exuss

Glomerulus the ste

ad
e
iny fA1ters of the kidre uhich renves
vnne
form o
Flud from blond then erete it in he
Glomerular Filtration Rate rervlus
the qlomrvi
mch bled pasges though
A Hext that estimarte howa thet pacse hgh ony
Per mine speLialy qgainG notl mopuole

a
Cystatin C, Widely accepted as the best
overall measure or

Comparison to Creatinine and kidney function.

molecules
other Clearance Markers A measure of the clearance of normal
are freely
that are not bound to protein and
neither reabsorbed
filtered by glomeruli
the
Prepared by: nor secreted by the tubules.
Cystatin C Billy Africa, RMT, MPH sinte prorelns are mauromoleoles, they are net p l y
0ne ot he marker for oagssing one he ttn in urine (pesen ce
kldney damoge)
nean«
tohich is
the filirahin toed( eliminatemajor
fhe
funcion of tho dney
Apprmimottly 150L (125-130 ml/min) f glomarvlar
present in the árulchon) metubollo waste praducto fltrafe is pndued daily io aur kidey
Kidney
body's main fittraing system end ene f is hdjor funcrion is to rewye a
products rom wr bdy and then exerete * in tom of uine
FUNCTION6:
Fithation f blood moaiptenance of iniu eqikbrium
Regulahon t plasma 44 wattr volume and ad bast balançet
What is it used for? Vendocrine ftnchon (renin d EPO) l need GFR test?
Why do a
g h pogbibliky t wont pngrass to renal failurt or chronic kidney
disease
A GFR test is you may need a GFR test if you are at higher
used to help diagnose kidney
disease at an early stage mst treateble stmge risk of getting kidney disease. Risk factors
GFR may also be used to monitor people with include: Diebehc rehnopety /blindnss
chronic kidney disease (CKD) or other congrene
conditions that cause kidney damage. Diabetes(hyporglycemia) makes bjood nore vistous
Other anditions High blood pressure leods to damaqe in nephrons
Hypertension Family history of kidney failure hureditary
Diabetes most tammon compliuatien are
Kidney disease Nott: Early shage kidney disease has no
ymptoms
(Asymptomartic)

Clearance
Later stage kidney disease does cause symptoms. Volume of plasma from which the substance is completely
So you may need a GFR test if you have any of the
cleared (removed) by the kidney per unit of time.
following symptoms: Removal of the substance from plasma into urine over a fixed
Polyorna Auria time.
Oliguna I t is
- Urinating more or less often than usual expressed in mL/minute, representing the volume of plasma
that would be totally cleared of solute in one minute.
Itching
plasma concentration and
clearance of a substance is inversely
- Fatigue
porportional. clearonce ot absfance jn plasma Cnc
- Swelling in your arms, legs, or feet (elkcroyts afect the movemenit
Measurement of clearance may require accurate measurement
- Muscle cramps ofwater EDEMA of
serum and urinary concentration of the marker used

- Nausea and vomiting Anosarco: goner ali2ed edem a

- Loss of appetite to the whole buy
 Markers for Clearance Test Methods:
Most involved the ability of the kidney to clear
Substance used must be: an exogenous and endogenous marker.
Stable concentration (does not vary within the
day) Exogenous Marker
Physiologically inert (svbstun is ndt metabojize in Ideal, but costly and cumbersome.
Freely filtered at the glomerulus the bod)
Note: cells in Neither secreted,
-
Enable smaller deterioration in renal function to
the tubus
reabsorbed, synthesized, nor
metabolized by the kidney
be observed. (mere sensihive)
The amount of that substance
(ll goes to the uninte, nthing 3oes b -Examples: Radioisotopic- Cr-EDTA, TC-DTPA,
art nuoeated filtered at the in he
glomerulus is equal to the amount excreted in the blod) iothalamate
urine.
Non-Radioisotopic iohexol, inulin
Additi nal
Markers must not be prvtein bovnd Tnulin:reterene mdhod Ar 6FA test
cann ot be iHered f bound t
protein)

prodoced by all naeated cells in

Cystatin C tbes)
Endogenous Markers Aka
Simplest and readily available (produced in the bocy) Cystatin 3, formerly Gamma Trace, Post-Gammaglobulin
or Neuroendocrine Basic Polypeptide
-

Obviate the necessity for

injection and requires I s a low
molecular weight (12.8 kD) protein synthesized by all
only a single blood sample, it simplifies the nucleated celis whose physiologic role is that of
cysteine
procedure. proteinase inhibitor.
- Examples: With regards to renal function, its most important attributes
areits small size and high isoelectric
point (pl 9.2), which
Creatinine(waste prwuct of muscle that camc fron CREAtINE enable it to be more freely filtered than other
protein at the
Cystatin C(produ cod ball voleated cells) glomeruli.
The production rate of
Urea (deamin ahj on of ammonia) cystatin C has always been considered
qlso prodoced fnm prolein dtbxthicatian
to be constant
of LVER ( from age 4 mos. To 70 y/o.)
Serum concentration of
met abn lism Cystatin C appears to be
unaffected by muscle mass, diet, or gender. relatively
No extrarenal route elimination.

Creatinine affected by musle mass

-

, diet, gender
Vrta- variavly reabsorbed y the tvhwky
Tnulin-needls to be administerd byIV infisjan
(egeneas
uiolahon in the murker
Since it is completely reabsorbed, change in
serum concentration of cystatin C are used as
Several proteins with molecular weight of less indirect estimate of GFR. idirect estimate
kecage sanplc
than 30 kD are primarily cleared from Its presence in the urine denotes damage of in e test
circulation by renal filtration and can be the tubules. is BLODD!!
considered to be relatively freely filtered at Its plasma concentration is
inversely related to
the glomeruli. GFR.

Examples: a2-macroglobulin, RBP, a1- Renal clearance cannot be measured

microglobulin, B trace protein, Cystatin C, (Gphin Cis omplettly rlprbel un ks there i problen
tryptophan glycoconjugate. in the rena)
tubules
1
1
 Creari nineproduced in liver co liver disease affects
its on
Urea diet («ffeted conc. in protein diet)
ender Cretinine of male is tan female
Advantage of Cystatin C as GFR marker Creatinine vs. Cystatin C
sensitive and
Cystatin measurement may offer
a more
Asymptomoth c in changes in GFR
Virtually unaffected by non renal factorsy stoge kidney specific m e a s u r e m e n t of monitoring
than in serum creatinine.
Sensitive to called creatinine blind range damoge So it is
so
teded if .
cvstatin C increase faster than creatinine
Can be used to detect and monitor kidney
disease in patient with hepatic disease
damage is n abnormality.
certain
Swere Creatinine is affected by age, gender, exercise,
and nutitional status.
-

Creatinine for GFR in liver disease not recommended drugs, muscle mass,

C measurement appears resistant

to spectrall
Correlates to appearance of microalbuminuria Cystatin
-

Clinical studies suggest that very early renal failure interference. (st spechrophotometer in Masonng9)
may be the first clinical indication of progressive renal
damage associated with diabetes reftets the conc of
Tnicoakouminuria
Percistent elevation ofalbumin in vrine
Cystoin C
behwen 3o- 30 mg/day (bt the unine
dipshick can detect albumin conc at
300/day)
Cystatin C and other diseases HIV
Diabetes Studies have reported increased in Cystatin C
A reliable marker of GFR in patients with mild-to- levels in HIV
moderate kidney dysfuntion_(stage 2-3 of CKD) in
Because of an increase of cystatin C levels
both type 1 and 2 diabetes.
with active HIV infection, an overestimation of
Elevated serum cystatin C levels identified as a
kidney impairment may occur, particularly in
significant prognosticator for the development of treatment-naive patients with renal disease.
cardiovascular disease in people with diabetes. they dont rexponse to trearm ent
Cystatin C is not only a better indicator of GFR in
diabetes, it has the best correlation with changes f HIV nfechion
in GFR over two years, making it a useful measure
for follow up of patients with diabetes.

Cystatin is almst the same wth cardiac morkers,

EX: AST, LDH , CKMb, Tnpnin

Thyroid Function tpothyoid (shin C typertihyrd= Obesity Fat cels has nocleus mcons thy prduce (ystain C
Like creatinine concentrations, Cystatin C levelsalso ystatin C
are
lower in the hypothyroid and higher in the hyperthyroid Serum cystatin C concentration are increased in
state as compared with the euthyroid state. human obesity in relation to over production by
normel hrd normal Gyshtin C the adipose tissue. So, cystatin C levels are higher
in obese subjects as compare to lean.
Cardiovascular Disease
Cystatin C has been reported to be a potent predictor of Adipose tissue is a source of cystatin C in a way
that is not related to eGFR but to the status of
cardiovascular mortality beyond classical risk factors in
patient with CAD and normal or mildly reduced kidney adipose tissue itself, including enlarged
function. adipocytes, hypoxia, pro-inflammatory cytokines
Serum cystatin C may have a stronger association with production, increased number of macrophages,
mortality and cardiovascular disease than serum and probably other cellular and molecular
creatinine in patients without CKD, as reported in a large alterations known to occur in obesity.
study of older adults.
 Levels of cystatin C are Contraindication of Cystatin C Estimation
altered in following
conditions: Thyroid function
- Cancer
ient A ystatin - Levels of cystatin C are sensitive to change in thyroid
function and should not be performed without
-Thyroid dysfunction depends if tyothyroid or
tyorthy rotd
Glucocorticoid therapy AGysturin g r urtiwstenid whle knowledge of patients thyroid status

-HIV infection tostahin in oydasporine

Corticosteroids
-

Increased levels in MI, stroke, heart failure,

of
peripheral arterial syndrome -Cystatin C concentrations are affected in patients
-

Increased in metabolic syndrome impaired renal function receiving corticosteroids

- Cystatin Cis affected by corticosteroid (increase) and
-

Increased in alzheimer disease

cyclosporine (decrease).
-

Levels decreased in atherosclerosis and

aneurysmal (saccular bulging) lesions of aorta

Laboratory Measurement
Assay Principle Cstmrin C t AntcystatinC Asglutination
- Cystatin C in the sample binds to the specific anticystatin c
and causes
antibody which is coated on latex particles - Reference value:
agglutination
- The degree of turbidity caused by agglutination is Males: 0.52-0.98 mg/dl
amount of
measured optically and is proportional to the
Female: 0.52-0.90 mg/dl
C in the sample by a method called turbidimetry.
Cystatin
Specimen: serum or plasma (fastingg is not required)
-
Increased levels: acute or chronic renal failure, diabetic
nephropathy

Is there anything else I need to know abouta GFR

test?

you can
kidneys is usually permanent,
Athough damage to your
take steps to prevent
further damage. Steps may
include: Thank you for listening,
Blood pressure medicines (hypertension
Medicines to control blood sugar
if you have diabetes
exercise and maintaining a
getting
Study Hard!
more
Lifestyle dhanges such as

healty weight

.Limitingalcohol o subsons ir Billy

.Quitting smoking Kidney tranplant:

disose is treted erly, you mdy be able o prevent olt immnosvppresive drys etause t is ftreqn to the buly
kidnty
b t immuno 6uppresive drgs can wwken immine
kidney l t system
Kidnsy falurt uphon
only engfHen your te span to 10 yeacs
Dioysis
Kidney Tronsplont