) is an antioxidant that can regenerate glutathione and is primarily used for acetaminophen overdose. NAC has been tested and used for preventing iatrogenic acute kidney injury or slowing the progression of chronic kidney disease, with mixed results. There are conflicting reports that NAC may artificially lower measured serum creatinine without improving kidney function, potentially by assay interference. Given these mixed results, we conducted a systematic review of the literature to determine whether there is an effect of NAC on kidney function as measured with serum creatinine and cystatin C. Methods: A literature search was conducted to identify all study types reporting a change in serum creatinine after NAC administration. The primary outcome was change in serum creatinine after NAC administration. The secondary outcome was a change in cystatin C after NAC administration. Subgroup analyses were conducted to assess effect of creatinine assay (Jaffe vs. non-Jaffe and intravenous vs. oral). Results: Six studies with a total of 199 participants were eligible for the systematic review and meta-analysis. There was a small but significant decrease in serum creatinine after NAC administration overall (weighted mean difference [WMD], −2.80 μmol/L [95% confidence interval {CI} −5.6 to 0.0]; P = 0.05). This was greater with non-Jaffe methods (WMD, −3.24 μmol/L [95% CI −6.29 to −0.28]; P = 0.04) than Jaffe (WMD, −0.51 μmol/L [95% CI −7.56 to 6.53]; P = 0.89) and in particular with intravenous (WMD, −31.10 μmol/L [95% CI −58.37 to −3.83]; P = 0.03) compared with oral NAC (WMD, −2.5 μmol/L [95% CI −5.32 to 0.32]; P = 0.08). There was no change in cystatin C after NAC administration. Discussion: NAC causes a decrease in serum creatinine but not in cystatin C, suggesting analytic interference rather than an effect on kidney function. Supporting this, the effect was greater with non-Jaffe methods of creatinine estimation. Future studies of NAC should use the Jaffe method of creatinine estimation when kidney outcomes are being reported. Even in clinical settings, the use of an enzymatic assay when high doses of intravenous NAC are being used may result in underdiagnosis or delayed diagnosis of acute kidney injury.

Objective: Ringer's lactate (RL) was one of the perfusion fluid used in renal transplants, which were replaced by perfusion fluid with an intracellular composition like histidine-tryptophan-ketoglutarate (HTK) solution. These are preferred in cadaveric renal transplants. However, there are no guidelines for live-related donor renal transplant. We study whether HTK solution is better than RL solution, an extracellular composition fluid in preserving allograft in live-related donor renal transplantation. Materials and Methods: A single-blinded randomized trial comparing HTK solution and RL solution in 80 patients undergoing live-related donor renal transplantation from July 2017 to June 2018. The outcome was measured in serum cystatin C and plasma malondialdehyde (MDA) and serum creatinine for 30 days. Results: In 19 cases, surgeons preferred HTK solution as perfusion fluid due to the presence of multiple arteries; hence, these cases are removed from analysis due to deviation from the study protocol. Four patients in the HTK group and five patients in the RL group were excluded due to loss to follow-up. Recipient age, sex, and donor age, sex, and basic disease were comparable in both groups. The higher warm ischemia in the HTK group (5.58 min [standard deviation (SD) 1.44 min]) as compared to the RL group (5.00 min [SD 1.12 min]) with P 0.096. Similarly, the longer cold ischemia in the HTK group (82.00 min [SD 21.31 min]) as compared to the RL group (70.32 min [SD 24.56 min]) with P 0.783. 8.3% rejection in the HTK group and 17.9% rejection in the RL group. Serum cystatin C, marker of glomerular filtration was comparable, HTK group ((3.75 ± 1.98 mg/l) and RL (3.94 ± 1.68 mg/l) with P 0.714. The plasma MDA marker of ischemia-reperfusion injury was also comparable HTK group (80.16 ± 80.08 ng/ml) and RL group (61.50 ± 92.23 ng/ml) with a P 0.446. Fall in serum creatinine was significantly more in the HTK group than RL. At the end of 30 days, both groups had similar levels of serum creatinine level. Conclusion: Graft perfused by HTK solution and RL solution at our center had comparable 30-day outcomes. Although none of the differences was statistically significant, the HTK group had consistently better metrics in terms of fall in creatinine and serum cystatin C despite a trend to longer ischemia times and higher plasma MDA levels.

Background: Contrast-induced nephropathy (CIN) has been traditionally defined as an increase in serum creatinine (sCr) after contrast media (CM) exposure. It is generally a transient and reversible form of acute renal failure. Objectives: The objective was to compare changes in serum creatinine and serum cystatin C (sCys C) in patients undergoing CM administration during coronary angiography (CAG) and/or intervention, and whether these changes are a reliable index for early identification of CIN. Materials and Methods: In this prospective study, 50 patients were included, 9 of them were omitted, and remaining 41 patients undergoing CAG and/or intervention. sCr, serum urea, sCys C, and estimated glomerular filtration rate (eGFR) were evaluated at baseline as well as 24 h after exposure to CM. Results: Forty one patients, six of them develop CIN (CIN group) and the remainder 35 not develop CIN (non-CIN group). Clinical parameters showed no significant association between CIN group and non-CIN group except in diabetes mellitus. As comparing patients before and after catheterization, the CIN group showed increase in sCr and serum urea, while remain nearly the same for sCys C, and obvious decrease for eGFR1 and eGFR2, in addition there is significant association for sCr, eGFR1, and eGFR2. In the non-CIN group, only the serum urea showed significant difference. Conclusion: The concentration change of sCr is significantly superior to cystatin C as an early biomarker in the CIN detection. An absolute increase of the concentration of sCr is highly sensitive and specific for the CIN in comparing to cystatin C.

Tadesse Asmamaw,1 Solomon Genet,2 Menakath Menon,2 Getahun Tarekegn,3 Endeshaw Chekol,4 Zeleke Geto,5 Tadesse Lejisa,5 Wossene Habtu,5 Tigist Getahun,5 Yosef Tolcha5 1Department of Biochemistry, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; 2Department of Biochemistry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 3Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; 4Department of Biochemistry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia; 5National Reference Laboratory for Clinical Chemistry, Ethiopian Public Health Institute, Addis Ababa, EthiopiaCorrespondence: Tadesse Asmamaw Email as24tadesse@gmail.comBackground: The proportion of patients with end-stage renal disease caused by diabetes has progressively increased during the last few decades. Serum creatinine level is the most commonly used biochemical parameter to estimate GFR in routine practice. However, 50% of GFR can be lost before significant elevation of serum creatinine. Cystatin C is found to be a new promising marker for early detection of renal diseases.Objective of the Study: The aim of this study was to determine the value of serum cystatin C and serum creatinine levels for early detection of renal disease in patients with type 2 diabetes mellitus.Methodology: A hospital-based comparative cross-sectional study was conducted with a sample size of 120. For early detection of renal disease in patients with type 2 diabetes mellitus, serum creatinine and cystatin C levels were measured and compared.Result and Discussion: Serum creatinine and cystatin C levels were significantly increased in patients with type 2 diabetes mellitus compared to healthy controls. The mean±SD value of serum creatinine was found to be 0.87± 0.44 mg/dL in patients and 0.63± 0.27 mg/dL in control. Serum cystatin C level was also found to be significantly (P=0.0001) higher in patients (0.92± 0.38 mg/L) compared to controls (0.52± 0.20 mg/L). The mean±SD of eGFR in three equations (Creatinine Equation, Cystatin C Equation, and Creatinine–Cystatin C Equation) were 105.7± 27.5 mL/min/m2, 90.4± 28.2 mL/min/m2, and 100± 29.5 mL/min/m2, respectively.Conclusion: Cystatin C-based GFR estimation equations detect renal impairment in patients with type 2 diabetes mellitus earlier than creatinine-based GFR estimation equations.Keywords: diabetic nephropathy, type 2 diabetes, serum cystatin C, creatinine

Copyright of Journal of China Medical University is the property of Journal of China Medical University Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To assess the predictive abilities of serum and urinary cystatin C levels for glomerular lesions in pregnant women with pre-eclampsia. Methods In this study, kidney function markers were compared between38 pregnant women with pre-eclampsia and 22 healthy pregnant women. Results The serum and urine levels of cystatin C and urea were significantly higher in the pre-eclampsia group than in the control group. Receiver operating characteristic curve analysis demonstrated that the serum cystatin C level (91.7%) had a superior diagnostic accuracy for pre-eclampsia than the other markers. Conclusion Serum cystatin C level maybe a significant marker of pre-eclampsia.

Abstract Introduction To investigate the relationship between serum cystatin C levels and disease activity, renal function test, and histopathological findings in patients with lupus nephritis that did not receive any previous treatment. Methods. 20 patients with lupus nephritis and 20 healthy subjects were included in the study. Before initiation of spesific treatment, clinical and laboratory findings including serum creatinine, cystatin C, daily proteinuria and Cockcroft and Gault (C-G) and Modification of Diet in Renal Disease (MDRD) study equation in adults creatinine clearances (CrCl), as well as histopathological activity and chronicity indices and systemic lupus erythematosus disease activity index (SLEDAI) were evaluated. Results.Serum creatinine, cystatin C, C-G and MDRD CrCls in the patients with lupus nephritis and controls were comparable. Both serum creatinine and cystatin C levels positively correlated with activity index and SLEDAI. There was a negative correlation between C-G CrCl with activity index and MDRD CrCl with activity index and SLEDAI. Conclusions.Our findings suggest that in lupus nephritis measuring the cystatin C level before renal biopsy is performed can not provide a more beneficial predictor than creatinine.

Background: Coronary heart disease (CHD) and heart failure (HF) are the major causes of morbidity and mortality worldwide. Early and accurate diagnoses of CHD and HF are essential for optimal management and prognosis. However, conventional diagnostic methods such as electrocardiography, echocardiography, and cardiac biomarkers have certain limitations, such as low sensitivity, specificity, availability, and cost-effectiveness. Therefore, there is a need for simple, noninvasive, and reliable biomarkers to diagnose CHD and HF., Aim: To investigate serum cystatin C (Cys-C), monocyte/high-density lipoprotein cholesterol ratio (MHR), and uric acid (UA) diagnostic values for CHD and HF., Methods: We enrolled 80 patients with suspected CHD or HF who were admitted to our hospital between July 2022 and July 2023. The patients were divided into CHD ( n = 20), HF ( n = 20), CHD + HF ( n = 20), and control groups ( n = 20). The serum levels of Cys-C, MHR, and UA were measured using immunonephelometry and an enzymatic method, respectively, and the diagnostic values for CHD and HF were evaluated using receiver operating characteristic (ROC) curve analysis., Results: Serum levels of Cys-C, MHR, and UA were significantly higher in the CHD, HF, and CHD + HF groups than those in the control group. The serum levels of Cys-C, MHR, and UA were significantly higher in the CHD + HF group than those in the CHD or HF group. The ROC curve analysis showed that serum Cys-C, MHR, and UA had good diagnostic performance for CHD and HF, with areas under the curve ranging from 0.78 to 0.93. The optimal cutoff values of serum Cys-C, MHR, and UA for diagnosing CHD, HF, and CHD+HF were 1.2 mg/L, 0.9 × 10 9 , and 389 µmol/L; 1.4 mg/L, 1.0 × 10 9 , and 449 µmol/L; and 1.6 mg/L, 1.1 × 10 9 , and 508 µmol/L, respectively., Conclusion: Serum Cys-C, MHR, and UA are useful biomarkers for diagnosing CHD and HF, and CHD+HF. These can provide information for decision-making and risk stratification in patients with CHD and HF., Competing Interests: Conflict-of-interest statement: We all authors jointly declare that there is no conflict of interest., (©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background/aimsPersons with occult-reduced estimated glomerular filtration rate (eGFR60 ml/min/1.73 m2), tools to guide cystatin C testing are needed.MethodsWe developed a risk score to estimate an individual's probability of reduced eGFR by cystatin C (eGFRcys

Background: Contrast-induced nephropathy (CIN) has been traditionally defined as an increase in serum creatinine (sCr) after contrast media (CM) exposure. It is generally a transient and reversible form of acute renal failure. Objectives: The objective was to compare changes in serum creatinine and serum cystatin C (sCys C) in patients undergoing CM administration during coronary angiography (CAG) and/or intervention, and whether these changes are a reliable index for early identification of CIN. Materials and Methods: In this prospective study, 50 patients were included, 9 of them were omitted, and remaining 41 patients undergoing CAG and/or intervention. sCr, serum urea, sCys C, and estimated glomerular filtration rate (eGFR) were evaluated at baseline as well as 24 h after exposure to CM. Results: Forty one patients, six of them develop CIN (CIN group) and the remainder 35 not develop CIN (non-CIN group). Clinical parameters showed no significant association between CIN group and non-CIN group except in diabetes mellitus. As comparing patients before and after catheterization, the CIN group showed increase in sCr and serum urea, while remain nearly the same for sCys C, and obvious decrease for eGFR1 and eGFR2, in addition there is significant association for sCr, eGFR1, and eGFR2. In the non-CIN group, only the serum urea showed significant difference. Conclusion: The concentration change of sCr is significantly superior to cystatin C as an early biomarker in the CIN detection. An absolute increase of the concentration of sCr is highly sensitive and specific for the CIN in comparing to cystatin C. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Some studies have reported that both serum cystatin C (Cys C) and dyslipidemia are independently associated with hypertension. However, the combined effect of the two factors is still unknown. The present study was aimed at investigating the effect of Cys C combined with dyslipidemia on hypertension in a large health check-up population in China. METHODS: A total of 203 233 health check-up subjects from January 2011 to July 2016 were recruited into this cross-sectional study. A multivariate logistic regression model was used to evaluate the combined effect of Cys C and dyslipidemia on hypertension. RESULTS: In univariate analysis, Cys C, high-density lipoprotein cholesterol, low-density lipoprotein, total cholesterol, and triglycerides were independently correlated with hypertension (p

Aim: Our previous study demonstrated that the cystatin C-based chronic kidney disease (CKD)-EPI equation and combined by serum creatinine (CKD-EPIscr-cys) had better capability to accurately evaluate glomerular filtration rate in the CKD participants. Considering that the accuracy of estimated glomerular filtration rate (eGFR) remains less ideally, it is essential to modify the equation by including the Chinese eGFR racial factor in order to improve its performance. Methods: Two prospective cohorts were enrolled in 2 medical centers. New equations were developed in 529 participants and validated in 313 participants. Reference glomerular filtration rate (rGFR) was taken by 99mTc-DTPA renal dynamic imaging method (Gates method). The primary outcomes of this study were bias, precision (interquartile range of difference [IQR]), and accuracy (the proportion of eGFR within 30% of rGFR [P30] and root mean square error [RMSE]) of eGFR versus rGFR. Results: In a development data set, Chinese coefficients for CKD-EPIscr (C-CKD-EPIscr), CKD-EPIcys (C-CKD-EPIcys), and CKD-EPIscr-cys (C-CKD-EPIscr-cys) were 0.871, 0.879, and 0.891, respectively. In a validation data set, C-CKD-EPIcys was the most accurate with highest P30 value (62.3%), relative lowest IQR (15.45), and RMSE (0.80) among 6 equations, though the bias of C-CKD-EPIcys was not better than CKD-EPIcys. C-CKD-EPIscr and C-CKD-EPIscr-cys equations were improved in bias (p < 0.001), ­precision, and accuracy (p = 0.004 and

Abstract Background Many studies have evaluated the usefulness of creatinine- (eGFRcr) and cystatin C-based estimated glomerular filtration rate (eGFRcys) at specific time points in predicting renal outcome. This study compared the performance of both eGFR changing slopes in identifying patients at high risk of end-stage renal disease (ESRD). Methods From 2012 to 2017, patients with more than three simultaneous measurements of serum creatinine and cystatin C for 1 year were identified. Rapid progression was defined as eGFR slope

Objective: Serum cystatin C (sCysC) used clinically for detecting early acute kidney injury (AKI) was reported to be independently associated with hemoglobin (HbA1c) levels, diabetes, and prediabetes. We aimed to assess the influence of HbA1c levels, diabetes, or prediabetes on the performance of sCysC for AKI detection in critically ill adults. Methods: A prospective observational study was conducted in a mixed medical-surgical intensive care unit (ICU). Patients were divided into four quartiles based on levels of HbA1c or serum glucose at ICU admission, respectively. Additionally, patients were stratified into four subgroups according to HbA1c levels and history of diabetes, namely recognized diabetes (previous diagnosis of diabetes), unrecognized diabetes, prediabetes, and normal glycemic status. Comparisons were made using the area under the receiver operator characteristic curve (AUC) for AKI detection, and reassessed after patient stratification by above-mentioned glycemic status. Results: Multivariable linear regression revealed that HbA1c levels and history of diabetes were positively related with sCysC (all p .05), sCysC yielded the highest AUCs for detecting AKI in diabetic patients. Moreover, higher optimal cutoff values of sCysC to detect AKI were observed in patients with versus without diabetes. Conclusion: Glycemic status has no significant impact on the accuracy of sCysC for AKI detection in critically ill adults and a higher optimal cutoff value of sCysC for AKI detection should be considered in diabetic patients.