Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels : Journal of Medical Biochemistry Jump to ContentJump to Main Navigation
Show Summary Details

Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia


IMPACT FACTOR 2015: 0.742

SCImago Journal Rank (SJR) 2015: 0.204
Source Normalized Impact per Paper (SNIP) 2015: 0.333
Impact per Publication (IPP) 2015: 0.507

Open Access
Online
ISSN
1452-8266
See all formats and pricing

 


Select Volume and Issue
Loading journal volume and issue information...

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

Todor Gruev1 / Koco Chakalarovski1 / Olivera Stojceva-Taneva1 / Ani Grueva1 / Katerina Trenceva1

University Clinic for Clinical Biochemistry, Skopje, Macedonia1

University Nephrology Clinic, Skopje, Macedonia2

This content is open access.

Citation Information: Journal of Medical Biochemistry. Volume 28, Issue 3, Pages 191–196, ISSN (Online) 1452-8266, ISSN (Print) 1452-8258, DOI: 10.2478/v10011-009-0014-y, October 2009

Publication History

Published Online:
2009-10-06

Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

The aim of the present study is to describe the influence of glucocorticoid immunosuppression on serum cystatin C concentration in renal transplant patients. To evaluate the influence of immunosuppressive regimens, especially glucocorticoids, on serum cystatin C level, 38 clinically stable patients on immunosuppression therapy with low-dose glucocorticoids were compared to 30 clinically stable patients receiving cyclosporin A alone, and 18 clinically stable patients receiving cyclosporin A together with azathioprine. Clinical stability was defined as the absence of acute rejection, febrile infection, and cyclosporin A toxicity, as well as stability of creatinine clearance as estimated by the formula of Cockroft and Gault. All groups were compared for estimated creatinine clearance (CrCl) values and had comparable gender, age and time since transplantation. The group receiving short-course, high-dose methylprednisolone was analyzed at four time points: a) before methylprednisolone commencement (median, 15 days); b) the day methylprednisolone was introduced (before medication); c) after 3 days of methylprednisolone therapy; and d) on a follow-up 9-10 days after the last dose. Intravenous administration of high-dose methylprednisolone led to significant differences in cystatin C levels at different time points (before administration, after three doses, and 8 days after discontinuation). Glucocorticoid medication in adult renal transplant patients is associated in a dose-de pendent manner with increased cystatin C, leading to systematic under estimation of GFR. Moreover, our data illustrate the need for specific reference intervals in patients on glucocorticoid therapy. In clinical routine settings, as well as in future clinical studies, it is important to take glucocorticoid medication into account when interpreting serum cystatin C concentrations in renal transplant patients presumably, as well as in other patient groups.

Uticaj Glukokortikoidnih Imunosupresiva na Nivo Cistatina C U Serumu

U radu je opisan uticaj glukokortikoidne imunosupresije na koncentraciju cistatina C u serumu pacijenata posle transplantacije bubrega. Kako bi se odredio uticaj imunosupresivne terapije, naročito glukokortikoida, na nivo cistatina C u serumu, upoređeno je 38 klinički stabilnih pacijenata koji su primali niske doze glukokortikoida sa 30 klinički stabilnih pacijenata koji su primali samo ciklosporin A, i 18 klinički stabilnih pacijenata koji su primali ciklosporin A zajedno sa azatioprinom. Klinička stabilnost je definisana kao odsustvo akutne reakcije, febrilne infekcije i ciklosporinske nefrotoksičnosti uz stabilan klirens kreatinina utvrđen pomoću formule Kokrofta i Golta. Grupa pacijenata koji su primali u kratkom periodu visoke doze metilprednizolona analizirana je 15 dana ranije, na dan aplikacije, trećeg i 9-10 dana po završetku terapije. Rezultati su potvrdili da u prva tri dana od primene (500 mg/dan) postoji značajno povećanje koncentracije cistatina C, koja se normalizovala po završetku terapije. Rezultati dobijeni primenom niskih doza glukokortikosteroidne terapije pokazuju značajno povećanje koncentracije cistatina C u odnosu na kontrolnu grupu. Ova preliminarna ispitivanja ukazuju na potrebu uvođenja specifičnog referentnog intervala za pacijente na glukokortikoidnoj terapiji.

Keywords: cystatin C; renal transplantation; methylprednisolone

Keywords: cistatin C; transplantacija bubrega; metilprednizolon

  • Grubb AO. Cystatin C — properties and use as diagnostic marker. Adv Clin Chem 2000; 35: 63-99. [PubMed]

  • Finney H, Newman DJ, Price CP. Adult reference ranges for serum cystatin C, creatinine and predicted creatinine clearance. Ann Clin Biochem 2000; 37: 49-59. [CrossRef] [PubMed]

  • Swan SK. The search continues — an ideal marker of GFR [Editorial]. Clin Chem 1997; 43: 913-14. [PubMed]

  • Tanaka A, Suemaru K, Araki H. A new approach for evaluating renal function and its practical application. J Pharmacol Sci 2007; 105: 1-5. [PubMed] [CrossRef] [Web of Science]

  • Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C — a new marker of glomerular filtration rate in children independent of age and height. Pediatrics 1998; 101: 875-81. [CrossRef]

  • Filler G, Priem F, Lepage N, et al. β-Trace protein, cystatin C, β2-microglobulin and creatinine compared for detecting impaired glomerular filtration rates in children. Clin Chem 2002; 48: 729-36. [PubMed]

  • Le Bricon T, Thervet E, Froissart M, Benlakehal M, Bousquet B, Legendre C, Erlich D. Plasma cystatin C is superior to 24-h creatinine clearance and plasma creatinine for estimation of glomerular filtration rate 3 months after kidney transplantation [Letter]. Clin Chem 2000; 46: 1206-7.

  • Newman DJ, Thakkar H, Edwards RG, Wilkie M, White T, Grubb AO, Price CP. Serum cystatin C: a replacement for creatinine as a biochemical marker of GFR. Kidney Int 1994; 46: S20-S21.

  • Hillege HL, Verhave JC, Bakker SJL, et al. Cystatin C is superior to serum creatine in prediction of mortality in the general population; data obtained from the PRE-VEND study. ASN congress 2003; Abstract SA-FC 150.

  • Bokenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J. Cystatin C serum concentrations underestimate glomerular filtration rate in renal transplant recipients. Clin Chem 1999; 45: 1866-8. [PubMed]

  • Bjarnadottir M, Grubb A, Olafsson I. Promoter-mediated, dexamethasone-induced increase in cystatin C production by HeLa cells. Scand J Clin Lab Invest 1995; 55: 617-23. [PubMed] [CrossRef]

  • Kalansoorija A, Holbrook I, Jennings P, et. al. Serum cystatin C, enzymuria, tubular proteinuria and early renal insult in type 2 diabetes. Br J Biomed Sci 2007; 64: 121-3.

  • Randers E, Erlandsen EJ, Pedersen OL, Hasling C, Danielsen H. Serum cystatin C as an endogenous parameter of the renal function in patients with normal to moderately impaired kidney function. Clin Nephrol 2000; 54: 203-9. [PubMed]

  • Le Bricon T, Tervet E, at al. Changes of Plasma Cystatin C after Renal Transplantation and Acute Rejection in Adults. Clin Chem 1999; 44: 2243-9.

  • Herget-Rosenthal S, Trabold S, Huesing J, Heemann U, Philipp T, Kribben A. Cystatin C - an accurate marker of glomerular filtration rate after renal transplantation? Transpl Int 2000; 13, 285-9. [CrossRef]

  • Gowans E, Fraser CG. Biological variation of serum and urine creatinine and creatinine clearance: ramifications for interpretation of results and patient care. Ann Clin Biochem 1988; 25: 259-63. [PubMed]

  • Roos JF, Doust J, Tett SE, et al. Diagnostic accuracy of cystatin C compared to serum creatinine for the estimation of renal dysfunction in adults and children. A meta analysis. Clin Biochem 2007; 40: 383-91. [PubMed] [Web of Science] [CrossRef]

  • Newman D, Thakkar H, Edwards R, Wilkie M, White T, Grubb A, Price C. Serum cystatin C measured by automated immunoassay: a more sensitive marker of changes in GFR than serum creatinine. Kidney Int 1995; 47: 312-8. [CrossRef] [PubMed]

  • Kyse-Andersen J, Schmidt C, Nordin G, Andersson B, Nilsson-Ehle P, Lindström V, Grubb A. Serum cystatin C, determined by a rapid, automated particle-enhanced turbidimetric method, is a better marker than serum creatinine for glomerular filtration rate. Clin Chem 1994; 40: 1921-6.

  • Helin I, Axenram M, Grubb A. Serum cystatin C as a determinant of glomerular filtration rate in children. 1998; Clin Nephrol 49, 221-5. [PubMed]

  • Knapp ML, Mayne PD. Development of an automated kinetic Jaffé method designed to minimise bilirubin interference in plasma creatinine assays. Clin Chim Acta 1987; 168: 239-46. [CrossRef] [PubMed]

  • Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-4. [CrossRef] [PubMed]

  • Hoek FJ, Kemperman FAW, Ktediet RT. A comparison between Cystatin C, plasma creatinine and the Cocroft and Gault formula for the estimation of glomerular filtration rate. Nephrol Dial Transplant 2003; 18: 2024-31.

  • Larson A, Malm J, Grubb A, et al. Calculation of glomerular filtration rate expressed im mL/min prom plasma Cystatin C values in mg/L. Scand J Clin Lab Invest 2004; 64: 25-30. [CrossRef]

  • Cimerman N, Brguljan PM, Krasovec M, Suskovic S, Kos J. Serum cystatin C, a potent inhibitor of cysteine proteinases, is increased in asthmatic patients. Clin Chim Acta 2000; 300: 83-95. [CrossRef]

  • Risch L, Blumberg A, Huber A. Rapid and accurate assessment of glomerular filtration rate in patients with renal transplants using serum cystatin C. Nephrol Dial Transplant 1999; 14: 1991-6. [PubMed]

  • Bokenkamp A, Ozden N, Dieterich C, Schumann G, Ehrich JHH, Brodehl J. Cystatin C and creatinine after successful kidney transplantation in children. Clin Nephrol 1999; 52: 371-6. [PubMed]

  • Fliser D, Ritz E. Serum cystatin C concentration as a marker of renal dysfunction in the elderly. Am J Kidney Dis 2001; 37: 79-83. [PubMed]

Citing Articles

Here you can find all Crossref-listed publications in which this article is cited. If you would like to receive automatic email messages as soon as this article is cited in other publications, simply activate the “Citation Alert” on the top of this page.

[1]
A. Softić, L. Begić, A. Halilbašić, T. Vižin, and J. Kos
ISRN Oncology, 2013, Volume 2013, Page 1
[2]
Velibor Čabarkapa, Romana Mijović, Zoran Stošić, Nikola Ćurić, Radmila Žeravica, and Branislava Ilinčić
Journal of Medical Biochemistry, 2012, Volume 31, Number 2

Comments (0)

Please log in or register to comment.