Serum cystatin C in advanced liver cirrhosis and different stages of the hepatorenal syndrome.

Abstract

BACKGROUND AND STUDY AIMS:

The hepatorenal syndrome (HRS) is classified into two types (HRS-2 and HRS-1) based on mild or high serum creatinine elevations. Although it has been identified as an early marker of renal dysfunction, data are lacking about cystatin C across the wide range of renal changes in end-stage liver disease. This study investigates serum cystatin C and creatinine in patients with advanced liver cirrhosis and classic HRS throughout its whole spectrum.

PATIENTS AND METHODS:

Serum cystatin C immunonephelometric measurements were obtained from 65 Child-Pugh C patients: 32 with normal creatinine, 17 with HRS-2 and 16 with HRS-1. The glomerular filtration rate (GFR) was estimated according to modification of diet in renal disease (MDRD) and the Hoek formulae (creatinine- and cystatin C-based, respectively) with staging of renal dysfunction severity into an increasing order from 1 to 5.

RESULTS:

Early HRS was identified by the raised cystatin C in 56.3% of patients having normal creatinine. Cystatin C correlated significantly with creatinine in HRS-2 (r=0.74; p<0.001) and showed a significantly lower multiplication ratio (folds of rise) compared to creatinine in HRS-1 patients (p<0.01). There was no satisfactory agreement between MDRD and Hoek GFR staging (k=0.29).

CONCLUSIONS:

The 'early' HRS identified by a rise in cystatin C in cases with advanced cirrhosis was found to be common and can be added to the already classified two types, as type-3 HRS. Compared to creatinine, cystatin C provides no better information in HRS-2, and underestimates the renal deterioration in HRS-1. Further studies are required to determine the course of the early HRS.

• Authors: Maha Barakat, Mohamed Khalil
• Journal: Arab journal of gastroenterology : the official publication of the Pan-Arab Association of Gastroenterology (Arab J Gastroenterol) Vol. 12 Issue 3 Pg. 131-5 (Sep 2011) ISSN: 2090-2387 [Electronic] Egypt
• PMID: 22055590 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Arab Journal of Gastroenterology. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Biomarkers
• Cystatin C
• Creatinine

Topics

• Adult
• Aged
• Biomarkers (blood)
• Creatinine (blood)
• Cystatin C (blood)
• Disease Progression
• Follow-Up Studies
• Glomerular Filtration Rate
• Hepatorenal Syndrome (blood, diagnosis, etiology)
• Humans
• Liver Cirrhosis (blood, complications, diagnosis)
• Male
• Middle Aged
• Nephelometry and Turbidimetry
• Prognosis
• Severity of Illness Index
• Time Factors