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      Cystatin C: Efficacy as Screening Test for Reduced Glomerular Filtration Rate


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          Serum cystatin C, a cysteine proteinase inhibitor, has been proposed as a marker of glomerular filtration rate (GFR). Serum cystatin C, serum creatinine and creatinine clearance were measured in 226 patients with various nephropathies, covering the entire range of renal function, to evaluate the efficacy of cystatin C as a screening test to detect reduced creatinine clearance in comparison to creatinine. Subgroups of 53 patients with glomerular and 26 patients with tubular impairment were compared to assess whether cystatin C performed differently in either glomerular or tubular impairment. Cystatin C detected reduced creatinine clearance with higher sensitivity (97 vs. 83%), and higher negative predictive value (96 vs. 87%) compared to creatinine. In parallel, 95% sensitivity of cystatin C as derived from receiver-operating characteristic plot was significantly higher (p < 0.05). In the subgroups with glomerular or tubular impairment, cystatin C and creatinine did not significantly differ with regard to efficacy. Serum cystatin C is as efficacious as serum creatinine to detect reduced GFR as measured by creatinine clearance. The efficacy of cystatin C as a screening test may even be superior compared to creatinine. In addition, the efficacy of cystatin C is independent of either glomerular or tubular impairment.

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          Cystatin C--a new marker of glomerular filtration rate in children independent of age and height.

          Serum creatinine is the most common endogenous marker of renal function. The proportionality between creatinine production and muscle mass requires adjustment for height and body composition. The low molecular weight protein cystatin C is produced by all nucleated cells and eliminated by glomerular filtration. Therefore, cystatin C was studied as an alternative marker of glomerular filtration rate (GFR) in children. Cystatin C and creatinine were measured in sera from inulin clearance (CIn) examinations performed in 184 children aged 0.24 to 17.96 years. CIn ranged from 7 to 209 mL/min/1.73 m (median, 77). The reciprocal of cystatin C correlated better with CIn (r = 0.88) than the reciprocal of creatinine (r = 0.72). Stepwise regression analysis identified no covariates for the correlation between cystatin C and CIn, whereas height was a covariate for creatinine. Using an estimate of GFR from serum creatinine and height, correlation with CIn was similar to cystatin C, but female gender and dystrophy were associated with an overestimation of GFR. Diagnostic accuracy in the identification of reduced GFR measured as area under the receiver-operating characteristic plot was 0.970 +/- 0.135 (mean +/- SE) for cystatin C and 0.894 +/- 0.131 for creatinine (NS). A cutoff cystatin C concentration of 1.39 mg/L had 90% sensitivity and 86% specificity for detecting abnormal GFR. Unlike creatinine, serum cystatin C reflects renal function in children independent of age, gender, height, and body composition.
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            Use of methodological standards in diagnostic test research. Getting better but still not good

            M Reid (1995)

              Author and article information

              Am J Nephrol
              American Journal of Nephrology
              S. Karger AG
              April 2000
              19 April 2000
              : 20
              : 2
              : 97-102
              aDivision of Nephrology and bDepartment of Transfusion Medicine, University Hospital, Essen, Germany
              13564 Am J Nephrol 2000;20:97–102
              © 2000 S. Karger AG, Basel

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              Page count
              Figures: 2, Tables: 2, References: 26, Pages: 6
              Self URI (application/pdf): https://www.karger.com/Article/Pdf/13564
              Self URI (text/html): https://www.karger.com/Article/FullText/13564
              Self URI (journal page): https://www.karger.com/SubjectArea/Nephrology
              Clinical Study

              Cardiovascular Medicine,Nephrology
              Creatinine,Creatinine clearance,Cystatin C,Glomerular filtration rate


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