Title: Urinary Cystatin C as an Early Biomarker of Acute Kidney Injury in Critically ill Patient

Authors: Suja Lakshmanan, Karthik .B, Santosh Kumar, S.Vaishnavi, R.B. Sudagar Singh

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i5.158

Abstract

Introduction: Acute kidney injury is associated with high mortality in critically ill patients. We usually measure serum creatinine to detect AKI, but it is a poor predictor of accuracy particularly in the early stages of AKI(1). We studied the utility of urinary cystatin C and its significance in AKI.

Materials and Methods: This prospective observational study was done in 83 critically ill patients admitted in ICU. Serum creatinine was done on day 1 and day 3 which was compared with Urinary Cystatin C done on day 1.

Results:  Out of the 83 patients, 36 (43.3%;) developed AKI. Serum creatinine on day 1 and  day 3 were compared with urinary cystatin C  done on day 1. We observed that in the AKI group there was significant elevation of urinary cystatin C (15% (p=0.001)). On contrary in the non AKI group there was a marginal level of increase in urinary cystatin C. As the urinary cystatin C is the early excretory product it can be used as an early biomarker of AKI.

Conclusions: We found that the urinary cystatin C levels were significantly elevated in AKI groups when compared with the creatinine levels. Hence we suggest that urinary cystatin C is a significant early biomarker for AKI. Moreover, further studies are warranted with large number of sample size with multicentric population to confirm these results

Keywords: urinary cystatin C, acute kidney injury, critically ill patients.

References

  1. Waikar SS, Betensky RA, Bonventre JV. Creatinine asthe gold standard for kidney injury biomarker studies? Nephrology, dialysis, transplantation: official publication of the European Dialysis and Transplant Association - European Renal Association. 2009 Nov;24(11):3263-5. PubMed PMID: 19736243.
  2. Chertow GM, Burdick E, Honour M, BonventreJV,Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. Journal of theAmerican Society of Nephrology: JASN. 2005 Nov;16(11):3365-70. PubMed PMID: 16177006.
  3. Bellomo R, Kellum JA, Ronco C. Defining acute renal failure: physiological principles. Intensive care medicine. 2004 Jan;30(1):33-7. PubMed PMID:14618231.
  4. de Mendonca A, Vincent JL, Suter PM, Moreno R, Dearden NM, Antonelli M, et al. Acute renal failure in the ICU: risk factors and outcome evaluated by the SOFA score. Intensive care medicine. 2000 Jul;26(7):915-21. PubMed PMID: 10990106.
  5. Urbschat A, Obermuller N, Haferkamp A. Biomarker of kidney injury. Biomarkers : biochemical indicators of exposure, response, and susceptibility to chemicals. 2011 Jul;16 Suppl 1:S22-30. PubMed PMID: 21707441.
  6. Sirota JC, Klawitter J, Edelstein CL. Biomarkers of acute kidney injury. Journal of toxicology. 2011;2011:328120. PubMed PMID: 22131986. Pubmed Central PMCID: 3205656.
  7. Herget-Rosenthal S, Marggraf G, Husing J, Goring F, Pietruck F, Janssen O, et al. Early detection of acute renal failure by serum cystatin C. Kidney international. 2004 Sep;66(3):1115-22. PubMed PMID: 15327406.
  8. Goldstein SL. Kidney function assessment in the critically ill child: is it time to leave creatinine behind? Critical care. 2007;11 (3):141. PubMed PMID:17581273. Pubmed Central PMCID: 2206426
  9. Jo SK, Rosner MH, Okusa MD. Pharmacologic treatment of acute kidney injury: why drugs haven't worked and what is on the horizon. Clinical journal of the American Society of Nephrology: CJASN. 2007 Mar; 2(2):356-65. PubMed PMID: 17699435.
  10. Stevens LA, Levey AS. Measurement of kidney function. The Medical clinics of North America. 2005 May;89(3):457-73. PubMed PMID: 15755462.
  11. Wald R, Liangos O, Perianayagam MC, Kolyada A, Herget-Rosenthal S, Mazer CD, et al. Plasma cystatin C and acute kidney injury after cardiopulmonary bypass. Clinical journal of the American Society of Nephrology : CJASN. 2010 Aug;5(8):1373-9. PubMed PMID: 2052-2534. Pubmed Central PMCID: 2924412.
  12. Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl Cystatin C--a new marker of glomerular filtration rate in children independent of age and height. Pediatrics. 1998 May;101 (5):875-81.PubMed PMID: 9565418.
  13. Pavicevic S, Peco-Antic A. Cystatin C: our experience. Pediatric nephrology. 2005 Jun;20(6):842-43. PubMed PMID: 15782298
  14. Murty MS, Sharma UK, Pandey VB, Kankare SB.Serum cystatin C as marker of renal function in detection of early acute kidney injury. Indianjournal of nephrology. 2013 May;23(3):180-3. PubMed PMID: 23814415. Pubmed Central PMCID: 3692142
  15. Park MY, Choi SJ, Kim JK, Hwang SD, Lee YW, 2013 Apr; Urinary cystatin C levels as a diagnostic and prognostic biomarker in patients with acute kidney injury. Nephrology (Carlton).18(4):256-62. doi: 10.1111/nep.12037.
  16. Nejat M, Pickering JW, Walker RJ, Westhuyzen J, Shaw GM, Frampton CM, Endre ZH..2010. Urinary cystatin C is diagnostic of acute kidney injury and sepsis, and predicts mortality in the intensive care unit. Crit Care. 14(3):R85. doi: 10.1186/cc9014. Epub 2010 May 12.

Corresponding Author

Dr Karthik .B

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