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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Editorial Board Member: Gillery, Philippe / Kazmierczak, Steven / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Schlattmann, Peter / Whitfield, John B.

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

Yucel Ustundag1 / Ufuk Samsar2 / Sereften Acikgoz3 / Mehmet Cabuk4 / Sibel Kiran5 / Eyup Kulah6 / Selim Aydemir7

1Department of Internal Medicine, Clinic of Gastroenterology, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

2Department of Internal Medicine, Clinic of Gastroenterology, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

3Department of Biochemistry, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

4Department of Nuclear Medicine, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

5Department of Public Health, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

6Department of Internal Medicine, Clinic of Nephrology, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

7Department of Internal Medicine, Clinic of Gastroenterology, School of Medicine, Zonguldak Karaelmas University, Zonguldak, Turkey

Corresponding author: Yucel Ustundag, MD, Mehmetcik cad, Incivez sk, 5/18, Yavuz Apt, Site, Zonguldak 67100, Turkey Phone: +90-35-9543556, Fax: +90-37-22610155

Citation Information: Clinical Chemical Laboratory Medicine. Volume 45, Issue 7, Pages 890–894, ISSN (Online) 14374331, ISSN (Print) 14346621, DOI: 10.1515/CCLM.2007.130, July 2007

Publication History

Received:
2007-01-14
Accepted:
2007-02-19
Published Online:
2007-07-08

Abstract

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.

Clin Chem Lab Med 2007;45:890–4.

Keywords: ascites; glomerular filtration rate; liver cirrhosis stage; renal resistive index; serum cystatin C

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