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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 6  |  Page : 1015-1017
Value of serum cystatin C as a marker of renal function in the early post kidney transplant period


Transplant Research Center, Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran

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Date of Web Publication27-Oct-2009
 

   Abstract 

Management of renal transplant patients requires periodic measurement of renal function especially in early post transplant period. This is usually assessed by measuring the crea­tinine clearance, but because of its limitations, it is not an ideal marker for assessing the renal function. Serum Cystatin C (sCyC) appears to be an endogenous marker of glomerular filtration rate (GFR). To assess the use of sCyC as a marker of renal function in kidney transplant patients, we compared it with serum creatinine (sCr) and 24-hour urine creatinine clearance (CrCl) in the first week post-transplantation. Among 60 patients (62.8% men, 37.2% women) undergoing kidney transplantation (average age: 44.87 ± 13.37 years), we determined renal function at 1, 3, 5, and 7 days after kidney transplantation using: sCr, sCyC and CrCl in a 24-hours urine specimen. During the first 5 days following transplantation, there was a progressive decline in sCr levels. In the first 5 days, post transplantation we could not find good correlation between CrC and sCyC, and the sCyC increased during these 5 days, but after that in day 7, there was a good correlation between CrC and sCyC which is coinciding with decreasing the dose of steroid (r= .625). Therefore, we recommend using sCyC may be used as a marker of renal function after one-week post kidney transplantation.

How to cite this article:
Geramizadeh B, Azarpira N, Ayatollahi M, Rais-Jalali GA, Aghdai M, Yaghoobi R, Banihashemi M, Malekpour Z, Malek-Hosseini SA. Value of serum cystatin C as a marker of renal function in the early post kidney transplant period. Saudi J Kidney Dis Transpl 2009;20:1015-7

How to cite this URL:
Geramizadeh B, Azarpira N, Ayatollahi M, Rais-Jalali GA, Aghdai M, Yaghoobi R, Banihashemi M, Malekpour Z, Malek-Hosseini SA. Value of serum cystatin C as a marker of renal function in the early post kidney transplant period. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2019 Dec 9];20:1015-7. Available from: http://www.sjkdt.org/text.asp?2009/20/6/1015/57256

   Introduction Top


Accurate and rapid assessment of renal func­tion is crucial in renal transplant recipients espe­cially in the early post transplantation period. [1] The ideal marker for GFR is an endogenous substance with a regular production rate and constant level in the circulation. It should be freely filtered by glomeruli, appear exclusively in the urine and should not bind proteins. It also should not suffer alteration by drugs. Serum creatinine (sCr) is the time tested parameter for renal function. [2] GFR is under or over estimated by creatinine clearance, because of its tubular secretion, and variations with muscle mass, diet, and drugs. For years, attempts have been made with many substances, one of which is sCyC. Serum Cystatin C (sCyC) has recently been proposed as an alternative marker for estima­tion of GFR. [3]

The goal of this study was to assess the value of sCyC as a marker of renal function in the early post kidney transplant period and com­pare with sCr and creatinine clearance in 24­ hour urine.


   Patients and Methods Top


Sixty consecutive randomly selected renal transplant recipients were prospectively inclu­ded in this study (62.8% men, 37.2% women, and average age 44.87 ± 13.37 years). sCyC, sCr and urine Cr (UCr) were measured at 1, 3, 5 and 7 days post transplant. sCr was mea­sured by Jaffe colorimetric method and sCyC by ELISA method.

Estimation of creatinine clearance (CrCl) was performed according to the 24 hours urine spe­cimen collection. Estimates of GFR were ob­tained using CrCl:

Cr Cl = Urine Cr Χ Urine volume/sCr Χ minutes All clearances were expressed as mL/min/1.73 m 2 .

For statistical analysis, data were analyzed using version 15 of the SPSS statistical pro­gram. A Pearson correlation coefficient was employed to correlate sCyC with sCr and crea­tinine clearance. Values of P< 0.001 were con­sidered statistically significant.


   Results Top


During the first 5 days, following transplan­tation there was a progressive decline in sCr levels. Levels of sCr declined during the first 5 days post transplant, but the levels of sCyC did not decrease in these days. From day 7 on­wards, there was a good correlation between CrC and sCyC with a similar decline (P< 0.001 and r= 0.625).

There was a significant correlation with sCys­tatin C levels and steroid dose in the first 5 days post transplant (r= 0.625). The concentration of sCyC was not affected by age, gender and body weight.


   Discussion Top


The ideal marker for GFR should appear en­dogenously in plasma at a constant rate, be freely filtered at the glomeruli, be neither re­absorbed or, secreted by renal tubules and nor undergo extra renal elimination. [4]

Cystatin C is a low molecular weight basic protein (13.26 KD), which is synthesized by all nucleated cells at a constant rate. [5] Because of its low molecular weight and positive charge, Cystatin C is freely filtered by the glomeruli. It is not secreted but reabsorbed by tubular epi­thelial cells and subsequently catabolized, so that it does not return to the blood. [6] Many studies have indicated that sCyC may be superior to sCr as a GFR marker for patients suffering from renal diseases especially those with early and moderate reduction of GFR. [7]

Our study showed that sCyC is well corre­lated with CrC after 5 days of post trans­plantation period. During the first 5 days post transplantation sCyC is affected by the steroid dose; higher dose resulted in higher levels of sCyC when serum creatinine was decreasing. Our results are similar to the report by Xu et al [2] and Mendiluce et al [8] ; who showed that sCyC is a useful determinant of GFR in the renal transplant patients with moderate impairment of renal function and higher steroid dose re­sults in higher sCyC levels respectively.

In conclusion our study suggests that during the first week, after transplantation, sCr is still a good marker to assess the renal function. The level of sCyC is dependent on high steroid dose in the first week post renal transplantation and should be used as a marker of renal function afterwards.

 
   References Top

1.Akbas SH, Yavuz A, Tuncer M, et al. Serum Cystatin C as an index of renal function in kidney transplant patients. Transplant Proc 2004;36:99-101.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Xu H, Lu Y, Teng D, Wang L, Li Y. Assess­ment of glomerular filtration rate in renal trans­plant patients using serum Cystatin C. Transplant Proc 2006;38:2006-8.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Kyshe-Anderson J, Schmidt C, Nordin G, et al. Serum Cystatin C, determined by a rapid, automated particle-enhanced turbidimetric me­thod, is a better marker than serum glomerular filtration rate. Clin Chem 1994;40:1921.  Back to cited text no. 3      
4.Swan SK. The search continues- an ideal marker of GFR. Clin Chem 1997;43:913.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]  
5.Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration rate to replace creatinine. Nephron 1995;70:370.  Back to cited text no. 5  [PUBMED]    
6.Paskalev E, Lambreva L, Simeonov P, et al. Serum Cystatin C in renal transplant patients. Clin Chim Acta 2001;310:53.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Poege U, Stoschus B, Stoffel-Wagner B, et al. Cystatin C as an endogenous marker of glome­rular filtration rate in renal transplant patients. Kidney Blood Press Res 2003;26:55.  Back to cited text no. 7      
8.Mendiluce A, Bustamante J, Martin D, et al. Cystatin C as a marker of renal function in kid­ney transplant patients. Transplant Proc 2005; 37:3844-7.  Back to cited text no. 8  [PUBMED]  [FULLTEXT]  

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Correspondence Address:
Bita Geramizadeh
Pathology Department,Transplant Research Center, Shiraz University of Medical Sciences, P.O. Box 71345-1864, Shiraz
Iran
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PMID: 19861863

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    References
 

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