Serum Cystatin C, Creatinine and Estimated Glomerular Filtration Rate : Current School News

Assessment of Serum Cystatin C, Creatinine and Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease in Zaria, Nigeria 

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Assessment of Serum Cystatin C, Creatinine and Estimated Glomerular Filtration Rate in Patients with Chronic Kidney Disease in Zaria, Nigeria.

ABSTRACT

The limitations of serum creatinine as a marker of impairment in GFR have led to continuing search for a better marker.

Most studies have shown that serum cystatin C may be a more sensitive indicator of glomerular filtration rate (GFR) than serum creatinine in the clinical setting.

This study was designed to evaluate serum cystatin C,creatinineand estimated GFR (eGFR)in Chronic Kidney Disease (CKD) patients.

One hundred and fourteen (114) CKD Patients (comprising 59 males and 55 females) attending Nephrology Clinic at ABUTH and apparently healthy age and sex matched controls were recruited for the study.

Serum creatinine and cystatin C were assayed by the Jaffe kinetic and immunoturbidimetric methods respectively. Estimated GFR was calculated usingthe Cockcroft-Gault (C-G) formula.

Serum creatinine, cystatin C and Estimated GFR (eGFR) in patients and controls were comparedusing the t-test. Relationships between serum cystatin C, creatinine and estimated GFR were analysed using the Pearson’s correlation.

In this study,serumcystatin C and creatinine were significantly higher(p<0.0001)and estimated GFR significantly lower (p<0.0001) in patients than the control subjects.

Cystatin C was better correlated with Estimated GFR (r =-0.708;p<0.0001) than creatinine (r =- 0.694;p<0.0001). Mean cystatin C concentration showed step-by-step statistically significant increase as GFR decreases, allowing very early detection of reduction in renal function.

The findings from this study showed that serum cystatin C is a better marker compared with serum creatininein evaluating GFR particularly for detecting very early reduction of renal function. Use of cystatin C to assess renal function will optimize early detection,treatment and monitoring strategies forpatients with CKD. 

TABLE OF CONTENTS

Title page….i
Declaration…….ii
Certification……iii
Acknowledgement……….iv
Abstract………..v
Table of contents….……vi
List of tables……………….x
List offigures..………xi
List of appendices…….……xii
Abbreviations/Symbols………xiii

CHAPTER ONE

1.0 INTRODUCTION
1.1 Background……………1
1.2 Statement of the problem…………..5
1.3 Justification……….5
1.4 Aimand Objectives………5

CHAPTER TWO

2.0 LITERATURE REVIEW
2.1 The kidney………7
2.1.1 Functions of the kidney………….…10
2.2 Chronic kidney disease…….11
2.2.1 Aethiopathogenesis of Chronic kidney disease…12
2.2.2 Clinical features ……13
2.2.3Laboratory diagnosis….13
2.2.4Treatment…..15
2.2.5Prevention ….16

CHAPTER THREE

3.0 MATERIALS AND METHODS
3.1 Background of study area……17
3.2 Study population (Subjects)….17
3.2.1 Inclusion criteria……17
3.2.2 Exclusion criteria………18
3.2.3 Consent….18
3.2.4 Sample size……….18
3.2.5 Ethical approval…….19
3.3 Study protocol………19
3.4 Specimen collection and processing…19
3.4.1 Blood……..19
3.4.2Urine……20
3.5 Chemicals………20
3.6 Equipment………20
3.7 Analytical methods…….21
3.7.1 Creatinine…………21
3.7.2 Cystatin C……22
3.7.3 Urine MicroalbuminTest..……..23
3.8 Quality control…….24
3.9 Statistical analysis…….…25

CHAPTER FOUR

4.0 RESULTS
4.1 Description of the Study Population…26
4.2Biochemical characteristics of the study population…..29
4.3 Staging of the CKD patients using the eGFR…32
4.4The biochemical analytes and stages of Chronic Kidney Disease……….34
4.5 Relationship between serumcystatin C, creatinine and eGFR among the CKD patients…36

CHAPTER FIVE

5.1 DISCUSSION..….41

CHAPTER SIX

6.0 SUMMARY, CONCLUSION AND RECOMMENDATIONS
6.1 Summary…….….44
6.2 Conclusion ……44
6.3 Recommendations……….45

REFERENCES…46

INTRODUCTION

Chronic kidney disease (CKD) is defined by the occurrence of kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for ≥3 months.

According to the definition by the Kidney Disease Outcome Quality Initiative (K/DOQI) (2002), the presence of CKD should be established base on the occurrence of kidney damage and the level of kidney function, regardless of the specific diagnosis of diseases and conditions causing the damage.

Disease staging is based on the GFR (Table 1.1). Chronic kidney disease is characterized by a gradual and permanent loss of kidney function that worsens as it progresses from stages 1 to 5 (National Kidney Foundation. K/DOQI 2002).

The global increase in the incidence and prevalence of CKD is being driven by the global increase in the prevalence of diabetes mellitus, hypertension, obesity, and aging.

The prevalence of CKD increases exponentially with age, and we can expect numbers to rise as the population continues to age and the prevalence of type II diabetes increases (Stevens et al, 2007).

The World Health Report (2003) and Global Burden of Disease project reports show that diseases of the kidney and urinary tract contribute to the global burden of diseases with approximately 847,000 deaths every year and 15, 214,000 disability-adjusted life years (WHO, 2003).

Community surveys have shown that the number of people with end-stage kidney disease (ESRD) is just the tip of the “CKD iceberg” (Olugbengaet al, 2010).

More than 10% of people, or more than 20 million, aged 20 years or older in the United States have CKD.More than 35% of people aged 20 years or older with diabetes have CKD and more than 20% of people aged 20 years or older with hypertension have CKD (CDC, 2010). 

REFERENCES

Abiodun M.T., Iduoriyekemwen N.J., &Abiodun P.O. (2012).Cystatin C- Based Evaluation of Kidney Function of HIV-Infected Children in Benin City, Southern Nigeria.International Journal of Nephrology, 2012; 2012, 861296. doi: 10.1155/2012/861296.

Abioye-Kuteyi, E.A., Akinsola, A., EzeomaIT(1999). Renal disease: The need for community-based screening in rural Nigeria. African Journal of Medical Practice; 6(5), 198-201.

ABU (2014).Zaria at a Glance. Retrieved April 14, 2014 from http://www.abu.edu.ng/info/zaria.php

Alebiosu C.O. &Ayodele O. E. (2005).The global burden of chronic kidney disease and the way forward.Ethnicity & Disease, 15, 418-423.

Aminu K.B., Emeka N., &Meguid A.E. (2005).Prevention of chronic kidney disease: A global challenge. Kidney International, 68, S11–S17. doi:10.1111/j.1523- 1755.2005.09802.x

Arend, B., Joanna, A.E., van, W., Michael, J.L.,&Birgit, S. (2002).Effect of Corticosteroid Therapy on Serum Cystatin C and β2-Microglobulin Concentrations.Clinical Chemistry, 48(7), 1123-1126.

Arogundade, F.A., & Barsoum, R.S. (2008).CKD prevention in Sub-Saharan Africa: a call for governmental, nongovernmental, and community support. American Journal of Kidney Disease, 51(3), 515-23.

Arthur CG and John EH: Urine formation by the kidney- Glomerular filtration, Renal blood flow, and their control. In: Textbook of Medical Physiology 11th edition, 2006; pp. 307-310.

Bosan, I. B. (2007).Recommendations for early diagnosis of chronic kidney disease. AnnalsNof African medicine, 6(3), 130.

Buysschaert M., Joudi I., Wallemacq P., Hermans M. P.(2003). Performance of Serum Cystatin-C Versus Serum Creatinine in Subjects With Type 1 Diabetes Diabetes Care, vol. 26 no. 4 1320. doi: 10.2337/diacare.26.4.1320

CDC-National Chronic Kidney Disease Fact Sheet 2010. pp 1-4. Retrieved April 14, 2013 from http://www.cdc.gov/diabetes/pubs/pdf/kidney_Factsheet.pdf

Cepeda, F. J., Fernandez, E., Pobes, A., &Baños, L. M. (2007).Utility of Cystatin-C in hospitalized patients.Comparison with different methods of assessing renal function. Nefrologia, 27(2).

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