Skip to main content


Log in

Influence of commonly used drugs on the accuracy of cystatin C-derived glomerular filtration rate

  • Original Article
  • Published:
Pediatric Nephrology Aims and scope Submit manuscript


There is controversy about the effect of certain drugs on cystatin C (CysC) concentrations, which would limit the usability of CysC for estimation of glomerular filtration rate (GFR) in patients with renal disease. Seventy-one children (ages 2.6 months to 18 years) with renal disease and on at least one study medication (tacrolimus, cyclosporine, mycophenolate mofetil, corticosteroids, fosinopril, ramipril and enalapril, losartan, cotrimoxazole) were tested in 85 nuclear medicine GFR clearance studies with simultaneous CysC determinations. We analyzed the relationship between the dose per kilogram and the ratio of the measured GFR to the CysC-derived GFR, with a ratio of 1 resembling agreement. A non-zero slope in linear regression analysis was considered significant for a drug effect on CysC. No significant relationship was found between the doses of the medication and the cystatin C GFR for any of the medications. Only cotrimoxazole showed a GFR ratio that was significantly lower than 1, which may be related to small numbers; otherwise the value was always 1. CysC provides accurate data for calculating GFR independent of the drug doses studied and avoids the use of methods of direct GFR measurement.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others


  1. Grubb A, Simonsen O, Sturfelt G, Truedsson L, Thysell H (1985) Serum concentration of cystatin C, factor D and beta 2-microglobulin as a measure of glomerular filtration rate. Acta Med Scand 218:499–503

    PubMed  Google Scholar 

  2. Bökenkamp A, Domanetzki M, Zinck R, Schumann G, Byrd D, Brodehl J (1998) Cystatin C: a new marker of glomerular filtration rate in children independent of age and height. Pediatrics 101:875–881

    Article  PubMed  Google Scholar 

  3. Uchida K, Gotoh A (2002) Measurement of cystatin C and creatinine in urine. Clin Chim Acta 323:121–128

    Article  PubMed  Google Scholar 

  4. Filler G, Lepage N (2003) Should the Schwartz formula for estimation of GFR be replaced by cystatin C formula? Pediatr Nephrol 18:981–985

    Article  PubMed  Google Scholar 

  5. Schwartz GJ, Haycock GB, Edelmann CM Jr, Spitzer A (1976) A simple estimate of glomerular filtration rate in children derived from body length and plasma creatinine. Pediatrics 58:259–263

    PubMed  Google Scholar 

  6. Laterza OF, Price CP, Scott MG (2002) Cystatin C: an improved estimator of glomerular filtration rate? Clin Chem 48:699–707

    PubMed  Google Scholar 

  7. Dharnidharka VR, Kwon C, Stevens G (2002) Serum cystatin C is superior to serum creatinine as a marker of kidney function: a meta-analysis. Am J Kidney Dis 40:221–226

    Article  PubMed  Google Scholar 

  8. Fricker M, Wiesli P, Brandle M, Schwegler B, Schmid C (2003) Impact of thyroid dysfunction on serum cystatin C. Kidney Int 63:1944–1947

    Article  PubMed  Google Scholar 

  9. Risch L, Huber AR (2002) Glucocorticoids and increased serum cystatin C concentrations. Clin Chim Acta 320:133–134

    Article  PubMed  Google Scholar 

  10. Bökenkamp A, van Wijk J, Lentze MJ, Stoffel-Wagner B (2002) Effect of corticosteroid therapy of serum cystatin C and β-microglobulin concentrations. Clin Chem 48:1123–1126

    PubMed  Google Scholar 

  11. Filler G, Priem F, Lepage N, Sinha P, Vollmer I, Clark H, Keely E, Matzinger M, Akbari A, Althaus H, Jung K (2002) Beta-trace protein, cystatin C, beta(2)-microglobulin, and creatinine compared for detecting impaired glomerular filtration rates in children. Clin Chem 48:729–736

    PubMed  Google Scholar 

  12. Barbour GL, Crumb CK, Boyd CM, Reeves RD, Rastogi SP, Patterson RM (1976) Comparison of inulin, iothalamate, and 99mTc-DTPA for measurement of glomerular filtration rate. J Nucl Med 17:317–320

    PubMed  Google Scholar 

  13. Bjarnadottir M, Grubb A, Olafsson I (1995) Promoter-mediated, dexamethasone-induced increase in cystatin C production by HeLa cells. Scand J Clin Lab 55:617–623

    Google Scholar 

  14. Risch L, Herklotz R, Blumberg A, Huber AR. (2001) Effects of glucocorticoid immunosuppression on serum cystatin C concentrations in renal transplant patients. Clin Chem 47:2055–2059

    PubMed  Google Scholar 

  15. Cimerman N, Brguljan PM, Krasovec M, Suskovic S, Kos J (2000) Serum cystatin C, a potent inhibitor of cysteine proteinases, is elevated in asthmatic patients. Clin Chim Acta 300:83–95

    Article  PubMed  Google Scholar 

  16. Knight EL, Verhave JC, Spiegelman D, Hillege HL, De Zeeuw D, Curhan GC, De Jong PE (2004) Factors influencing serum cystatin C levels other than renal function and the impact on renal function measurement. Kidney Int 65:1416–1421

    Article  PubMed  Google Scholar 

  17. Koenig W, Twardella D, Brenner H, Rothenbacher D (2005) Plasma concentrations of cystatin C in patients with coronary heart disease and risk for secondary cardiovascular events: more than simply a marker of glomerular filtration rate. Clin Chem 51:321–327

    Article  PubMed  Google Scholar 

  18. Randers E, Kornerup K, Erlandsen EJ, Hasling C, Danielsen H (2001) Cystatin C levels in sera of patients with acute infectious diseases with high C-reactive protein levels. Scand J Clin Lab Invest 61:333–335

    Article  PubMed  Google Scholar 

Download references


This study was supported by a research grant from the American Academy of Pediatrics.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Guido Filler.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Foster, J., Reisman, W., Lepage, N. et al. Influence of commonly used drugs on the accuracy of cystatin C-derived glomerular filtration rate. Pediatr Nephrol 21, 235–238 (2006).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: