J Korean Med Sci.  2011 Feb;26(2):258-263. 10.3346/jkms.2011.26.2.258.

Cystatin C as an Early Biomarker of Nephropathy in Patients with Type 2 Diabetes

• Jeon YK
• Kim MR
• Huh JE
• Mok JY
• Song SH
• Kim SS
• Kim BH
• Lee SH
• Kim YK
• Kim IJ

• KMID: 1782115
• DOI: http://doi.org/10.3346/jkms.2011.26.2.258

Abstract

This study was done to evaluate clinical usefulness of cystatin C levels of serum and urine in predicting renal impairment in normoalbuminuric patients with type 2 diabetes and to evaluate the association between albuminuria and serum/urine cystatin C. Type 2 diabetic patients (n = 332) with normoalbuminuria (n = 210), microalbuminuria (n = 83) and macroalbuminuria (n = 42) were enrolled. Creatinine, urinary albumin levels, serum/urine cystatin C and estimated glomerular filtration rate (eGFR by MDRD [Modification of Diet in Renal Disease] and CKD-EPI [Chronic Kidney Disease Epidemiology Collaboration] equations) were determined. The cystatin C levels of serum and urine increased with increasing degree of albuminuria, reaching higher levels in macroalbuminuric patients (P < 0.001). In multiple regression analysis, serum cystatin C was affected by C-reactive protein (CRP), sex, albumin-creatinine ratio (ACR) and eGFR. Urine cystatin C was affected by triglyceride, age, eGFR and ACR. In multivariate logistic analysis, cystatin C levels of serum and urine were identified as independent factors associated with eGFR < 60 mL/min/1.73 m2 estimated by MDRD equation in patients with normoalbuminuria. On the other hand, eGFR < 60 mL/min/1.73 m2 estimated by CKD-EPI equation was independently associated with low level of high-density lipoprotein in normoalbuminuric patients. The cystatin C levels of serum and urine could be useful markers for renal dysfunction in type 2 diabetic patients with normoalbuminuria.

Keyword

Cystatin C; Diabetic Nephropathies; Albuminuria

MeSH Terms

Aged
Albuminuria/urine
*Biological Markers/blood/urine
Creatinine/blood/urine
*Cystatin C/blood/urine
Diabetes Mellitus, Type 2/*blood/physiopathology/*urine
Diabetic Nephropathies/*blood/physiopathology/*urine
Female
Glomerular Filtration Rate
Humans
Kidney Function Tests
Male
Middle Aged
ROC Curve
Retrospective Studies

Figure

• 

  Fig. 1 Cystatin C in patient groups with normoalbuminuria (NA), microalbuminuria (MA) or macroalbuminuria (diabetic nephropathy, DN). (A) Serum cystatin C. *P < 0.01 NA vs MA; †P < 0.001 MA vs DN; ‡P < 0.001 NA vs DN. (B) Urine cystatin C. *P < 0.05 NA vs MA; †P < 0.01 MA vs DN; ‡P < 0.001 NA vs DN.

• 

  Fig. 2 ROC curves of cystatin C in serum and urine in reference to eGFR < 60 mL/min/1.73 m2 calculated by the MDRD equation. The AUC for was 0.906 (95% CI, 0.865-0.947) for serum cystatin C and 0.807 (95% CI, 0.741-0.873), for urine cystatin C. For serum cystatin C, the cutoff value for the identification of eGFR < 60 mL/min/1.73 m2 conducted by the MDRD equation was found to be 1.06 mg/L with a sensitivity of 81.0% and a specificity of 87.1%, whereas for urine cystatin C, it was 0.1 mg/L with a sensitivity of 70.9% and a specificity of 86.3%.

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