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Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia

4 Issues per year

IMPACT FACTOR 2016: 1.148

CiteScore 2016: 0.84

SCImago Journal Rank (SJR) 2016: 0.279
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Volume 28, Issue 3 (Jul 2009)


Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Levels

Todor Gruev / Koco Chakalarovski / Olivera Stojceva-Taneva / Ani Grueva / Katerina Trenceva
Published Online: 2009-10-06 | DOI: https://doi.org/10.2478/v10011-009-0014-y

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.PubMedGoogle Scholar

  • 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.CrossrefPubMedGoogle Scholar

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

  • Tanaka A, Suemaru K, Araki H. A new approach for evaluating renal function and its practical application. J Pharmacol Sci 2007; 105: 1-5.PubMedCrossrefWeb of ScienceGoogle Scholar

  • 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.CrossrefGoogle Scholar

  • 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.PubMedGoogle Scholar

  • 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.Google Scholar

  • 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.Google Scholar

  • 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.Google Scholar

  • 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.PubMedGoogle Scholar

  • 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.PubMedCrossrefGoogle Scholar

  • 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.Google Scholar

  • 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.PubMedGoogle Scholar

  • 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.Google Scholar

  • 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.CrossrefGoogle Scholar

  • 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.PubMedGoogle Scholar

  • 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.PubMedWeb of ScienceCrossrefGoogle Scholar

  • 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.CrossrefPubMedGoogle Scholar

  • 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.Google Scholar

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

  • 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.CrossrefPubMedGoogle Scholar

  • Cockcroft DW, Gault MH. Prediction of creatinine clearance from serum creatinine. Nephron 1976; 16: 31-4.CrossrefPubMedGoogle Scholar

  • 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.Google Scholar

  • 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.CrossrefGoogle Scholar

  • 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.CrossrefGoogle Scholar

  • 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.PubMedGoogle Scholar

  • 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.PubMedGoogle Scholar

  • 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.PubMedGoogle Scholar

About the article

Published Online: 2009-10-06

Published in Print: 2009-07-01

Citation Information: Journal of Medical Biochemistry, ISSN (Online) 1452-8266, ISSN (Print) 1452-8258, DOI: https://doi.org/10.2478/v10011-009-0014-y.

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