Early detection of kidney diseases in diabetic patients with serum cystatin-C

Background: Prevalence of chronic kidney disease (CKD) is increased worldwide. According to Kidney Disease Improving Global Outcomes guidelines, CKD is defined as abnormalities of kidney structure or function, present for >3 months with implications for health. In individuals with Type-2 diabetes, assessment of kidney function is mandatory, as diabetic nephropathy constitutes the major cause of CKD which leads to end-stage renal disease in diabetic patients. Cystatin-“C”, an alternative biomarker of kidney function, is a better predictor of CKD and is less affected by age, race, or muscle mass. Hence, the presence of elevated serum cystatin C is directly linked with risk of developing a progressive form of CKD. Aim and Objectives: This study aims to evaluate the importance of serum cystatin C as a marker for early detection of CKD in diabetic and non-diabetic patients. Materials and Methods: A total of 25 non-diabetics with CKD (Group-I) and 25 diabetics with CKD (Group-II) were included in the study. Cystatin C and glucose were estimated in the serum sample. Latex-enhanced immunoturbidimetric assay method was used for the estimation of serum cystatin-C. Random blood glucose was estimated using glucose oxidase-peroxidase method. Student’s t-test was used for comparison between CKD with non-diabetics and CKD with diabetics by SPSS statistical package version 20.0. “P” < 0.05 was considered as statistically significant. The results of the two groups are expressed as Mean ± SD. Results: Serum cystatin-C levels were significantly increased (P < 0.001) in Group-I when compared to Group-II. There was a significant negative correlation (r = –0.447, P < 0.001) between serum cystatin C and estimating glomerular filtration rate was observed, which indicates that there is a possibility of renal damage in non-diabetic subjects. Conclusion: Cystatin C can be used as a good alternative marker compared to creatinine for assessing severe kidney damage.

Clinical analysis of serum creatinine cystatin c ratio and diabetes complicated with fractures / 中华内分泌外科杂志

Objective:To explore the relationship between the ratio of serum creatinine and cystatin C (Creatinine/Cystatin C, Cr/CysC) and the risk of fracture in diabetic patients, and to provide a basis for evaluating the risk of fracture in diabetic patients.Methods:Prospectively selected 216 patients with type 2 diabetes (T2DM) who were treated in our hospital from Apr. 2019 to Apr. 2021. Among them, they were divided into fracture group (56 cases) and non-fracture group (160 cases) according to whether they were combined with fractures.Collected two groups of baseline data, general clinical data, laboratory, imaging data, use sarcosine oxidase method to detect serum creatinine (Cr) content, use immunoturbidimetric method to determine serum cystatin C (CysC) level, and calculate The ratio of the two, After matching the propensity scores for age, gender, body mass index, diabetes course, etc., multi-factor Logistic regression analysis was used to evaluate the influencing factors of fracture risk in diabetic patients, and the restrictive cubic spline was used to evaluate the relationship between Cr/CysC and diabetic fracture risk. Relationship.Results:After the two groups were matched by propensity scores, 42 groups were successfully matched, and there was no statistically significant difference in baseline data after matching ( P>0.05) ; Compared with the fracture group, the AGEs (129.13±37.51) ng/mL andALP (97.50±23.80) U/L in the fracture group were higher than those in the non-fracture group (108.41±29.33) ng/mL, (84.35±25.66) U/L higher; Cr/CysC (0.87±0.15) , limb skeletal muscle mass (19.58±3.99) kg were higher than those in the non-fracture group (0.99±0.21) , (21.81±4.38) kg low ( P<0.05) ;Multivariate logistic regression analysis showed that the skeletal muscle mass of extremities ( OR=0.865, 95% CI0.761~0.985) and Cr/CysC ( OR=0.048, 95% CI0.002~0.933) were protective factors for diabetes complicated with fractures; ALP ( OR=1.023, 95% CI1.002~1.044) , AGEs ( OR=1.022, 95% CI1.006~1.039) risk factors for diabetes and fracture (all P<0.05) ,Restricted cubic spline showed a significant non-linear relationship between Cr/CysC and diabetic fractures ( P<0.05) . Conclusion:Cr/CysC is related to the occurrence of fractures in diabetic patients and can be used as a potential predictor of the occurrence of diabetic fractures.

Effects of OSAS on cardiac function and serum cystatin-C levels in patients with chronic heart failure / 中国医师杂志

Objective:To probe the influence of obstruction sleep apnea syndrome (OSAS) on cardiac function and serum cystatin-C (CC) levels in patients with chronic heart failure (CHF), and to discuss its clinical significance.Methods:129 CHF patients suspected of OSAS were selected and divided into observation group (with apnea) and control group (without apnea) according to sleep apnea hypopnea index (AHI). The observation group included mild, moderate and severe groups. After admission, the levels of left ventricular ejection fraction (LVEF), N-terminal forebrain natriuretic peptide (NT-proBNP) and CC were collected for further analysis.Results:The levels of NT-proBNP and CC in 99 patients with CHF complicated with OSAS were higher than those in the control group, while LVEF was lower than those in the control group ( P<0.05); The levels of NT-proBNP and CC in severe group were higher than those in mild and moderate group, while LVEF was significantly lower ( P<0.05); The level of CC in mild to moderate group was higher than that in control group, while LVEF was lower than that in control group ( P<0.05). Rank correlation analysis showed that CC was positively correlated with AHI ( r=0.726, P<0.01); However, there was no significant difference in NT proBNP between mild to moderate group and control group ( P>0.05). Conclusions:OSAS can lead to the deterioration of cardiac function. The CC of CHF patients with OSAS is higher and increases with the aggravation of obstruction. CC may participate in the progression of the disease. A high level of CC may aggravate the development of the disease, and the incidence and mortality of cardiovascular events may also increase.Early prevention and treatment should be given.

Cystatin-C as a potential risk factor for acute myocardial infarction with normal renal function

Background: Myocardial Infarction accounts for 20% of all medical emergency admissions and has the highest risk for adverse effects and deaths. Risk of CAD could be prevented by various strategies and most of the developed countries could reduce the incidence and mortality related to CAD especially Myocardial Infarction by various preventive methods. Cystatin-C thus acts as an independent risk factor for Myocardial Infarction and heart failure. Aim and objective: To estimate the Serum level of Cystatin-C in Acute Myocardial Infarction with normal renal function Materials and methods: The study included 40 patients admitted in the medicine ward of RMMCH. The study period was from February 2018- July 2018. Patients with acute coronary syndromes were identified over a period according to the criteria and were included in the study. Primary complaints like angina, dyspnea, symptoms of cardiac failure were recorded. Risk factors for coronary artery disease like diabetes mellitus, systemic hypertension, smoking, hyperlipidemia, renal failure, and other complaints if any were noted. Clinical examination included a detailed general examination including vital signs and systemic examination of cardiac, respiratory, gastrointestinal, and nervous systems. 2 ml of blood was withdrawn from all patients within 12 hours of onset of symptoms for measuring Cystatin-C. Results: The common age was 52 to 59 years (47.5%) and 45 to 51 years (45.0%). The mean age of the study patients was 51.10 ±5.47 years. The majority of the patients had ST-elevated MI (N=27, 67.5%). Among STEMI, 14 patients were AWMI (N=14, 51.9%) IWMI- STEMI was identified in 18.5% patients. Likewise, posterior wall MI-STEMI was the diagnosis for 18.5% and Inferior-lateral- Bharat Lochan, K. Babu Raj. Cystatin-C as a potential risk factor for acute myocardial infarction with normal renal function. IAIM, 2019; 6(1): 1-7. Page 2 STEMI was the feature for 11.1%. The mean Cystatin-C for STEMI was 1.24 + 0.26 whereas it was 1.38 ± 28 for NSTEMI. The difference was statistically insignificant (t=1.46, p=151). The overall Cystatin-C Mean was 1.29 ± .27, which was higher than the normal level. The correlation of CystatinC with LV function is poor (r = .181, p=26). The relationship was weakly positive and insignificant. That was when Cystatin ‘C’ was more, LV function was less and vice-versa. The correlation of Cystatin-C with TIMI was negative i.e. when Cystatin was more, TIMI was less and vice-versa but the relationship was poor (r=.126, p = .44) and insignificant. Conclusion: Cystatin-C plays an important role in the pathogenesis of Acute Myocardial Infarction, and one of the mechanisms is thought to be that Cystatin-C facilitates the progress of atherosclerosis by regulating inflammation. Cystatin-C is less influenced by age, gender, and muscle mass and thus may be a better indicator of cardiovascular risk especially Myocardial Infarction.

Application of cystatin C and β2-microglobulin in the assessment of condition and short-term efficacy of multiple myeloma / 国际肿瘤学杂志

Objective To explore the application value of serum cystatin C (Cys-C)and β2-micro-globulin (β2-MG)in the diagnosis and short-term efficacy evaluation of multiple myeloma (MM). Methods A total of 450 patients with MM admitted to Anqing Hospital of Chinese People's Liberation Army Navy and Jin-hua Central Hospital of Zhejiang Province from October 2016 to October 2018 were selected as subjects (MM group),according to the Durie-Salmon staging criteria,including 150 patients in stage Ⅰ,Ⅱ and Ⅲ. A total of 150 healthy subjects were selected as the control group. The levels of Cys-C and β2-MG in the serum of the subjects were determined. The differences of Cys-C and β2-MG levels between the two groups and the MM patients with different Durie-Salmon stages were compared. The differences of Cys-C and β2-MG levels between the patients with different short-term efficacy were compared. The receiver operating characteristic (ROC) curve was used to analyze the value of the two indicators in the evaluation of MM efficacy,and the correlation between Cys-C and β2-GM was analyzed. Logistic regression analysis was used to analyze the multiple factors affecting the clinical efficacy of MM patients. Results The levels of Cys-C and β2-MG in the serum of the patients with MM were (2. 11 ± 0. 78)mg/ L and (6. 07 ± 3. 08)g/ L respectively,and those in the control group were (0. 75 ± 0. 20)mg/ L and (1. 78 ± 0. 59)g/ L,with significant differences (t = 33. 848,P <0. 001;t = 28. 084,P < 0. 001). The Cys-C levels of Durie-Salmon stage Ⅰ,Ⅱ and Ⅲ patients were (0. 99 ± 0. 21)mg/ L,(1. 36 ± 0. 17)mg/ L and (3. 07 ± 1. 02)mg/ L respectively,and the difference was statistically significant (F = 44. 157,P < 0. 001). The β2-MG levels in the serum of patients with stage Ⅰ,Ⅱand Ⅲ were (2. 57 ± 0. 75)g/ L,(4. 66 ± 1. 43)g/ L,(8. 63 ± 2. 26)g/ L respectively,and the difference was statistically significant (F = 57. 285,P < 0. 001). In all the patients,338 patients were effective,accoun-ting for 75. 11％,and 112 patients were ineffective,accounting for 24. 89％ . The levels of Cys-C and β2-MG in the serum of the effective MM patients were (1. 28 ± 0. 23)mg/ L and (2. 82 ± 0. 78)g/ L,and those of ineffective patients were (2. 97 ± 0. 77)mg/ L and (6. 22 ± 1. 92)g/ L,with statistically significant differences (t = 35. 874,P < 0. 001;t = 26. 633,P < 0. 001). The sensitivity of serum Cys-C for predicting short-term efficacy was 83. 0％,the specificity was 76. 6％,and those of serum β2-MG were 89. 3％ and 73. 6％ . The area under curve (AUC)of the serum Cys-C was 0. 813 (95％ CI:0. 764-0. 862),and the AUC of serumβ2-MG was 0. 865 (95％ CI:0. 825-0. 906),with a statistically significant difference (Z = 2. 490,P =0. 011). Spearman correlation analysis showed a positive correlation between serum Cys-C and β2-MG (r =0. 539,P = 0. 041). Logistic regression analysis showed that both β2-MG (95％ CI:2. 386-5. 144,P <0. 001)and Cys-C (95％ CI:2. 367-9. 702,P < 0. 001)were independent factors affecting the short-term effi-cacy of MM. Multivariate analysis showed that β2-MG (95％ CI:3. 549-13. 739,P = 0. 001 )was an independent factor affecting the efficacy of MM. Conclusion The levels of serum Cys-C and β2-M in MM patients are significantly higher than those in healthy people,and they show an increasing trend with the pro-gression of MM disease,which can be used as markers for the pathological staging diagnosis of MM patients. The short-term efficacy of the patients can be evaluated by using the two indicators,and the clinical significance in efficacy evaluation of β2-MG is slightly better than that of Cys-C.

The preoperative serum cystatin-C as an independent prognostic factor for survival in upper tract urothelial carcinoma / 亚洲男科学杂志(英文版)

Cystatin-C (Cys-C) has been reported as a valuable prognostic biomarker in various malignancies. However, its effect on upper tract urothelial carcinoma (UTUC) patients has not been investigated before. Thus, to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy (RNU), a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center (West China Hospital, Chengdu, China) were included in this study. Kaplan-Meier method and Cox regression analyses were performed to assess the relationship between Cys-C and survival outcomes using SPSS version 22.0. The cutoff value of Cys-C was set as 1.4 mg l-1 using the receiver operating characteristic (ROC) curves and Youden index. The mean age of patients included was 66.1 ± 11.1 years, and the median follow-up duration was 38 (interquartile range: 19-56) months. Overall, 162 (30.1%) patients had elevated Cys-C, and they were much older and had worse renal function than those with Cys-C <1.4 mg l-1 (both P < 0.001). Meanwhile, Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival (CSS, P = 0.001), disease recurrence-free survival (RFS, P = 0.003), and overall survival (OS, P < 0.001). Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS (hazard ratio [HR]: 1.997, 95% confidential interval [CI]: 1.331-2.996), RFS (HR: 1.429, 95% CI: 1.009-2.023), and OS (HR: 1.989, 95% CI: 1.366-2.896). In conclusion, our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.

The preoperative serum cystatin-C as an independent prognostic factor for survival in upper tract urothelial carcinoma / 亚洲男科学杂志(英文版)

Cystatin-C (Cys-C) has been reported as a valuable prognostic biomarker in various malignancies. However, its effect on upper tract urothelial carcinoma (UTUC) patients has not been investigated before. Thus, to explore the impact of Cys-C on survival outcomes in patients undergoing radical nephroureterectomy (RNU), a total of 538 patients with UTUC who underwent RNU between 2005 and 2014 in our center (West China Hospital, Chengdu, China) were included in this study. Kaplan-Meier method and Cox regression analyses were performed to assess the relationship between Cys-C and survival outcomes using SPSS version 22.0. The cutoff value of Cys-C was set as 1.4 mg l-1 using the receiver operating characteristic (ROC) curves and Youden index. The mean age of patients included was 66.1 ± 11.1 years, and the median follow-up duration was 38 (interquartile range: 19-56) months. Overall, 162 (30.1%) patients had elevated Cys-C, and they were much older and had worse renal function than those with Cys-C <1.4 mg l-1 (both P < 0.001). Meanwhile, Kaplan-Meier analysis revealed that the group with elevated Cys-C had worse cancer-specific survival (CSS, P = 0.001), disease recurrence-free survival (RFS, P = 0.003), and overall survival (OS, P < 0.001). Multivariable Cox analysis suggested that the elevated Cys-C was identified as an independent prognostic predictor of CSS (hazard ratio [HR]: 1.997, 95% confidential interval [CI]: 1.331-2.996), RFS (HR: 1.429, 95% CI: 1.009-2.023), and OS (HR: 1.989, 95% CI: 1.366-2.896). In conclusion, our result revealed that the elevated preoperative serum Cys-C was significantly associated with worse outcomes in UTUC patients undergoing RNU.

Application of cystatin C and β2-microglobulin in the assessment of condition and short-term efficacy of multiple myeloma / 国际肿瘤学杂志

Objective@#To explore the application value of serum cystatin C (Cys-C) and β2-microglobulin (β2-MG) in the diagnosis and short-term efficacy evaluation of multiple myeloma (MM).@*Methods@#A total of 450 patients with MM admitted to Anqing Hospital of Chinese People′s Liberation Army Navy and Jinhua Central Hospital of Zhejiang Province from October 2016 to October 2018 were selected as subjects (MM group), according to the Durie-Salmon staging criteria, including 150 patients in stage Ⅰ, Ⅱ and Ⅲ. A total of 150 healthy subjects were selected as the control group. The levels of Cys-C and β2-MG in the serum of the subjects were determined. The differences of Cys-C and β2-MG levels between the two groups and the MM patients with different Durie-Salmon stages were compared. The differences of Cys-C and β2-MG levels between the patients with different short-term efficacy were compared. The receiver operating characteristic (ROC) curve was used to analyze the value of the two indicators in the evaluation of MM efficacy, and the correlation between Cys-C and β2-GM was analyzed. Logistic regression analysis was used to analyze the multiple factors affecting the clinical efficacy of MM patients.@*Results@#The levels of Cys-C and β2-MG in the serum of the patients with MM were (2.11±0.78) mg/L and (6.07±3.08) g/L respectively, and those in the control group were (0.75±0.20) mg/L and (1.78±0.59) g/L, with significant differences (t=33.848, P<0.001; t=28.084, P<0.001). The Cys-C levels of Durie-Salmon stage Ⅰ, Ⅱ and Ⅲ patients were (0.99±0.21) mg/L, (1.36±0.17) mg/L and (3.07±1.02) mg/L respectively, and the difference was statistically significant (F=44.157, P<0.001). The β2-MG levels in the serum of patients with stage Ⅰ, Ⅱ and Ⅲ were (2.57±0.75) g/L, (4.66±1.43) g/L, (8.63±2.26) g/L respectively, and the difference was statistically significant (F=57.285, P<0.001). In all the patients, 338 patients were effective, accoun-ting for 75.11%, and 112 patients were ineffective, accounting for 24.89%. The levels of Cys-C and β2-MG in the serum of the effective MM patients were (1.28±0.23) mg/L and (2.82±0.78) g/L, and those of ineffective patients were (2.97±0.77) mg/L and (6.22±1.92) g/L, with statistically significant differences (t=35.874, P<0.001; t=26.633, P<0.001). The sensitivity of serum Cys-C for predicting short-term efficacy was 83.0%, the specificity was 76.6%, and those of serum β2-MG were 89.3% and 73.6%. The area under curve (AUC) of the serum Cys-C was 0.813 (95%CI: 0.764-0.862), and the AUC of serum β2-MG was 0.865 (95%CI: 0.825-0.906), with a statistically significant difference (Z=2.490, P=0.011). Spearman correlation analysis showed a positive correlation between serum Cys-C and β2-MG (r=0.539, P=0.041). Logistic regression analysis showed that both β2-MG (95%CI: 2.386-5.144, P<0.001) and Cys-C (95%CI: 2.367-9.702, P<0.001) were independent factors affecting the short-term efficacy of MM. Multivariate analysis showed that β2-MG (95%CI: 3.549-13.739, P=0.001) was an independent factor affecting the efficacy of MM.@*Conclusion@#The levels of serum Cys-C and β2-M in MM patients are significantly higher than those in healthy people, and they show an increasing trend with the progression of MM disease, which can be used as markers for the pathological staging diagnosis of MM patients. The short-term efficacy of the patients can be evaluated by using the two indicators, and the clinical significance in efficacy evaluation of β2-MG is slightly better than that of Cys-C.

Early diagnostic value of urinary insulin-like growth factor binding protein-7 in patients with sepsis-induced acute kidney injury / 中华急诊医学杂志

Objective To evaluate the early diagnostic value of urinary insulin-like growth factor binding protein-7 (IGFBP-7) in sepsis-induced acute kidney injury (AKI),and to compare the effects of urinary IGFBP-7 to that of serum cystatin-C (sCys-C) and serum creatinine (sCr) on predicting the severity of sepsis-induced AKI patients.Methods A total of 105 patients with sepsis admitted to ICU in Tianjin First Hospital from September 2015 to August 2016 were divided into AKI group (n =48) and non-AKI group (n =57) according to the AKI diagnostic criteria.The samples of blood and urine of the patients were collected at 0,3,6,12,24 and 48 h,to measure the levels of urinary IGFBP-7,and serum Cys-C and sCr.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of urinary IGFBP-7,and serum sCys-C and sCr in sepsis-induced AKI patients was determined.Results With the increase in length of ICU stay,the levels of urinary IGFBP-7,and serum sCys-C and sCr in AKI patients increased gradually.There was a significant difference between the two groups in the level of IGFBP-7 at 3 h [2.34 (2.03,4.19) ng/mL vs.1.79 (1.51,2.62) ng/mL,P ＜0.05].At 6 h,the difference in sCys-C between two groups was statistically significant [(1.63 ± 0.42)ng/mL vs.(1.20 ±0.46) ng/mL,P ＜ 0.05].At 12 h,the difference in sCr between two groups was statistically significant [80.5 (74.3,88.0) ng/mL vs.77.0 (67.0,84.0) ng/mL,P ＜ 0.05].The AUCs of urinary IGFBP-7 and sCys-C of sepsis-induced AKI patients were 0.881 (95％ CI:0.813-0.949) and 0.782 (95％ CI:0.692-0.872),which were superior to those in AUC of sCr 0.629 (95％CI:0.522-0.737).When the cutoff value of urinary IGFBP-7 was 1.82 ng/mL,the sensitivity was 93.8％ and the specificity was 77.2％.Conclusions Urine IGFBP-7 and sCys-C have higher predictive value in sepsis-induced AKI than sCr,whereas urine IGFBP-7 is more sensitive and specific than sCys-C,suggesting that IGFBP-7 may be used as sepsis signs of early diagnosis of AKI.

Early diagnostic value of urinary insulin-like growth factor binding protein-7 in patients with sepsis-induced acute kidney injury / 中华急诊医学杂志

Objective To evaluate the early diagnostic value of urinary insulin-like growth factor binding protein-7 (IGFBP-7) in sepsis-induced acute kidney injury (AKI),and to compare the effects of urinary IGFBP-7 to that of serum cystatin-C (sCys-C) and serum creatinine (sCr) on predicting the severity of sepsis-induced AKI patients.Methods A total of 105 patients with sepsis admitted to ICU in Tianjin First Hospital from September 2015 to August 2016 were divided into AKI group (n =48) and non-AKI group (n =57) according to the AKI diagnostic criteria.The samples of blood and urine of the patients were collected at 0,3,6,12,24 and 48 h,to measure the levels of urinary IGFBP-7,and serum Cys-C and sCr.Based on the receiver operating characteristic curve (ROC) and the area under the curve (AUC),the early diagnostic value of urinary IGFBP-7,and serum sCys-C and sCr in sepsis-induced AKI patients was determined.Results With the increase in length of ICU stay,the levels of urinary IGFBP-7,and serum sCys-C and sCr in AKI patients increased gradually.There was a significant difference between the two groups in the level of IGFBP-7 at 3 h [2.34 (2.03,4.19) ng/mL vs.1.79 (1.51,2.62) ng/mL,P ＜0.05].At 6 h,the difference in sCys-C between two groups was statistically significant [(1.63 ± 0.42)ng/mL vs.(1.20 ±0.46) ng/mL,P ＜ 0.05].At 12 h,the difference in sCr between two groups was statistically significant [80.5 (74.3,88.0) ng/mL vs.77.0 (67.0,84.0) ng/mL,P ＜ 0.05].The AUCs of urinary IGFBP-7 and sCys-C of sepsis-induced AKI patients were 0.881 (95％ CI:0.813-0.949) and 0.782 (95％ CI:0.692-0.872),which were superior to those in AUC of sCr 0.629 (95％CI:0.522-0.737).When the cutoff value of urinary IGFBP-7 was 1.82 ng/mL,the sensitivity was 93.8％ and the specificity was 77.2％.Conclusions Urine IGFBP-7 and sCys-C have higher predictive value in sepsis-induced AKI than sCr,whereas urine IGFBP-7 is more sensitive and specific than sCys-C,suggesting that IGFBP-7 may be used as sepsis signs of early diagnosis of AKI.

Change in Renal Function among HIV-Infected Koreans Receiving Tenofovir Disoproxil Fumarate-Backbone Antiretroviral Therapy: A 3-Year Follow-Up Study

PURPOSE: Tenofovir disoproxil fumarate (TDF) is commonly prescribed as a fixed-dose, co-formulated antiretroviral drug for HIV-1 infection. The major concern of long-term TDF use is renal dysfunction. However, little is known about the long-term patterns of changes in renal function in HIV-infected Koreans receiving TDF. MATERIALS AND METHODS: We prospectively followed 50 HIV-infected Koreans, performing laboratory tests every 3 months during the first year and every 6 months for the next 2 years. Urine N-acetyl-β-D-glucosaminidase (NAG) and plasma cystatin-C were measured using samples collected in the first year. Data on renal function were retrospectively collected on HIV-infected patients receiving first-line TDF (n=40) and in antiretroviral therapy (ART)-naïve patients (n=24) for 3 years. Renal function was evaluated as estimated glomerular filtration rate (eGFR) from serum creatinine [Modification of Diet in Renal Disease (MDRD)] and cystatin-C. RESULTS: The eGFR (cystatin-C) showed significant changes from 0 to 48 wks (p=0.002), with the lowest levels at 24 wks (84.3±18.8 mL/min vs. 90.3±22.5 mL/min, p=0.021 by post hoc test). Urine NAG levels did not differ at 0, 12, 24, and 48 wks, although eGFR (MDRD) significantly decreased from 0 (98.7±18.9 mL/min/1.73 m²) to 144 wks (89.0±14.7 mL/min/1.73 m²) (p=0.010). The first-line TDF group had significantly lower eGFR (MDRD) than the ART-naïve group at 144 wks (89.7 mL/min/1.73 m² vs. 98.4 mL/min/1.73 m², p=0.036). Thirteen (26%) participants experienced a decrease in renal impairment of 10 mL/min/1.73 m² in eGFR (MDRD) at 144 wks. CONCLUSION: These data suggest that clinically meaningful renal injury can develop in HIV-infected Koreans receiving long-term TDF.

Establishment of reference ranges for serum cystatin C in healthy middle-aged and elderly Chinese individuals / 中华老年医学杂志

Objective To establish normal reference ranges for serum cystatin C (Cys C)in relatively healthy middle-aged and elderly(＞50 years)Chinese individuals.Methods A total of 1087 candidates were consecutively selected and serum Cys-C levels were measured by transmission turbidimetry.Frequency analysis and histogram were used to establish the 95％ confidence reference range according to methods provided by CLSI (C28-A2).Results Based on the definition and verification procedures for clinical laboratory reference ranges(CLSI C28-A2,second edition),Cys-C levels of 1087 participants fell within the range of 0.30-1.55 mg/L;Male participants had higher serum Cys-C levels than female participants(Z=-10.19,P＜0.01).The serum Cys-C level increased with age,regardless of gender(R =0.600,P＜ 0.01).Differences in Cys-C levels between age groups were statistically significant (x2=411.17,P＜ 0.01).The reference ranges of normal serum Cys-C levels for different age groups (50-,55-,60-,65-,70-,75-,) were 0.42-0.98mg/L,0.45-1.04mg/L,0.47-1.34mg/L,0.46-1.38mg/L,0.61-1.33mg/L,0.61-1.28 mg/L,respectively,for males,and 0.39-0.94mg/L,0.42-1.01mg/L,0.40-0.91mg/L,0.46-1.03mg/L,0.57-1.04mg/L,0.55-1.27mg/L,respectively,for females.Conclusions This study established preliminary normal serum Cys-C reference ranges for healthy middle-aged and elderly(＞ 50 years)individuals in this region,which can serve as parameters for disease diagnosis and treatment evaluation.

Quantitative analysis of renal injury using CEUS in hypertensive rabbits model induced by L-NAME / 天津医药

Objective To assess the value of contrast-enhanced ultrasound (CEUS) on quantitative analysis of re?nal cortex perfusion in hypertensive rabbits model. Methods Hypertensive rabbit modal (n=10) were established by inject?ing N-nitro-L-arginin methylester (L-NAME). CEUS and Cystatin C (CysC) serum level analysis were performed at differ?ent time points:before and the 2nd, 4th, 6th and 8th week after injecting L-NAME. Time-intensity curve and area under curve (AUC) were analyzed quantatively while correlation of AUC and CysC were also analyzed. Results Serum level of Cys C in?creased significantly at the 6th week after L-NAME administration which is earlier than the increase of serum levels of Scr and BUN. AUC decreased at first then increased after L-NAME administration. Upon addition of L-NAME, rise time (RT) and peak intensity (PI) decreased while mean transit time (MTT), time from peak to one half (HPT) and time to peak (TTP) in?creased. Our study confirmed a positive correlation between AUC and Cys C (r=0.950, P<0.001). Conclusion Setting up rabbits model by L-NAME is convenient and reproducible, which is an useful tool in experimental study of preclinical and clinical phase of hypertensive renal injury. CEUS combining with CysC serum level analysis is considered as an effective technology for evaluating renal function in hypertensive patients.

Serum cystatin C level and risk of hypertensive cerebral hemorrhage / 国际脑血管病杂志

ObjectiveToinvestigatetherelationshipbetweenserumcystatinC(CysC)leveland hypertensive intracerebral hemorrhage (HICH). Methods The patients w ith HICH and healthy controls w ere enroled. The demographic and clinical data were colected. Immunoturbidimetric assay was used to detect serum CysC level. Results A total of 94 consecutive patients w ith HICH and 131 healthy controls w ere enroled. The baseline systolic blood pressure ( 168.57 ±28.64 mmHg vs.128.13 ±16.23 mmHg; t=-13.442, P<0.001;1 mmHg=0.133 kPa), diastolic blood pressure ( 95.56 ±14.68 mmHg vs.76.80 ± 8.76 mmHg; t= -11.965, P<0.001 ), fasting plasma glucose ( 6.24 ±1.83 mmol/L vs.5.22 ± 1.13 mmol/L; t= -4.234, P<0.001), and serum CysC level (1.02 ±0.26 mg/L vs.0.91 ±0.13 mg/L, P<0.001) in the HICH group w ere significantly higher than those in the control group. Multivariable logistic regression analysis show ed that baseline systolic blood pressure≥140 mmHg ( odds ratio [ OR] 12.523, 95% confidence interval [CI] 5.353-29.299; P<0.01), diastolic blood pressure ≥90 mmHg (OR 3.968, 95%CI 1.792-8.784; P<0.01 ) and serum CysC level≥1.09 mg/L ( OR 3.279, 95%CI 1.336-8.050; P<0.05) w ere the independent risk factors for HICH. In patients w ith HICH, the CysC serum level (1.13 ±0.26 mg/L) in the bleeding ≥30 ml group w as higher than that in the bleeding <30 ml group (0.99 ±0.25 mg/L; P<0.001) and the control group ( 0.91 ±0.13 mg/L; P<0.001). The serum CysC level in the bleeding volume <30 ml w as higher than that in the control group ( P=0.004). There w ere positive correlations betw een serum CysC and age, creatinine, urea, and uric acid (al P<0.01);there w ere negative correlations betw een serum CysC level and the estimated glomerular filtration rate ( P<0.01). Multivariable linear regression analysis show ed that age, creatinine, urea and uric acid w ere independent associated w ith the serum CysC level ( al P<0.05 ). Conclusions The increased serum CysC level is correlated w ith the amount of bleeding in patients w ith HICH. The increased serum CysC level is an independent risk factor for HICH.

The clinical significance of joint detection of β2-MG,glycated hemoglobin and cystatin C in early diabetic renal damage / 国际检验医学杂志

Objective To explore the clinical significance of joint detection of β2‐microglobulin(β2‐MG) ,glycated hemoglobin and Cystatin‐C (CysC) in early renal injury in patients with diabetes mellitus .Methods 60 patients with early diabetic renal damage were in early diabetic renal damage group and 100 patients with simple diabetes mellitus were in simple diabetes mellitus group .50 healthy persons were the control group .Using immunoturbidimetry to detect the serum level of CysC ,immunoturbidimetry trans‐mission to detect the urine level of β2‐microglobulin and ion exchange high performance liquid chromatography method to detect the level of HbA1c .Results There were statistically significant differences in the level of β2‐MG ,glycated hemoglobin between early diabetic renal damage group and the other two groups (P<0 .05) .There were statistically significant differenees in the level of gly‐cated hemoglobin between simple diabetes mellitus group and healthy control group (P<0 .05) .Conclusion It is important for pa‐tients with diabetes mellitus to detect the β2‐MG ,glycated Hemo globin and CysC in diagnosis ,monitoring .prevention of early renal injury .

Changes of procalcitonin level in cirrhosis patients complicated with hepatorenal syndrome / 天津医药

Objective To observe changes of procalcitonin (PCT) level in cirrhosis patients complicated with hepatorenal syn?drome (HRS). Methods Cirrhosis without HRS (Non-HRS group, n=115), cirrhosis with HRS (HRS group, n=28) and control group (40 cases) were enrolled. Levels of serum PCT, C-reactive protein (CRP), Cystatin-C (Cys-C), white blood count, percentage of neutro?phils, serum creatinine and urine creatinine were examined in all participants. Correlation between serum PCT levels and incidence of HRS was analyzed. Correlations between serum PCT levels with CRP, Cys-C, 24 h-Creatinine clearance (24 h-Ccr) were analyzed. Re?sults Among cirrhosis patients, those with increased PCT had higher chance of complication with HRS than those with normal PCT (P=0.026). Levels of serum PCT, CRP and Cys-C are higher in HRS Group than those in Non-HRS group,both which are higher than those incontrol group (P<0.05);Level of 24 h-Ccr is lower in HRS Group than that in non-HRS group, both of which are lower than that in control group (P<0.05). Levels of serum PCT positively correlated to levels of serum CRP and Cys-C but, negatively correlated to levels of 24 h-Ccr. Conclusion Serum PCT level contribute to early infection and renal damage in cirrhosis and might play an im?portant role in development of HRS. It is valuable in giving early information of cirrhosis complicated with HRS.

Correlation of serum IMD,CysC and FGF23 with hypertensive left ventricular hypertrophy / 安徽医科大学学报

Objective To analyze the relationship between serum intermedin ( IMD ) , CystatinC ( CysC ) and fibro-blast growth factor23(FGF23) with hypertensive left ventricular hypertrophy (HLVH). Methods Serum IMD,Cy-sC and FGF23 levels of 30 patients with essential hypertension(EH group),30 hypertensions with LVH(HLVH group)and 30 healthy subjects(control group)were detected by enzyme-linked immunosorbent assay(ELISA). All the subjects did UCG for LVMI. Results LVMI and serum IMD,CysC,FGF23 levels were significantly higher in EH group than in control(P<0. 05),higher in HLVH group than in EH and control groups(P<0. 05). In the pa-tients with hypertension LVMI and serum IMD,CysC,FGF23 levels were increasing with increased blood pressure levels. LVMI level was positively correlated with serum IMD,CysC and FGF23 levels(r=0. 769,0. 517,0. 700;P<0. 01). Line to LVMI level as the dependent variable,multiple stepwise regression analysis showed that:systolic blood pressure( SBP) ,IMD,CysC,homocysteine( Hcy) ,FGF23 entered regression equation. They were independent risk factors for LVMI. Conclusion Serum IMD, CysC and FGF23 levels are closely associated with EH and HLVH. They may participate in the development of EH and affect the process of HLVH. Combined-detection of ser-um IMD,CysC and FGF23 can be used as a reference index for the condition and prognosis of HLVH.

Diagnostic value of joint detection of biomarkers for the early renal impairment in multiple myeloma patients / 国际检验医学杂志

Objective To discuss the diagnostic value of serum cystatin-C(Cys-C) and urinary retinol binding protein(RBP) for the early renal impairment in multiple myeloma(MM) patients .Methods According to estimated glomerular filtration rate(eGFR) , the MM patients were divided into two groups :the normal renal function group(eGFR≥90 mL/min ,n=78)marked group A ,the renal impairment group(eGFR<90 mL/min ,n=40)marked group B .130 healthy subjects were selected as control group .The con-centrations of serum Cys-C ,urinary RBP ,serum creatinine(Cr) and serum urea nitrogen(UN) were measured and compared .Results The levels of Cys-C and RBP in group A were significantly higher than those in the control group(P<0 .01) .There were signifi-cant difference of the levels of Cys-C ,Cr ,UN and RBP levels between group B and control group(P<0 .01) .The sensitivity of the combined detection of Cys-C and RBP was 57 .69% ,significantly higher than single index test(P<0 .05) .Conclusion Compared with traditional biomarkers ,Cys-C and RBP are more sensitive and effective indexes for the diagnosis of early renal impairment in the patients with MM ,and jointed detection of the two biomarkers has important value .

Significance of Serum Cystatin C in Early Diagnosis of Henoch-Schonlein Purpura Nephritis / 实用儿科临床杂志

Objective To explore the change and clinical significance of serum Cystain-C in children with Henoch-Schonlein purpura(HSP).Methods Thirty-three children diagnosed HSP according to the domestic criteria hospitalized in department of pediatrics were enrolled in patient group and 31 children outpatients during the corresponding time period as controls.Venous blood of each child in 2 groups was collected in the day of admission,serum Cystain-C was determined by enzyme-linked immunosorbent assay,plasma D-dimer was measured by gold standard double antibody sandwich method,and blood urea nitrogen(BUN) and serum creatinine(Scr) were detected by automatic biochemistry analyzer.At the same time each child undertook routine urine examination.Data was analyzed by Stata 8.0 software.Results 1.BUN and Scr of 2 groups were both normal.2.Proteinuria or hematuria was found in 15 of all 33 patients through routine urianlysis,and the detection rate was 45%.3.The pre-and post-therapy level of serum cystain-C[(3.83?0.83) mg/L,(3.76?1.02) mg/L] and plasma D-dimer [(1.93?2.05) mg/L,(0.77?0.79) mg/L] in HSP group were higher than that in controls [(1.21?0.43) mg/L,(0.13?0.07) mg/L] significantly (P0.05).5.In HSP group,the level of plasma D-dimer pretherapy was significantly higher than that of post-therapy(P0.05).Conclusion The level of serum Cystain-C can act as the significant indicator of early diagnosis and continuous observation of HSP nephritis.