RESUMEN
Aim: To evaluate the urinary biomarkers related to sepsis in preterm newborns (NBs) and to investigate the predictive capacity of these biomarkers for a longer hospital stay.Methods: Serum and urine were collected from 27 healthy NBs, 24 NBs with neonatal infection without sepsis and 11 NBs with sepsis for the measurement of sindecan-1, lipocalin associated with urinary neutrophil gelatinase (uNGAL), urinary cystatin-C (uCysC) and urinary kidney injury molecule-1.Results: Levels of uNGAL and urinary cystatin-C were elevated in NBs with sepsis and neonatal infection, and uNGAL was significant predictor of hospital stay longer than 30 days (odds ratio: 1.052; 95% CI: 1.012-1.093; p = 0.01).Conclusion: uNGAL was associated with sepsis in preterm NBs and was useful to predict extended hospital stay.
[Box: see text].
Asunto(s)
Biomarcadores , Cistatina C , Recien Nacido Prematuro , Tiempo de Internación , Lipocalina 2 , Sepsis , Humanos , Recién Nacido , Cistatina C/sangre , Cistatina C/orina , Lipocalina 2/orina , Lipocalina 2/sangre , Biomarcadores/orina , Biomarcadores/sangre , Sepsis/orina , Sepsis/diagnóstico , Sepsis/sangre , Masculino , Femenino , Recien Nacido Prematuro/orina , Proteínas de Fase Aguda/orina , Proteínas Proto-Oncogénicas/orina , Proteínas Proto-Oncogénicas/sangreRESUMEN
Visceral leishmaniasis (VL) is an infectious disease caused by Leishmania infantum. Clinically, VL evolves with systemic impairment, immunosuppression and hyperactivation with hypergammaglobulinemia. Although renal involvement has been recognized, a dearth of understanding about the underlying mechanisms driving acute kidney injury (AKI) in VL remains. We aimed to evaluate the involvement of immunoglobulins (Igs) and immune complexes (CIC) in the occurrence of AKI in VL patients. Fourteen VL patients were evaluated between early treatment and 12 months post-treatment (mpt). Anti-Leishmania Igs, CIC, cystatin C, C3a and C5a were assessed and correlated with AKI markers. Interestingly, high levels of CIC were observed in VL patients up to 6 mpt. Concomitantly, twelve patients met the criteria for AKI, while high levels of cystatin C were observed up to 6 mpt. Plasmatic cystatin C was positively correlated with CIC and Igs. Moreover, C5a was correlated with cystatin C, CIC and Igs. We did not identify any correlation between amphotericin B use and kidney function markers in VL patients, although this association needs to be further explored in subsequent studies. Our data reinforce the presence of an important renal function impairment during VL, suggesting the involvement of Igs, CIC, and C5a in this clinical condition.
Asunto(s)
Lesión Renal Aguda , Complejo Antígeno-Anticuerpo , Leishmaniasis Visceral , Humanos , Leishmaniasis Visceral/inmunología , Leishmaniasis Visceral/sangre , Lesión Renal Aguda/sangre , Lesión Renal Aguda/inmunología , Lesión Renal Aguda/parasitología , Masculino , Femenino , Complejo Antígeno-Anticuerpo/sangre , Adulto , Biomarcadores/sangre , Persona de Mediana Edad , Cistatina C/sangre , Adolescente , Adulto Joven , Anfotericina B/uso terapéutico , Leishmania infantum/inmunologíaRESUMEN
Acute kidney injury (AKI) is defined as the rapid decline in kidney function. Its development is related to critical clinical statuses, such as sepsis, complicated post-surgical recovery, and infectious diseases. Serum cystatin C (CysC) has the best correlation with the glomerular filtration rate. Ultrasonography stands out because it is highly accessible and can be done at the bedside. Twenty-eight dogs admitted to the intensive care unit with serum creatinine values <1.6 mg/dL and at-risk factors of AKI development were selected. CysC measurements and ultrasound assessments were performed daily for 72 hours. Using CysC dosage, 22/28 animals (78.6%) were considered to have AKI, and 17/22 had ultrasound compatible with AKI changes, demonstrating moderate agreement with CysC dosage. Increased cortical renal echogenicity is the most prevalent alteration in critically ill patients and is correlated with serum increases in CysC and is associated with renal structural damage.
A injúria renal aguda (IRA) é definida como o declínio rápido da função renal. Seu desenvolvimento está relacionado a quadros clínicos críticos, como sepse, pós-operatório complicado e doenças infecciosas. A cistatina C sérica (CisC) tem melhor correlação com taxa de filtração glomerular. A ultrassonografia se destaca por ser altamente acessível e pode ser realizada à beira do leito. Foram selecionados 28 cães, internados em unidade de terapia intensiva, com valores de creatinina sérica <1,6mg/dL e fatores de risco para o desenvolvimento de IRA. Medições de CisC e avaliações ultrassonográficas foram realizadas diariamente por 72 horas. Utilizando-se a dosagem de CisC, 22/28 animais (78,6%) foram considerados portadores de IRA e 17/22 apresentaram ultrassom compatível com alterações de IRA, demonstrando concordância moderada com a dosagem de CisC. O aumento da ecogenicidade cortical renal é a alteração mais prevalente em pacientes críticos, está correlacionado com aumentos séricos de CisC e associado a dano estrutural renal.
Asunto(s)
Animales , Perros , Biomarcadores/análisis , Cistatina C/sangre , Lesión Renal Aguda/veterinaria , Riñón/diagnóstico por imagen , Diagnóstico Precoz , Enfermedades Renales/veterinariaRESUMEN
Objective: The goal of this study is to evaluate the benefits of an increase in water intake guided by a mathematical formula (per kg of body weight) on kidney function in older adults. Methods: Older adults (≥ 65 years old) cared for at the Internal Medicine Unit of a tertiary hospital will be randomized to receive or not guidance on water intake (30 mL/kg per day) after initial assessment of kidney function. After 14 days, participants will be reevaluated through clinical and laboratory examinations. Patients with uncompensated disease will be excluded. The main outcomes will be glomerular filtration rate and laboratory measures such as serum and urinary osmolality, sodium, urea, 24-h urine volume and serum creatinine, uric acid, and copeptin. The Mini Nutritional Assessment (MNA) questionnaire will be applied to participants at each visit. Categorical variables will be described as numbers of cases (%) and compared using the χ2 test whereas continuous variables will be analyzed with Student's t-test in relation to baseline measures. The Generalized Estimating Equations (GEE) method will be performed to assess differences over time and between groups. This study was approved by the Institution's Research Ethics Committee (grant number 16-0153) and is in accordance with the Declaration of Helsinki. Expected Results:By increasing water intake (ml/Kg) we expect to provide an improvement in kidney function in older population assessed by serum creatinine and cystatin-c applied to eGFR formulas. Relevance:Many conditions, both organic and behavioral, can contribute to chronic dehydration states in older adults. To mention, decreased ability to concentrate urine, reduced kidney mass, blood flow, and glomerular filtration rate (GFR) along with changes in sensitivity to hormones such as renin, vasopressin and natriuretic peptide can generate water imbalance, leading to dehydration. For being simple and inexpensive, this strategy may be broadly used and bring several health benefits to older adults.
Objetivo: O objetivo deste estudo é avaliar os benefícios de um aumento da ingestão de água guiado por uma fórmula matemática (por kg de massa corporal) na função renal de idosos. Metodologia:Idosos (≥ 65 anos) atendidos pelo Serviço de Clínica Médica de um hospital terciário foram randomizados para receber ou não orientação sobre o consumo de água (30 mL/kg por dia) após uma avaliação inicial da função renal. Após 14 dias, os participantes serão reavaliados através de exames clínicos e laboratoriais. Pacientes com doença descompensada serão excluídos. Os desfechos principais são a taxa de filtração glomerular e medidas laboratoriais como osmolaridade, sódio e ureia séricos e urinários, volume de urina de 24 horas e creatinina, ácido úrico e copeptina séricos. A Mini Avaliação Nutricional (MNA) será aplicada aos participantes a cada consulta. Variáveis categóricas serão descritas como números de casos (%) e comparadas usando o teste χ2 , enquanto variáveis contínuas serão analisadas com o teste t de Student em relação às medidas iniciais. O método de Equações de Estimativas Generalizadas (GEE) será usado para avaliar diferenças ao longo do tempo e entre grupos. Este estudo foi aprovado pelo Comitê de Ética em Pesquisa da nossa Instituição (processo número 16-0153) e está de acordo com a Declaração de Helsinki. Resultados esperados:Ao aumentar a ingestão de água (ml/Kg) esperamos proporcionar uma melhora na função renal na população idosa avaliada pela creatinina sérica e cistatina-c aplicada às fórmulas de eGFR. Relevância:Muitas condições, tanto orgânicas quanto comportamentais, podem contribuir para estados de desidratação crônica em idosos. Vale mencionar que a diminuição da capacidade de concentração da urina, redução da massa renal, fluxo sanguíneo e taxa de filtração glomerular (TFG) juntamente com alterações na sensibilidade a hormônios como renina, vasopressina e peptídeo natriurético podem gerar desequilíbrio hídrico, levando à desidratação. Por ser simples e de baixo custo, essa estratégia pode ser amplamente utilizada e trazer diversos benefícios à saúde dos idosos.
Asunto(s)
Humanos , Anciano , Agua/administración & dosificación , Creatinina/sangre , Ingestión de Líquidos/fisiología , Cistatina C/sangre , Riñón/fisiología , Tasa de Filtración Glomerular , Pruebas de Función Renal , Modelos TeóricosRESUMEN
INTRODUCTION: Essential amino acid α-keto acid analogs are used in the treatment of chronic kidney disease to delay the symptoms of uremia. However, it is unknown whether essential amino acid α-keto acid analogs affect the oxidative stress and the inflammation in acute renal injury such as those produced by ischemia-reperfusion. OBJECTIVE: To evaluate the effect of essential amino acid α-keto acid analogs on renal ischemia-reperfusion injury in Wistar rats. MATERIALS AND METHODS: Rats were divided into 11 groups (n=6/group): Two groups received physiological saline with or without ischemia-reperfusion injury (45 min/24 h), six groups received essential amino acid α-keto acid analogs (400, 800, or 1,200 mg/kg/24 h/7d) with or without ischemia-reperfusion injury (essential amino acid α-keto acid analogs + ischemia-reperfusion), and two groups received allopurinol (50 mg/kg/24 h/7d) with or without ischemia-reperfusion injury. Biochemical markers included creatinine and blood urea nitrogen (BUN), proinflammatory cytokines (IL-1ß, IL-6, and TNF-α), renal damage markers (cystatin C, KIM-1, and NGAL), and markers of oxidative stress such as malondialdehyde (MDA) and total antioxidant activity. RESULTS: The essential amino acid α-keto acid analog- and allopurinol-treated groups had lower levels of creatinine, BUN, renal damage markers, proinflammatory cytokines, and MDA than their corresponding ischemia-reperfusion groups. These changes were related to the essential amino acid α-keto acid analogs dosage. Total antioxidant activity was lower in essential amino acid α-keto acid analog- and allopurinol-treated groups than in the corresponding ischemia-reperfusion groups. CONCLUSIONS: This is a new report on the nephroprotective effects of essential amino acid α-keto acid analogs against ischemia-reperfusion injury. Essential amino acid α-keto acid analogs decreased the levels of biochemical markers, kidney injury markers, proinflammatory cytokines, and MDA while minimizing total antioxidant consumption.
Introducción. Los α-cetoanálogos de aminoácidos esenciales se utilizan en el tratamiento de la enfermedad renal crónica para retrasar los síntomas de la uremia. Sin embargo, se desconoce si los α-cetoanálogos de aminoácidos esenciales afectan el estrés oxidativo y la inflamación en la lesión renal aguda tal como en la producida por la isquemia-reperfusión. Objetivo. Evaluar el efecto de las α-cetoanálogos de aminoácidos esenciales sobre la lesión renal por isquemia-reperfusión en ratas Wistar. Materiales y métodos. Se emplearon 11 grupos de ratas (n=6): dos grupos recibieron solución salina fisiológica con lesión isquemia-reperfusión o sin ella (45 min/24 h), seis grupos recibieron α-cetoanálogos de aminoácidos esenciales (400, 800 o 1.200 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella (α-cetoanálogos de aminoácidos esenciales + isquemia-reperfusión), y dos grupos recibieron (50 mg/kg/24 h/7d) con lesión isquemia-reperfusión o sin ella. Los marcadores bioquímicos incluyeron creatinina y nitrógeno ureico en sangre (BUN), citocinas proinflamatorias (IL-1ß, IL-6 y TNF-α), marcadores de daño renal (cistatina C, KIM-1 y NGAL) y marcadores del estrés oxidativo como el malondialdehído (MDA) y la actividad antioxidante total. Resultados. Los grupos tratados con α-cetoanálogos de aminoácidos esenciales y alopurinol tuvieron niveles inferiores de creatinina, BUN, marcadores de daño renal, citocinas proinflamatorias, actividad antioxidante total y MDA que los grupos isquemia-reperfusión correspondientes. Estos cambios se asociaron con la dosis. La actividad antioxidante total fue menor en los grupos tratados con α-cetoanálogos de aminoácidos esenciales que en los grupos isquemia-reperfusión correspondientes. Conclusiones. Este es un nuevo informe de los efectos nefroprotectores de las α-cetoanálogos de aminoácidos esenciales contra la lesión isquemia-reperfusión. Los α-cetoanálogos de aminoácidos esenciales disminuyeron los niveles de los marcadores bioquímicos, de los de lesión renal, de las citocinas proinflamatorias y el MDA, a la vez que minimizaron el consumo total de antioxidantes.
Asunto(s)
Aminoácidos Esenciales/uso terapéutico , Antioxidantes/uso terapéutico , Cetoácidos/uso terapéutico , Riñón/irrigación sanguínea , Daño por Reperfusión/tratamiento farmacológico , Alopurinol/uso terapéutico , Aminoácidos Esenciales/administración & dosificación , Animales , Antioxidantes/análisis , Biomarcadores , Nitrógeno de la Urea Sanguínea , Creatinina/sangre , Cistatina C/sangre , Citocinas/sangre , Relación Dosis-Respuesta a Droga , Evaluación Preclínica de Medicamentos , Cetoácidos/administración & dosificación , Riñón/patología , Lipocalina 2/sangre , Masculino , Malondialdehído/sangre , Estrés Oxidativo/efectos de los fármacos , Distribución Aleatoria , Ratas , Ratas Wistar , Daño por Reperfusión/sangre , Daño por Reperfusión/patología , Daño por Reperfusión/prevención & controlRESUMEN
OBJECTIVE: To assess the predictive abilities of serum and urinary cystatin C levels for glomerular lesions in pregnant women with pre-eclampsia. METHODS: In this study, kidney function markers were compared between38 pregnant women with pre-eclampsia and 22 healthy pregnant women. RESULTS: The serum and urine levels of cystatin C and urea were significantly higher in the pre-eclampsia group than in the control group. Receiver operating characteristic curve analysis demonstrated that the serum cystatin C level (91.7%) had a superior diagnostic accuracy for pre-eclampsia than the other markers. CONCLUSION: Serum cystatin C level maybe a significant marker of pre-eclampsia.
Asunto(s)
Cistatina C/metabolismo , Enfermedades Renales/diagnóstico , Glomérulos Renales/patología , Preeclampsia/patología , Adulto , Biomarcadores/sangre , Biomarcadores/orina , Creatinina/sangre , Creatinina/orina , Estudios Transversales , Cistatina C/sangre , Cistatina C/orina , Femenino , Tasa de Filtración Glomerular/fisiología , Humanos , Enfermedades Renales/etiología , Enfermedades Renales/metabolismo , Preeclampsia/sangre , Preeclampsia/orina , Embarazo , Urea/sangre , Urea/orina , Adulto JovenAsunto(s)
Biomarcadores/sangre , Cistatina C/sangre , Riñón/metabolismo , Lesión Renal Aguda/metabolismo , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/mortalidad , Catepsinas/metabolismo , Creatinina/sangre , Estudios Transversales , Cistatina C/genética , Cistatina C/metabolismo , Tasa de Filtración Glomerular/genética , Rechazo de Injerto/metabolismo , Humanos , Riñón/fisiopatología , Pruebas de Función Renal/métodos , Diálisis Peritoneal/métodos , Medición de RiesgoRESUMEN
BACKGROUND: Cystatin C (CysC) is an early biomarker of renal dysfunction scarcely studied in patients awaiting liver transplantation (LT). Sarcopenia is frequent in cirrhosis and impacts prognosis. We aimed to assess the capability of these factors to predict survival and acute-on-chronic liver failure (ACLF) in patients awaiting LT, as well as early post-LT outcomes. METHODS: Single-center study that included all cirrhotic patients listed for LT between 2014 and 2017. Competing risk regression analysis was used to evaluate the capability of liver-, kidney-, and global status-related variables at waitlist (WL) inclusion to predict WL mortality and ACLF. Variables associated with post-LT outcomes were evaluated with logistic regression analysis. RESULTS: One-hundred-and-eighty patients were included. Fifty-six (31%) patients developed ACLF, 54 (30%) underwent LT and 35 (19%) died. In the adjusted competing risk regression analysis, CysC ≥ 1.5 mg/L, sarcopenia and MELD-Na were independent predictors of ACLF in the WL, while CysC ≥ 1.5 mg/L, sarcopenia and albumin were independent predictors of mortality. The cumulative incidence of ACLF and mortality at 12 months were 50% and 34% in patients with sarcopenia and CysC ≥1.5 mg/L. An estimated glomerular filtration rate by chronic kidney disease (CKD)-EPI-CysC-creatinine <60 mL/min/1.73 m at WL inclusion was an independent predictor of the need for renal replacement therapy (RRT) in the first month post-LT. CONCLUSIONS: Higher levels of CysC and sarcopenia are strongly associated with the ACLF and mortality in WL. The assessment of both risk factors may improve the prognostic evaluation and allow identifying a group of patients with a very high risk of poor outcomes while awaiting LT.
Asunto(s)
Insuficiencia Hepática Crónica Agudizada/diagnóstico , Cistatina C/sangre , Enfermedad Hepática en Estado Terminal/mortalidad , Cirrosis Hepática/mortalidad , Trasplante de Hígado/efectos adversos , Sarcopenia/embriología , Lesión Renal Aguda/sangre , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Lesión Renal Aguda/terapia , Insuficiencia Hepática Crónica Agudizada/epidemiología , Insuficiencia Hepática Crónica Agudizada/etiología , Insuficiencia Hepática Crónica Agudizada/terapia , Anciano , Biomarcadores/sangre , Creatinina/sangre , Enfermedad Hepática en Estado Terminal/sangre , Enfermedad Hepática en Estado Terminal/complicaciones , Enfermedad Hepática en Estado Terminal/diagnóstico , Femenino , Tasa de Filtración Glomerular , Humanos , Incidencia , Cirrosis Hepática/sangre , Cirrosis Hepática/complicaciones , Cirrosis Hepática/diagnóstico , Masculino , Persona de Mediana Edad , Selección de Paciente , Pronóstico , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/epidemiología , Insuficiencia Renal Crónica/etiología , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal/estadística & datos numéricos , Estudios Retrospectivos , Medición de Riesgo/métodos , Factores de Riesgo , Sarcopenia/sangre , Sarcopenia/etiología , Índice de Severidad de la Enfermedad , Listas de Espera/mortalidadAsunto(s)
Humanos , Biomarcadores/sangre , Cistatina C/sangre , Riñón/metabolismo , Enfermedades Cardiovasculares/metabolismo , Enfermedades Cardiovasculares/mortalidad , Catepsinas/metabolismo , Estudios Transversales , Diálisis Peritoneal/métodos , Medición de Riesgo , Creatinina/sangre , Cistatina C/genética , Cistatina C/metabolismo , Lesión Renal Aguda/metabolismo , Tasa de Filtración Glomerular/genética , Rechazo de Injerto/metabolismo , Riñón/fisiopatología , Pruebas de Función Renal/métodosRESUMEN
ABSTRACT Introduction: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. Aim: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. Methods: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. Results: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. Conclusions: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.
RESUMO Introdução: Tem sido sugerido que os níveis de cistatina C são modificados pela obesidade e inflamação. Além disso, a cistatina C tem sido associada a eventos cardiovasculares e desfechos de mortalidade. Objetivo: Estudar a associação da cistatina C com o perfil metabólico e doença cardiovascular de pacientes em diálise peritoneal. Métodos: Os dados coletados incluíram avaliação clínica, laboratorial e de bioimpedância múltipla de 52 pacientes estáveis em diálise peritoneal. A função renal residual mínima foi definida como > 2mL/min/1,73m2. Resultados: A cistatina C sérica não esteve significativamente associada à excreção peritoneal ou urinária. A correlação negativa da cistatina C com a taxa catabólica protéica normalizada (rho -0,33, p = 0,02) e uma tendência de correlação positiva com a gordura corporal relativa (rho 0,27, p = 0,05) não foram independentes da função renal residual. A cistatina C não se associou significativamente à doença cardiovascular (p = 0,28), nem com hemoglobina glicada (p = 0,19) ou proteína C reativa (p = 0,56). No modelo multivariado, idade e diabetes foram os mais fortes preditores de doença cardiovascular (razões de probabilidade 1,09, p = 0,029 e 29,95, p = 0,016, respectivamente) enquanto a gordura corporal relativa se associou negativamente à doença cardiovascular (p = 0,038). A cistatina C não se associou significativamente com doença cardiovascular (p = 0,096), tampouco a função residual mínima (p = 0,756). Conclusão: Neste grupo de pacientes em diálise peritoneal, a cistatina C não se correlacionou com o estado metabólico ou inflamatório, nem com doença cardiovascular, após ajuste para função renal residual.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Diálisis Peritoneal , Cistatina C/sangre , Metaboloma , Tasa de Filtración Glomerular , Proteína C-Reactiva/análisis , Hemoglobina Glucada/análisis , Biomarcadores/sangre , Riesgo , Estudios Transversales , Estudios de CohortesRESUMEN
An interdigitated immunosensor for Cystatin C detection based on polypyrrole/carbon nanotube electrochemical capacitor is described. Cystatin C (CysC) is powerful biomarker for early acute renal failure and one predictive for cardiovascular risk, sepsis, cancer and death. Recently, electrochemical immunosensors based on interdigitated electrodes (IDE) have been successfully focused on development of point-of-care testing, due to their miniaturization facilities and higher sensitivity as compared with the screen-printed electrochemical sensing. Herein, a polypyrrole/carbon nanotube nanoyhibrid film was grafted on two gold fingers by electropolymerization obtaining a supercapacitor. Anti-CysC antibodies were immobilized on the IDE by covalent entrapment via ethylenediamine bifunctional agent, followed by glycine blocking in acid and alkaline medium. Under low frequency, capacitive effect of antigen-antibody interaction were observed by double layer capacitance, and analytical responses of this IDE immunosensor to CysC serum were obtained by changes on phase angle a linear range up to 300 ng/mL. The cutoff was calculated for serum samples showing a total reducing of non-specific binding at approximately 28 ng/mL CysC. This immunosensor based on interdigitated electrode (IDE) is a potential tools as portable device,with possibility to use as a practical and rapid test for CysC diagnostic in samples of serum.
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Técnicas Biosensibles , Cistatina C/sangre , Técnicas Electroquímicas , Inmunoensayo , Nanotubos de Carbono/química , Polímeros/química , Pirroles/química , Biomarcadores/sangre , Electrodos , Humanos , Tamaño de la Partícula , Propiedades de SuperficieRESUMEN
INTRODUCTION: It has been suggested that cystatin C levels are modified by obesity and inflammation. Furthermore, cystatin C has been associated with cardiovascular events and mortality outcomes. AIM: To study the association of cystatin C with the metabolic profile and cardiovascular disease of peritoneal dialysis patients. METHODS: Data collected included clinical, laboratorial, and multifrequency bioimpedance assessment of 52 stable peritoneal dialysis patients. Minimal residual renal function was defined as > 2mL/min/1.73m2. RESULTS: Serum cystatin C was not significantly associated with peritoneal or urinary cystatin C excretion. Negative correlation of cystatin C with normalized protein catabolic rate (rho -0.33, p = 0.02) and a trend towards positive correlation with relative body fat (rho 0.27, p = 0.05) were not independent from residual renal function. Cystatin C was not significantly associated with cardiovascular disease (p = 0.28), nor with glycated hemoglobin (p = 0.19) or c-reactive protein (p = 0.56). In the multivariate model, both age and diabetes were the strongest predictors of cardiovascular disease (odds ratio 1.09, p = 0.029 and odds ratio 29.95, p = 0.016, respectively), while relative body fat was negatively associated with cardiovascular disease (p = 0.038); neither cystatin C (p = 0.096) nor minimal residual renal function (p = 0.756) reached a significant association with cardiovascular disease. CONCLUSIONS: In this group of peritoneal dialysis patients, cystatin C did not correlate with the metabolic or inflammatory status, nor cardiovascular disease, after adjustment for residual renal function.
Asunto(s)
Enfermedades Cardiovasculares/sangre , Enfermedades Cardiovasculares/epidemiología , Cistatina C/sangre , Tasa de Filtración Glomerular , Metaboloma , Diálisis Peritoneal , Adulto , Anciano , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Cohortes , Estudios Transversales , Femenino , Hemoglobina Glucada/análisis , Humanos , Masculino , Persona de Mediana Edad , RiesgoRESUMEN
OBJECTIVE: To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. METHODS: Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. RESULTS: The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). CONCLUSION: The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.
Asunto(s)
Proteína C-Reactiva/análisis , Cistatina C/sangre , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hemorragia Intracraneal Traumática/sangre , Adolescente , Adulto , Estudios de Casos y Controles , Niño , Femenino , Escala de Consecuencias de Glasgow , Humanos , Hemorragia Intracraneal Traumática/fisiopatología , Masculino , Persona de Mediana Edad , Valores de Referencia , Factores de Riesgo , Índices de Gravedad del Trauma , Adulto JovenRESUMEN
BACKGROUND: Since renal failure is one of the main causes of death in patients with Fabry disease (FD), renal follow-up is an important part of clinical monitoring in these patients. Despite its known limitations, serum creatinine is still the most widely used biomarker. While new renal biomarkers are described, their effectiveness has not yet been fully evaluated in relation to FD. OBJECTIVES: This study aimed to compare renal biomarkers commonly and rarely used in the evaluation of FD patients. METHOD: The usual biomarkers for renal monitoring (microalbuminuria, proteinuria, and creatinine) and some more rarely used (cystatin C, beta 2-microglobulin [ß2M], neutrophil gelatinase-associated lipocalin/lipocalin-2) were quantified in the blood and/or urine samples of 40 FD patients, 39 controls without chronic kidney disease (CKD) paired by age and sex and 38 controls with CKD undergoing hemodialysis. RESULTS: Significant statistical differences (p < 0.05) were observed for cystatin C and lipocalin-2 in plasma levels, for ß2M and serum creatinine levels and by estimated glomerular filtration rate when compared FD patients and control group with CKD and for proteinuria and microalbuminuria in urine samples and for lipocalin-2 in plasma levels when compared FD patients and control group without CKD. Urine creatinine (UCreat), pH, and urine specific gravity did not present a significant statistical difference between groups. CONCLUSION: Considering serum creatinine as gold standard, all renal parameters evaluated, including receiver operating characteristic curve, indicated ß2M as the best biomarker, followed by cystatin C, proteinuria and microalbuminuria, while the results for lipocalin-2 and UCreat do not indicate good predictors of renal impairment. It suggests that at least 2 altered biomarkers should be considered to characterize a renal alteration, thereby establishing a better therapeutic course for FD patients. If possible, along with serum creatinine, measurement of ß2M or cystatin C for renal evaluation of Fabry's patients should be considered.
Asunto(s)
Cistatina C/sangre , Enfermedad de Fabry/sangre , Enfermedad de Fabry/complicaciones , Lipocalina 2/sangre , Insuficiencia Renal Crónica/sangre , Insuficiencia Renal Crónica/etiología , Microglobulina beta-2/sangre , Adolescente , Adulto , Anciano , Biomarcadores/sangre , Biomarcadores/orina , Estudios de Casos y Controles , Niño , Creatinina/orina , Terapia de Reemplazo Enzimático , Enfermedad de Fabry/terapia , Femenino , Humanos , Trasplante de Riñón , Masculino , Persona de Mediana Edad , Diálisis Renal , Insuficiencia Renal Crónica/terapia , Adulto JovenRESUMEN
ABSTRACT Objective To investigate the expressions of plasma cystatin C (Cys-C), D-dimer (D-D) and hypersensitive C-reactive protein (hs-CRP) in patients with intracranial progressive hemorrhagic injury (IPHI) after craniocerebral injury, and their clinical significance. Methods Forty-two IPHI patients and 20 healthy participants (control) were enrolled. The severity and outcome of IPHI were determined according to the Glasgow Coma Scale and Glasgow Outcome Scale, and the plasma Cys-C, hs-CRP and D-D levels were measured. Results The plasma Cys-C, D-D and hs-CRP levels in the IPHI group were significantly higher than those in the control group (p < 0.01). There were significant differences of plasma Cys-C, D-D and hs-CRP levels among different IPHI patients according to the Glasgow Coma Scale and according to the Glasgow Outcome Scale (all p < 0.05). In the IPHI patients, the plasma Cys-C, D-D and hs-CRP levels were positively correlated with each other (p < 0.001). Conclusion The increase of plasma Cys-C, D-D and hs-CRP levels may be involved in IPHI after craniocerebral injury. The early detection of these indexes may help to understand the severity and outcome of IPHI.
RESUMO Objetivo Investigar as expressões da cistatina C plasmática (Cys-C), dímero-D (D-D) e proteína C-reativa hipersensível (hs-CRP) em pacientes com lesão hemorrágica progressiva intracraniana (IPHI) após lesão craniocerebral e seus significados clínicos. Métodos Quarenta e dois pacientes com IPHI e 20 indivíduos saudáveis (controle) foram incluídos. A gravidade e o resultado do IPHI foram determinados de acordo com a Escala de Coma de Glasgow (GCS) e Escala de Resultados de Glasgow (GOS), e os níveis plasmáticos Cys-C, hs-CRP e D-D foram detectados. Resultados Os níveis plasmáticos de Cys-C, D-D e hs-CRP no grupo IPHI foram significativamente maiores do que no grupo controle (P <0,01). Houve diferença significativa entre os níveis plasmáticos de Cys-C, D-D e hs-CRP entre os diferentes pacientes com IPHI de acordo com a GCS e entre os diferentes pacientes com IPHI de acordo com o GOS, respectivamente (todos P <0,05). Em pacientes com IPHI, os níveis plasmáticos de Cys-C, D-D e hs-CRP foram positivamente correlacionados entre si (P <0,001). Conclusão O aumento dos níveis plasmáticos de Cys-C, D-D e hs-CRP pode estar envolvido no IPHI após trauma crânio-encefálico. A detecção precoce desses índices pode ajudar a entender a gravidade e o resultado do IPHI.
Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Adulto Joven , Proteína C-Reactiva/análisis , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Hemorragia Intracraneal Traumática/sangre , Cistatina C/sangre , Valores de Referencia , Estudios de Casos y Controles , Índices de Gravedad del Trauma , Factores de Riesgo , Hemorragia Intracraneal Traumática/fisiopatología , Escala de Consecuencias de GlasgowRESUMEN
INTRODUCTION AND AIM: Acute-on-chronic liver failure (ACLF) is a syndrome with high short-term mortality, and predicting the prognosis is challenging. This study aimed to compare the performance of neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (CysC) in predicting the 90-day mortality in patients with hepatitis B virus (HBV)-associated ACLF (HBV-ACLF). MATERIALS AND METHODS: This prospective, observational study enrolled 54 patients with HBV-ACLF. The serum NGAL and CysC levels were determined. A multivariate logistic regression analysis was used to analyze the independent risk factors of mortality. RESULTS: Serum NGAL, but not CysC, was found to significantly correlate with the total bilirubin, international normalized ratio, and model for end-stage liver disease (MELD). Serum NGAL [odds ratio (OR), 1.008; 95% confidence interval (CI), 1.004-1.012; P < 0.01], but not CysC, was an independent risk factor for developing hepatorenal syndrome. Moreover, NGAL (OR, 1.005; 95% CI, 1.001-1.010; P < 0.01) along with the MELD score was independently associated with the overall survival in patients with HBV-ACLF. Patients with HBV-ACLF were stratified into two groups according to the serum NGAL level at baseline (low risk: <217.11 ng/mL and high risk: ≥ 217.11 ng/mL). The 90-day mortality rate was 22.73% (5/22) in the low-risk group and 71.88% (23/32) in the high-risk group. Moreover, NGAL, but not CysC, significantly improved the MELD score in predicting the prognosis of HBV-ACLF. CONCLUSION: The serum NGAL might be superior to CysC in predicting the prognosis of HBV-ACLF with the normal creatinine level.
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Insuficiencia Hepática Crónica Agudizada/sangre , Cistatina C/sangre , Lipocalina 2/sangre , Insuficiencia Hepática Crónica Agudizada/diagnóstico , Insuficiencia Hepática Crónica Agudizada/mortalidad , Adulto , Biomarcadores/sangre , China/epidemiología , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Estudios Prospectivos , Factores de Riesgo , Tasa de Supervivencia/tendenciasRESUMEN
PURPOSE: The aim of this study was to evaluate the association between the decline in estimated glomerular filtration rate (eGFR) and serum 25(OH)D with the physical and mental functional capacity of elderly individuals aged 80 years or older. METHODS: We evaluated the functional capacity in its multidomain aspects: Geriatric Depression Scale (GDS), Instrumental Activities of Daily Living (IADL), Mental State Mini-Exam (MMSE), Verbal Fluency Test (VF), handgrip strength and time to sit and rise from a chair five times, combined creatinine and cystatin C-based eGFR and 25(OH)D levels in 205 independent asymptomatic and community-dwelling elderly subjects in a cross-sectional study. RESULTS: Every 1 year of life, there was reduction of about 10% chance of adequate performance in functional capacity. Each 1 ml/min/m2 in eGFR was associated with 2% better chance of adequate performance in the IADL. We found no association between eGFR and cognition. Serum 25(OH)D between 15.00 and 22.29 ng/ml increased the chance of better performance in VF, IADL, handgrip strength and sit and rise from the chair compared to the lower level of serum vitamin D. CONCLUSIONS: Decreased renal function associated with age compromises the ability to perform activities for independent life in the community, but we did not observe influence in specific domains of cognition and physical performance. Low serum level of 25(OH)D appears to be a marker of greater risk of functional decline than eGFR measurement in independent oldest old dwelling in the community.
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Actividades Cotidianas , Cognición , Tasa de Filtración Glomerular/fisiología , Vitamina D/análogos & derivados , Anciano de 80 o más Años , Creatinina/sangre , Estudios Transversales , Cistatina C/sangre , Prueba de Esfuerzo , Femenino , Evaluación Geriátrica , Fuerza de la Mano , Humanos , Vida Independiente , Masculino , Pruebas de Estado Mental y Demencia , Escalas de Valoración Psiquiátrica , Vitamina D/sangreRESUMEN
The accuracy of estimated glomerular filtration rate (eGFR) equations in diabetes mellitus (DM) patients has been extensively questioned. We evaluated the performance of cystatin C-based equations alone or in combination with creatinine to estimate GFR in DM patients. A PRISMA-compliant systematic review was performed in the MEDLINE and Embase databases, with "diabetes mellitus" and "cystatin C" as search terms. Studies comparing cystatin C-based eGFR equations with measured GFR (mGFR) in DM patients were eligible. Accuracies P10, P15, P20, and P30 indicated the proportion of eGFR results within 10, 15, 20, and 30% of mGFR. Single-arm meta-analyses were conducted, and the Quality of Diagnostic Accuracy Studies-II tool (QUADAS-2) was applied. Twenty-three studies comprising 7065 participants were included, and 24 equations were analyzed in a broad range of GFRs. Meta-analyses were completed for 10 equations. The mean P30 accuracies of the equations ranged from 41% to 87%, with the highest values found with both CKD-EPI equations. Mean P10-P15 achieved 35% in the best scenario. A sensitivity analysis to evaluate different mGFR methods did not change results. In conclusion, cystatin C-based eGFR equations represent measured GFR fairly at best in DM patients, with high variability among the several proposed equations.
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Creatinina/sangre , Cistatina C/sangre , Nefropatías Diabéticas/sangre , Nefropatías Diabéticas/diagnóstico , Tasa de Filtración Glomerular , Factores de Edad , Índice de Masa Corporal , Exactitud de los Datos , Femenino , Humanos , Masculino , Factores SexualesRESUMEN
OBJECTIVE: To investigate the clinical significance of serum cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) in coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). METHODS: One hundred and twenty-eight CHD patients were divided into drug treatment (56 cases) and PCI treatment (72 cases) groups, receiving conventional drug treatment and PCI plus conventional drug treatment, respectively. At admission time and 4 weeks after treatment, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, and left ventricular end systolic diameter were measured. At admission time and 24h, 72h, 1 week, and 4 weeks after treatment, the serum levels of Cys-C and hs-CRP were determined. RESULTS: After 4 weeks of treatment, LVEF in the PCI treatment group was significantly higher than that before treatment (P<0.01) and it was significantly higher than in the drug treatment group at the same time (P<0.01). Cys-C and hs-CRP level in the PCI treatment group were significantly higher than in the drug treatment group 72h and 1 week after treatment (P<0.05 or P<0.01), respectively, but they were significantly lower than in the drug treatment group 4 weeks after treatment (P<0.01). There were obvious interaction effects between grouping factor and time factor in Cys-C (F=3.62, P<0.05) and hs-CRP (F=17.85, P<0.01). CONCLUSION: Serum levels of Cys-C and hs-CRP are closely related to the heart function in CHD patients undergoing PCI, and they may be used for predicting the outcome of PCI.
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Proteína C-Reactiva/análisis , Enfermedad Coronaria/sangre , Enfermedad Coronaria/cirugía , Cistatina C/sangre , Intervención Coronaria Percutánea/métodos , Anciano , Índice de Masa Corporal , Enfermedad Coronaria/tratamiento farmacológico , Enfermedad Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Valores de Referencia , Volumen Sistólico/fisiología , Factores de Tiempo , Resultado del Tratamiento , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
Abstract Objective: To investigate the clinical significance of serum cystatin C (Cys-C) and high-sensitivity C-reactive protein (hs-CRP) in coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Methods: One hundred and twenty-eight CHD patients were divided into drug treatment (56 cases) and PCI treatment (72 cases) groups, receiving conventional drug treatment and PCI plus conventional drug treatment, respectively. At admission time and 4 weeks after treatment, the left ventricular ejection fraction (LVEF), left ventricular end diastolic diameter, and left ventricular end systolic diameter were measured. At admission time and 24h, 72h, 1 week, and 4 weeks after treatment, the serum levels of Cys-C and hs-CRP were determined. Results: After 4 weeks of treatment, LVEF in the PCI treatment group was significantly higher than that before treatment (P<0.01) and it was significantly higher than in the drug treatment group at the same time (P<0.01). Cys-C and hs-CRP level in the PCI treatment group were significantly higher than in the drug treatment group 72h and 1 week after treatment (P<0.05 or P<0.01), respectively, but they were significantly lower than in the drug treatment group 4 weeks after treatment (P<0.01). There were obvious interaction effects between grouping factor and time factor in Cys-C (F=3.62, P<0.05) and hs-CRP (F=17.85, P<0.01). Conclusion: Serum levels of Cys-C and hs-CRP are closely related to the heart function in CHD patients undergoing PCI, and they may be used for predicting the outcome of PCI.