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العنوان
Serum Cystatin C as a Biomarker of Kidney Dysfunction in Patients with Advanced Cirrhosis /
المؤلف
Radwan, Ahmed Mohamed El -Sayed.
هيئة الاعداد
باحث / Ahmed Mohamed El -Sayed Radwan
مشرف / Afaf Aly Masoad
مشرف / Hany Mansour Khalil Dabbous
مناقش / Mohammed Sobhi Hassan
تاريخ النشر
2018.
عدد الصفحات
135 P. :
اللغة
الإنجليزية
الدرجة
الدكتوراه
التخصص
الطب (متفرقات)
تاريخ الإجازة
1/1/2018
مكان الإجازة
جامعة عين شمس - كلية الطب - قسم طب مناطق الحارة
الفهرس
Only 14 pages are availabe for public view

from 135

from 135

Abstract

R
enal imapirment (RI) is a serious complication in patients with chronic liver disease affecting about 20% hospitalized patients.
Renal impairment is a heterogeneous entity associated with various clinical presentations, treatments and procedures and is often seen in the setting of multiple organ failure and sepsis. Many potential therapeutic agents have been tried but with little success. Absence of reliable biomarkers for early detection of injury leads to delay in the introduction of treatment.
Causes of renal impairment include prerenal, HRS, ATN and post renal causes which are rare and represent less than 1% of the cases.
In current clinical practice, serum creatinine level and urine output are the most frequently used indicators of renal dysfunction despite they have limited sensitivity and specificity.
Serum creatinine, the commonly used marker for renal injury, is slow and insensitive. It is a marker of function and not injury and may take days after injury to increase limiting their usefulness in the early detection of RI.
An early detection of patients with kidney injury may provide the opportunity to treat and prevent the extension of kidney injury well before the serum creatinine rises resulting in fewer complications and improved outcomes.
Recent advances have found the early stress response of kidney tubule cells to ischemic injury and have provided several novel biomarkers for RI. CysC better correlates with GFR compared to creatinine, it is more sensitive for the diagnosis of mild decrease of GFR (60-90 ml/min/1.73 m2) and is a better early predictor of creatinine in ARF. Its disadvantages compared to creatinine are related to higher test price and need of standardization. Data for the dependence of its levels on advanced age (especially > 50 yrs), male gender, overweight, height, smoking and higher C-reactive protein levels, malignant diseases and some drugs (corticosteroids, ACE-inhibitors) are disputable
Our study included 60 patients with End Stage Liver Disease (ESLD) and 30 healthy subjects as control group. 30 patients ESLD, with renal impairment and 30 patients ESLD , without renal impairment.
In the current study, AST and ALT level was significantly higher in ESLD patients with and without renal in comparison to control group. AST level was not significantly different between ESLD patients with and without renal impairment while ALT level was significantly higher in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.
Bilirubin level was significantly higher in ESLD patients with and without renal impairment in comparison to control group. It was also significantly higher in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.
Albumin level was found to be significantly lower in ESLD patients with and without renal in comparison to control group. It was also significantly lower in ESLD patients without renal impairment in comparison to ESLD patients with renal impairment.
In our study, Creatinine clearance was found to be significantly lower in ESLD patients with and without renal impairment in comparison to control group. It was also significantly lower in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.
In our study, Cystatin C level was found to be significantly lower in ESLD patients with and without renal impairment in comparison to control group. It was also significantly lower in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.
MELD score was found to be significantly higher in ESLD patients with renal impairment in comparison to ESLD patients without renal impairment.
The comparison between ESLD patients with or without renal impairment and control group regarding Cystatin C level revealed that the best cut off value was found to be ≤ 169 mg/l with area under the curve (AUC), 0.800; Sensitivity, 88.3%; Specificity, 80%; Positive predictive value (PPV), 89.8%; Negative predictive value (NPV), 77.4%.
On the other hand, the comparison between ESLD patients with or without renal impairment and control group regarding creatinine clearance level revealed that the best cut off value was found to be ≤ 90 ml/min with area under the curve (AUC), 0.848; Sensitivity, 71.67%; Specificity, 100.00%; Positive predictive value (PPV), 100.0%; Negative predictive value (NPV), 63.8%.