Abstract
Cystatin C (CysC) is a low-molecular-mass protein (13,343 dalton, 120 amino acids) belonging to the cystatin superfamily of reversible inhibitors of cysteine proteases. CysC appears to be eliminated from the circulation almost exclusively by glomerular filtration, which makes it a promising endogenous marker of renal function. CysC has been demonstrated to reflect glomerular filtration rate better than other low-molecular-weight proteins, including creatinine (Cr). We established reference values for serum CysC and compared them with Cr in 108 preterm infants by particle-enhanced nephelometric immunoassay. On the first day, serum CysC values ranged from 1.25 to 2.84 mg/L, significantly decreasing after 3 days of life. Cr levels determined simultaneously on the first day ranged from 0.05 to 1.12 mg/dl and were also significantly different from day 3 levels. Both CysC and Cr levels were independent of gender, birth weight, hemoglobin levels, and hydration state. Cr correlated negatively with gestational age (r = −0.25, p = 0.009), but not CysC. A significant correlation was found between CysC and Cr on day 1 (r = 0.21, p = 0.031), but no correlation was found according to day 3 blood samples (r = 0.19, p = 0.053). CysC is regarded as an alternative for assessing renal function in preterm neonates, but its advantages over Cr are not yet proven.
References
Tóth-Heyn P, Drukker A, Guignard JP (2000) The stressed neonatal kidney: from pathophysiology to clinical management of neonatal vasomotor nephropathy. Pediatr Nephrol 14:227–239
Schwartz GJ, Brion LP, Spitzer A (1987) The use of plasma creatinine concentration for estimating glomerular filtration rate in infants, children, and adolescents. Pediatr Clin North Am 34:571–590
Heymsfield SB, Arteaga C, McManus C, Smith J, Moffitt S (1983) Measurement of muscle mass in humans: validity of the 24-hour urinary creatinine method. Am J Clin Nutr 37:478–494
Filler G (2006) How to measure renal function in children-what is the role of cystatin c? Current Pediatric Reviews 2:225–231
Counahan R, Chantler C, Ghazali S, Kirkwood B, Rose F, Barratt TM (1976) Estimation of glomerular filtration rate from plasma creatinine concentration in children. Arch Dis Child 51:875–878
Grubb A (1992) Diagnostic value of analysis of cystatin C and protein HC in biological fluids. Clin Nephrol 38:20–27
Nilsson M, Wang X, Rodziewicz-Motowidlo S, Janowski R, Lindström V, Onnerfjord P, Westermark G, Grzonka Z, Jaskolski M, Grubb A (2004) Prevention of domain swapping inhibits dimerization and amyloid fibril formation of cystatin C: use of engineered disulfide bridges, antibodies, and carboxymethylpapain to stabilize the monomeric form of cystatin C. J Biol Chem 279:24236–24245
Ylinen EA, Ala-Houhala M, Harmoinen AP, Knip M (1999) Cystatin C as a marker for glomerular filtration rate in pediatric patients. Pediatr Nephrol 13:506–509
Grubb AO (2000) Cystatin C-properties and use as diagnostic marker. Adv Clin Chem 35:63–99
Randers E, Erlandsen EJ (1999) Serum cystatin C as an endogenous marker of the renal function-a review. Clin Chem Lab Med 37:389–395
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
Risch L, Blumberg A, Huber AR (2001) Assessment of renal function in renal transplant patients using cystatin C. A comparison to other renal function markers and estimates. Ren Fail 23:439–448
Helin I, Axenram M, Grubb A (1998) Serum cystatin C as a determinant of glomerular filtration rate in children. Clin Nephrol 49:221–225
Tian S, Kusano E, Ohara T, Tabei K, Itoh Y, Kawai T, Asano Y (1997) Cystatin C measurement and its practical use in patients with various renal diseases. Clin Nephrol 48:104–108
Herget-Rosenthal S, Trabold S, Pietruck F, Holtmann M, Philipp T, Kribben A (2000) Cystatin C: efficacy as screening test for reduced glomerular filtration rate. Am J Nephrol 20:97–102
Feldman H, Guignard JP (1982) Plasma creatinine in the first month of life. Arch Dis Child 57:123–126
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Armangil, D., Yurdakök, M., Canpolat, F.E. et al. Determination of reference values for plasma cystatin C and comparison with creatinine in premature infants. Pediatr Nephrol 23, 2081–2083 (2008). https://doi.org/10.1007/s00467-008-0867-1
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DOI: https://doi.org/10.1007/s00467-008-0867-1