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Technical Briefs |
1
Medizinische Klinik und Poliklinik I, Allgemeine Innere Medizin
2
Institute of Clinical Biochemistry, University of Bonn, Sigmund-Freud-Strasse 25, D-53105 Bonn, Germany
a author for
correspondence: fax 49-228-287-4323, e-mail Woitas@uni-bonn.de
The gold standard for the evaluation of the glomerular filtration rate (GFR) is inulin clearance (CIn), but its widespread use is prevented by several technical difficulties (1). The most commonly used marker for GFR is serum creatinine. However, serum creatinine concentrations should be interpreted with caution as a filtration marker in liver cirrhosis because they do not adequately reflect renal dysfunction. Increased tubular secretion and muscle wasting account for the disparity between creatinine concentrations and GFR in cirrhotic patients (2)(3)(4). Thus, GFR has been demonstrated repeatedly to be overestimated by serum creatinine (1)(2)(3)(4)(5).
Cystatin C, a cationic 13-kDa protein that is produced by nucleated cells and catabolized by the renal tubular cells after passing the glomerular filter, has recently been reported as a reliable endogenous marker of GFR in healthy adults and children as well as in patients with nephrologic, urologic, and rheumatologic disorders (6)(7)(8)(9). For patients with liver cirrhosis, however, no data are available. Therefore, we studied cystatin C in comparison to creatinine for the assessment of GFR in these patients. We also determined the precision (10) of each analyte to predict GFR in cirrhotic patients.
Forty-four patients with liver cirrhosis who were classified according
to the Child–Pugh criteria [serum bilirubin, prothrombin time, serum
albumin, ascites, and encephalopathy (11)] had
their GFRs determined by steady-state CIn. All patients had
evidence of portal hypertension indicated by esophageal varices,
ascites, and characteristic features of liver cirrhosis by ultrasound
(Table 1
). The causes of liver disease were alcoholism (n = 31),
viral hepatitis (n = 10), and other liver diseases (n = 3).
No patient had evidence of renal disease as
Acknowledgments
References
The following articles in journals at HighWire Press have cited this article:
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  S. Gourishankar, M. Courtney, G. S. Jhangri, G. Cembrowski, and N. Pannu Serum cystatin C performs similarly to traditional markers of kidney function in the evaluation of donor kidney function prior to and following unilateral nephrectomy Nephrol. Dial. Transplant., September 1, 2008; 23(9): 3004 - 3009. [Abstract] [Full Text] [PDF]
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U. Poge, T. Gerhardt, B. Stoffel-Wagner, H. U. Klehr, T. Sauerbruch, and R. P. Woitas Calculation of glomerular filtration rate based on Cystatin C in cirrhotic patients Nephrol. Dial. Transplant., March 1, 2006; 21(3): 660 - 664. [Abstract] [Full Text] [PDF]
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 U. Poge, T. M. Gerhardt, B. Stoffel-Wagner, H. Palmedo, H.-U. Klehr, T. Sauerbruch, and R. P. Woitas {beta}-Trace Protein Is an Alternative Marker for Glomerular Filtration Rate in Renal Transplantation Patients Clin. Chem., August 1, 2005; 51(8): 1531 - 1533. [Full Text] [PDF]
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W. Koenig, D. Twardella, H. Brenner, and D. Rothenbacher 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., February 1, 2005; 51(2): 321 - 327. [Abstract] [Full Text] [PDF]
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R. Orlando, M. Mussap, M. Plebani, P. Piccoli, S. De Martin, M. Floreani, R. Padrini, and P. Palatini Diagnostic Value of Plasma Cystatin C as a Glomerular Filtration Marker in Decompensated Liver Cirrhosis Clin. Chem., June 1, 2002; 48(6): 850 - 858. [Abstract] [Full Text] [PDF]
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O. F. Laterza, C. P. Price, and M. G. Scott Cystatin C: An Improved Estimator of Glomerular Filtration Rate? Clin. Chem., May 1, 2002; 48(5): 699 - 707. [Abstract] [Full Text] [PDF]
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 A L Gerbes, V Gulberg, M Bilzer, and M Vogeser Evaluation of serum cystatin C concentration as a marker of renal function in patients with cirrhosis of the liver Gut, January 1, 2002; 50(1): 106 - 110. [Abstract] [Full Text] [PDF]
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R. P. Woitas, B. Stoffel-Wagner, U. Poege, P. Schiedermaier, U. Spengler, and T. Sauerbruch Low-Molecular Weight Proteins as Markers for Glomerular Filtration Rate Clin. Chem., December 1, 2001; 47(12): 2179 - 2180. [Full Text] [PDF]
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E. J. Uhlmann, K. G. Hock, C. Issitt, M. R. Sneeringer, D. R. Cervelli, R. T. Gorman, and M. G. Scott Reference Intervals for Plasma Cystatin C in Healthy Volunteers and Renal Patients, as Measured by the Dade Behring BN II System, and Correlation with Creatinine Clin. Chem., November 1, 2001; 47(11): 2031 - 2033. [Full Text] [PDF]
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L. Risch, R. Herklotz, A. Blumberg, and A. R. Huber Effects of Glucocorticoid Immunosuppression on Serum Cystatin C Concentrations in Renal Transplant Patients Clin. Chem., November 1, 2001; 47(11): 2055 - 2059. [Full Text] [PDF]
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