CYSTATIN C AS EARLY BIOMARKER FOR CONTRACT INDUCED ACYTE KIDNEY INJURI

AIM OF RESEARCH. To estimate in prospective study predicate capacity of serum cystatin C (sCysC) in diagnostics of acute kidney injury (AKI). PATIENTS AND METHODS. Serum creatinine (sCr) and sСysС were measured together in 68 patients with undergoing coronary angiography and/or angioplasty and who were at high risk to develop AKI. SCr and sСysС were assessed at baseline and 18–20 hours after contrast media exposure; sCr was detected also after 48 hours. SCysC was quantified by immunoturbidimetry. AKI was defined according to AKIN. The binary logistic regression analysis was undertaken and the ability of sCysC to predict AKI was assessed from the area under the receiver operator characteristic curve (AUROC). RESULTS. Contrast-induced AKI defined according to sCr increase ≥0,026mmol/l or ≥1,5 increase in sCr from baseline occurred in 11 patients. At 18–20 hours after contrast media exposure sCr increase wasn’t detected in anybody but sСysС increase was revealed in 30 patients. Cut off was identified with sCysC concentration ≥ 50% from basic with optimal correlation of sensitivity and specificity (81,8% and 98,2%) for early defining CI-AKI patients. The AUROC for this sCysC level was 0.90 (95% CI, 0.95- 0.97). CONCLUSION. The results of this study support that sCysC is a good biomarker of glomerular filtration decrease at AKI and may detect CI-AKI before a rise in sCr.

1. Сhertow GM BE, Honour M, Bonventre JV, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. JASN 2005; 16: 3365–3370

2. Bellomo R, Ronco C, Kellum JA et al. Acute kidney failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 2004; 8: R204–R212

3. Ермоленко ВМ, Николаев АВ. Острая почечная недостаточность. ГЭОТАР-Медиа, М., 2010: 19–22

4. Каюков ИГ, Смирнов АВ. Рентгеноконтрастная нефропатия. В: Мухин НА, ред. Нефрология: национальное руководство. ГЭОТАР-Медиа, М., 2009; 688–704

5. Xue JL, Daniel F, Star RA, et al. Incidence and mortality of acute kidney failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol 2006; 17:1135–1142

6. Devarajan P. Emerging Biomarker of Acute Kidney Injury. In: Ronco C, Bellomo R, Kellum JA, eds. Acute kidney injury. Contrib Nephrol. Karger, Basel; 2007; vol 156: 203–212

7. Kassirer JP. Clinical evaluation of kidney function – glomerular function. N Engl J Med 1971; 285: 385–389

8. Смирнов АВ, Каюков ИГ, Есаян АМ и др. Проблема оценки скорости клубочковой фильтрации в современной нефрологии: новый индикатор – цистатин С. Нефрология 2005; (9): 16–27

9. Eriksen BO, Mathisen UD, Melsom T et al. Estimating GFR with cystatin in general population. Kidney int 2010; 78: 1305–1311

10. Тишко А.Н. Цистатин С и его значение в диагностике поражения почек у больных с длительно текущим ревматоидным артритом. Мед-биол и соц-психолог пробл безопасности в чрезв ситуациях 2010; (1): 74–79

11. Волгина ГВ. Контраст – индуцированная нефропатия: патогенез, факторы риска, стратегия профилактики (Часть I). Нефрология и диализ 2006; (8), 1:69–77

12. Lameire N, Van Biesen W, Hoste E and Vanholder R. The prevention of acute kidney injury in depth narrative review: Part 2. NDT Plus 2009; 1: 1–10

13. Mehta RL, Kellum JA, Shah S et al. Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11:R31

14. Coca SG, Yalavarthy R, Concato J and Parikh CR. Biomarkers for the diagnosis and risk stratification of acute kidney injury: A systematic review. Kidney int 2008; 73: 1008–1016

15. Аниконова ЛИ, Болдуева СА. Контраст-индуцированная нефропатия. В: Радченко ВГ, ред. Актуальные вопросы внутренних болезней. ГОУВПО СПбГМА им. И.И. Мечникова Росздрава, СПб., 2010; 10–15

16. American society of nephrology. American society of nephrology renal research report. JASN 2005; 16: 1886–1903

17. McCullough PA, Wolyn R, Rocher LL et al. Acute renal failure after coronary intervention: incidence, risk factors, and relation to mortality. Am J Med 1997; 103: 368–375

18. Briguori C, Visconti G, Rivera NV, et al. Cystatin C and contrast-induced acute kidney injury. Circulation. 2010;121 (19): 2117–2122

19. Herget-Rosenthal S, Marggraf G, Husing J et al. Early detection of acute renal failure by serum cystatin C. Kidney int 2004; 66:1115–1122

20. Nejat M, Pickering J, Walker R and Endre Z. Rapid detection of acute kidney injury by plasma cystatin C in the intensive care unit. Nephrol Dial Transplant 2010, 25: 3283–3289

21. Zhang Z, Lu B, Sheng X, and Jin N. Cystatin C in Prediction of Acute Kidney Injury: A Systemic Review and Meta-analysis. Am J Kidney Dis 2011;58 (3): 356–365

22. Murray PT, Devarajan P, Levey AS et al. A Framework and key research questions in AKI diagnosis and staging in different environments. Clin J Am Nephrol 2008; 3:864–868

23. Waikar SS, Liu KD and Chertow GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008; 3:844–861

24. Mishra J, Dent C, Tarabishi R et al. Neutrophil gelatinaseassociated lipocalin (NGAL) as a biomarker for acute kidney injury after cardiac surgery. Lancet 2005; 365: 1231–1238

25. Endre ZH, Pickering JW, Walker RJ, et al. Improved performance of urinary biomarkers of acute kidney injury in the critically ill by stratification for injury duration and baseline renal function. Kidney int 2011; 79: 1119–1130

26. Han WK, Wagener G, Zhu Y et al. Urinary biomarkers in the early detection of acute kidney injury after cardiac surgery. Clin J Am Soc Nephrol 2009; 4:873–882

27. Bonventre JV. Kidney injury molecule-1 (KIM-1): a urinary biomarker and much more. Nephrol Dial Transplant 2009; 24: 3265–3268

28. FDA, European medicines agency to consider additional test result when assessing new drug safety collaborative effort by FDA and EMEA expected to yield additional safety data. FDA News 2008; 12 June

29. Lameire NH, Vanholder R and Van Biesen WA. How to use biomarkers efficiently in acute kidney injury. Kidney int 2011; 79: 1047–1049