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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

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

12 Issues per year


IMPACT FACTOR 2016: 3.432

CiteScore 2016: 2.21

SCImago Journal Rank (SJR) 2016: 1.000
Source Normalized Impact per Paper (SNIP) 2016: 1.112

Online
ISSN
1437-4331
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Volume 47, Issue 12 (Dec 2009)

Issues

Should kidney tubular markers be adjusted for urine creatinine? The example of urinary cystatin C

Marc Conti
  • Clinical Biochemistry Laboratory, APHP Bicêtre University Hospital, Le Kremlin Bicêtre, France
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/ Stéphane Moutereau
  • Clinical Biochemistry and Genetics Laboratory, APHP Mondor University Hospital, Créteil, France
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/ Liliane Esmilaire
  • Clinical Biochemistry and Genetics Laboratory, APHP Mondor University Hospital, Créteil, France
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/ Cédric Desbene
  • Clinical Biochemistry and Genetics Laboratory, APHP Mondor University Hospital, Créteil, France
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/ Karim Lallali
  • Clinical Biochemistry Laboratory, APHP Bicêtre University Hospital, Le Kremlin Bicêtre, France
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/ Michel Devanlay
  • Clinical Biochemistry and Genetics Laboratory, APHP Mondor University Hospital, Créteil, France
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/ Antoine Durrbach / Philippe Manivet
  • Clinical Biochemistry and Molecular Biology Laboratory, APHP Lariboisière University Hospital, Paris, France
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/ Pascal Eschwège / Sylvain Loric
  • Clinical Biochemistry and Genetics Laboratory, APHP Mondor University Hospital, Créteil, France
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Published Online: 2009-10-30 | DOI: https://doi.org/10.1515/CCLM.2009.341

Abstract

Background: Evaluation of specific urinary markers with respect to urine creatinine (uCreat) is common. However, as uCreat is a function of both glomerular filtration and tubular secretion, using uCreat for specific tubular markers, suggests that glomerular function is normal, and there is no tubular secretion. Thus, adjusting values of any tubular marker to uCreat, especially in patients with acute or even moderate chronic renal failure, can be misleading.

Methods: Using urine cystatin-C (uCST3) as a model tubular marker for following 120 kidney graft recipients daily, we evaluated the utility of either uCST3 alone or the uCST3/uCreat ratio to detect tubular damage. All positive kidney biopsies were always associated with a uCST3>0.18 mg/L.

Results: Using the uCST3/uCreat ratio, discrepancies regarding biopsy status were observed in nine patients (4 false positive, 5 false negative results). In two patients, variability of uCreat appeared to be the most important factor causing inconsistent uCST3/uCreat ratios. With a negative predictive value (NPV) of 85.7%, uCST3/uCreat can lead to errors in clinical interpretation. These errors can be avoided when estimates of tubular damage are based on uCST3 concentrations alone (NPV=100%).

Conclusions: We recommend using the uCST3 value to evaluate the extent of renal tubular damage. Indeed, our conflicting results on uCST3/uCreat can be extended to every marker of tubular function. Evaluating a urine marker specific for renal tubular damage to a second urine marker that is itself strongly dependent upon glomerular or other renal or non-renal conditions, impairs its clinical relevance and may lead to incorrect interpretations. Correction with uCreat can be performed only in pure glomerulopathy, when specific markers of glomerular function are measured (i.e., urinary albumin). In all other cases of renal diseases, such correction is inappropriate and should be avoided.

Clin Chem Lab Med 2009;47:1553–6.

Keywords: creatininuria; cystatinuria; kidney; tubular markers

About the article

Corresponding author: Prof. Sylvain Loric, Laboratoire de Biochimie Génétique, Hôpital Henri Mondor, 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France Phone: +33149812847, Fax: +33149812842,


Received: 2009-05-15

Accepted: 2009-08-31

Published Online: 2009-10-30

Published in Print: 2009-12-01


Citation Information: Clinical Chemistry and Laboratory Medicine, ISSN (Online) 1437-4331, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2009.341.

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©2009 by Walter de Gruyter Berlin New York. Copyright Clearance Center

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