Korean J Hepatol.  2011 Jun;17(2):130-138. 10.3350/kjhep.2011.17.2.130.

Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels

• Kim DJ
• Kang HS
• Choi HS
• Cho HJ
• Kim ES
• Keum B
• An H
• Kim JH
• Seo YS
• Kim YS
• Yim HJ
• Jeen YT
• Lee HS
• Um SH
• Kim CD
• Ryu HS

• KMID: 1015572
• DOI: http://doi.org/10.3350/kjhep.2011.17.2.130

Abstract

BACKGROUND/AIMS
Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level.
METHODS
We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by 99mTc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively.
RESULTS
Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55+/-11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8+/-0.2 mg/dL, 1.1+/-0.3 mg/L, and 73.4+/-25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFRMDRD, while it was not correlated with e-GFRC&G. In multivariate analysis, only CysC was significantly correlated with GFR (beta, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment.
CONCLUSIONS
Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.

Keyword

Ascites; Creatitine; Cystatin C; Liver cirrhosis; Renal dysfunction

MeSH Terms

Adult
Aged
Area Under Curve
Biological Markers/blood
Creatinine/blood
Cystatin C/*blood
Female
Glomerular Filtration Rate
Humans
Kidney Diseases/complications/*diagnosis/metabolism
Kidney Function Tests
Liver Cirrhosis/*complications/metabolism
Male
Middle Aged
Multivariate Analysis
ROC Curve
Severity of Illness Index
Technetium Tc 99m Pentetate/diagnostic use