Kidney Res Clin Pract.  2018 Dec;37(4):338-346. 10.23876/j.krcp.18.0080.

Cystatin C as a novel predictor of preterm labor in severe preeclampsia

• Wattanavaekin K
• Kitporntheranunt M
• Kreepala C

• KMID: 2447178
• DOI: http://doi.org/10.23876/j.krcp.18.0080

Abstract

BACKGROUND
The most common cause of acute kidney injury (AKI) in pregnancy is preeclampsia. Serum cystatin C (CysC) is a potential biomarker of early kidney damage as its levels are not disturbed by volume status changes in pregnancy, and serum CysC levels could serve as a replacement for conventionally used creatinine. In this study, we investigated the serum levels of CysC in severe preeclampsia cases and the associations between CysC levels and poor obstetric outcomes.
METHODS
Our cohort included severe preeclampsia patients with a normal serum creatinine level. Creatinine was measured to calculate estimated glomerular filtration rate (eGFR) based on the Cockcroft and Gault, Modification of Diet in Renal Disease Study (MDRD), and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations, while CysC was measured to calculated eGFR based on a CysC-based equation. We then evaluated the correlations between serum CysC level, eGFR, and obstetric outcomes.
RESULTS
Twenty-six patients were evaluated of which 38.5% delivered preterm and 30.8% had low-birth weight babies. Unlike creatinine-based eGFR and CysC-based eGFR, serum CysC demonstrate significant negative correlation with gestational age. Receiver operating characteristic curve analysis indicated that serum CysC is a potential biomarker of preterm delivery with a cut-off serum level of 1.48 mg/L with 80% sensitivity and 75% specificity.
CONCLUSION
GFR estimation using CysC is likely to be inaccurate in pregnancy. However, we found a significant correlation between preterm delivery and serum CysC level. Our results suggest that serum CysC level has the potential to predict preterm delivery in severe preeclampsia patients.

Keyword

Acute kidney injury; Cystatin C; Low birth weight infant; Preeclampsia; Premature obstetric labor

MeSH Terms

Acute Kidney Injury
Cohort Studies
Cooperative Behavior
Creatinine
Cystatin C*
Diet
Epidemiology
Female
Gestational Age
Glomerular Filtration Rate
Humans
Infant, Low Birth Weight
Infant, Newborn
Kidney
Obstetric Labor, Premature*
Pre-Eclampsia*
Pregnancy
Renal Insufficiency, Chronic
ROC Curve
Sensitivity and Specificity
Creatinine
Cystatin C