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Abstract
In paraplegic patients, urological and renal problems are major causes of both morbidity and mortality in all those who survive long term. The most common urological disorders in these patients are secondary to disordered bladder function
Renal failure is common in paraplegics and it is usually underdiagnosed because renal function is rarely or never checked regularly in these patients population, the interpretation of plasma creatinine is difficult in these patients with much reduced muscle mass and the interpretation of creatinine – based techniques for measurement of glomerular filtration rate.
Cystatin C is a nonglycosylated low molecular weight protein (122-amino-acid) that is a member of the Family of Cysteine proteinase inhibitors. It is the product of a “house keeping” gene expressed in all nucleated cells and is produced at a constant rate, independent upon age, sex and muscle mass.
Cystatin C is freely filtered by the glomerului, not secreted, but is reabsorbed by tubular epithelial cells and subsequently catabolized so, it neither returns to the blood nor appear concentrated in urine, closer to the “ideal endogenous marker”
Aim of The Work
Compare between serum cystatin C and estimated GFR equations that depend on serum creatinine level the most commonly used marker of the GFR as a marker of renal function in spinal cord injury (paraplegic patients) with various degree of renal diseases.
Patients and methods
40 patients were included in this study and were divided into control group 20 paraplegics with normal renal function; paraplegic patients with renal impairment group comprise 10 patients and end stage renal disease group comprising 10 patients suffering from renal failure on regular hemodialysis. The three groups were subjected to full clinical history, thorough clinical examination, routine investigations to evaluate renal insults, renal function tests (BUN and serum creatinine), abdominal ultra sonography and calculation of estimated GFR by using Cockcroft-Gault and MDRD equations and estimation of serum cystatin C level
Results
The collected data were statistically analyzed and the following results obtained:
1-There was highly significant negative correlation of GFR with serum creatinine and serum cystatin C but GFR correlated with cystatin C more than creatinine.
2-There was highly significant positive correlation between serum creatinine and serum cystatin C.
3-There was highly significant positive correlation between serum creatinine and body mass index and no such significant correlation between serum cystatin C and body mass index.
4-Serum cystatin C was more sensitive, specific and accurate than serum creatinine as a marker of GFR.
5-Serum cystatin C detected early reduction in GFR more than creatinine.
The higher cost of cystatin C and the lack of ready availability have prevented its wide acceptance as the replacement for creatinine to estimate renal function.
Conclusion
In conclusion, this study demonstrates that serum cystatin C offers more efficient diagnostic tool for estimation of GFR than serum creatinine in paraplegic patients with reduced muscle mass and various degrees of renal impairment.