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Journal of Medical Biochemistry

The Journal of Society of Medical Biochemists of Serbia

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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: https://doi.org/10.2478/v10011-009-0014-y, October 2009

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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

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