ABSTRACT
Objective: To determine the diagnostic accuracy and cut-off values of serum cystatin C as early diagnostic biomarker of diabetic kidney disease. Study Design: Cross-sectional analytical study. Place and Duration of Study: Department of Pathology, Army Medical College, Rawalpindi in collaboration with Endocrinology Department, Military Hospital [MH], Rawalpindi from November 2015 to November 2016
Methodology: One hundred and nineteen diagnosed patients of type 2 diabetes mellitus were enrolled in the study from the outpatient Endocrinology Department of the MH Rawalpindi. Fifty disease-free controls were also included. Fasting blood samples of the patients and controls were analysed for creatinine by Jaffé's kinetic method and estimated GFR was calculated using MDRD-based equation for GFR. Serum cystatin C was estimated by quantitative turbidimetric method
Results: Serum cystatin C was higher in the diabetic group [mean = 1.022 +/-0.33 mg/dl] as compared to the control group [mean = 0.63 +/-0.14 mg/dl]. ROC curve analysis, keeping less than 60 ml/min/1.73 m2 GFR [CKD-MDRD based] as reference value of the stat variable/gold standard; revealed an area under the curve of 0.914 [95% CI 0.85-0.98] and at optimal sensitivity of 88.2% and specificity of 84.8% the established cut-off of serum cystatin C was 1.26 mg/L
Conclusion: Cystatin C is an accurate biomarker of diabetic kidney disease with good sensitivity and specificity
ABSTRACT
Objective: To compare e-GFR estimated by creatinine or cystatin C based and combined creatinine and cystatin C based equations in type 2 diabetics in different stages of albuminuria. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Chemical Pathology, Army Medical College Rawalpindi in collaboration with endocrinology outpatient department Military Hospital Rawalpindi, from Nov 2015 to Nov 2016
Material and Methods: A total of 119 type 2 diabetic subjects of either gender, aged 30- 60 years were enrolled in the study with duration of diabetes less than 15 years and were divided into further sub groups on the basis of degree of albuminuria determined by spot urine albumin to creatinine ratio [uACR]. Fifty age matched disease free controls with no history of any systemic disease were also included in the study. Known patients of type 1 diabetes, chronic inflammatory disorders, uncontrolled hypertension, thyroid disease, chronic kidney disease, on lipid lowering drugs, steroids, ACE inhibitors and pregnant ladies were excluded from the study. Serum creatinine serum cystatin C were assessed on fully automated chemistry analyzer selectra. E-GFR was calculated by online GFR calculator by National Kidney Foundation. Comparison of means of e-GFR calculated by various equations was carried out by one way ANOVA and post-hoc Tukey tests. Degree of agreement between various equations for the estimation of GFR was assessed by kappa statistics. A p-value less than 0.05 were considered statistically significant
Results: Mean e-GFR [ml/min/1.73m[2]] was lowest in cystatin C based CKD-EPI equation [89.56 +/- 39.84] followed by combined cystatin C and creatinine based CKD-EPI [92.34 +/- 37.88]. Values of e-GFR by creatinine based CKD-EPI equation [95.84 +/- 27.24], and by creatinine based MDRD equation [105.37 +/- 64.98] were both higher. In creatinine based MDRD, equation normo albuminuria and micro albuminuria groups did not show statistically significant difference as compared to each other and control group. The mean value of e-GFR was found to be lowest in the normo albuminuric diabetics when estimated by cystatin C based CKD-EPI equation [88.82 +/- 46.98] followed by combined creatinine and cystatin C based CKD-EPI equation [95.73 +/- 42.96]
Conclusion: Cystatin C based CKD-EPI equation for e-GFR identifies more patients with glomerular dysfunction in normo-albuminuric stage of DKD as compared to cystatin C and creatinine based CKD-EPI and creatinine based MDRD equations. Therefore, e-GFR estimated by serum cystatin C based CKD-EPI formula is a better option for assessing the renal status in patients of early DKD
ABSTRACT
Introduction: The excess accumulation of free fluid in the peritoneal cavity is due to its multitude causes. Certain cytological and biochemical markers are reported for the differential diagnosis of ascites. In the present study, ascitic patients with liver cirrhosis and ovarian carcinoma are investigated. Aim: To study the concentrations of certain trace elements and ceruloplasmin levels in ascitic fluid and in serum of patients with liver cirrhosis in comparison to ovarian cancer patients. Study Design: The study includes 170 patients with liver cirrhosis, 95 patients with ovarian cancer and 100 serum controls. Place and Duration of Study: The study is performed in the department of Gastroenterology, Osmania General Hospital Hyderabad, A.P, INDIA, between December 2011 to July 2013. Methodology: The trace elements such as magnesium, copper, zinc, iron and ceruloplasmin were investigated in 170 patients with liver cirrhosis (120 males, 50 females, 22-75 years; mean age 46.2±11.2) and 95 ovarian cancer patients (19-84 years; mean age 50.2±12.2). All the analysts were measured in serum and ascitic fluid by using standard commercial kits. 100 serum samples from healthy controls were also included in the study. Results: The mean serum concentrations of copper and ceruloplasmin were significantly increased in ovarian cancer patients when compared to that of liver cirrhosis and healthy controls (P<. 001, P<. 001) respectively. The mean zinc levels in serum samples were low in both the groups when compared to controls (P<. 001). The ascitic fluid zinc levels in ovarian cancer were higher when compared to that of liver cirrhosis (P<. 001). Similar results were noted in the serum iron levels in both the groups. The serum magnesium levels in liver cirrhosis are comparable to that of controls but the levels of magnesium in ovarian cancer ascitic patients are high when compared to that of controls. Conclusion: Our results showed that there are differences in trace elements and ceruloplasmin levels in liver cirrhosis and ovarian cancer patients in both serum and ascitic fluid samples. The cutoff value of copper and ceruloplasmin in serum samples are 134.5 μg/dl and 43.5 mg/dl, while in ascitic fluid were 46.5 μg/dl and 21.0 mg/dl respectively. As the diagnostic efficiency of copper and ceruloplasmin in serum and ascitic fluid samples are 97% to 99% with highest sensitivity and specificity, analysis of trace elements with ceruloplasmin in depth with their ratios may be helpful in differentiating the cirrhotic and neoplastic illness.