title: Serum cystatin C level is a useful marker for the evaluation of renal function in patients with cirrhotic ascites and normal serum creatinine levels.
abstract: OBJECTIVE
  Several studies suggested that serum cystatin C (CysC) is more useful than serum creatinine (Cr) for the assessment of renal function in patients with liver cirrhosis. This study evaluated the clinical significance of CysC in patients with cirrhotic ascites and normal Cr level.
  
  
  METHODS
  We enrolled patients with cirrhotic ascites and a normal serum Cr level (<1.2 mg/dL). GFR was measured by (99m)Tc-DTPA renal scan. Serum Cr, CysC, and Cr clearance (CCr) were measured on the same day. Significant renal impairment and severe renal impairment were defined as GFR <60 mL/min and GFR <30 mL/min, respectively.
  
  
  RESULTS
  Eighty-nine patients with cirrhotic ascites were enrolled in the study (63 men and 26 women; age, 55±11 years). Forty-seven (52.8%) and 42 (47.2%) patients were in Child-Pugh grade B and C, respectively. Serum Cr and CysC levels and GFR were 0.8±0.2 mg/dL, 1.1±0.3 mg/L, and 73.4±25.5 mL/min, respectively. Significant and severe renal impairment were noted in 28 (31.5%) and 2 (2.2%) patients, respectively. GFR was well correlated with serum Cr, CysC, and e-GFR(MDRD), while it was not correlated with e-GFR(C&G). In multivariate analysis, only CysC was significantly correlated with GFR (β, 45.620; 95% CI, 23.042-68.198; P<0.001). Serum CysC level was the only independent predictor for significant renal impairment.
  
  
  CONCLUSIONS
  Significant renal dysfunction was not rare in patients with cirrhotic ascites, even their serum Cr level is normal. Serum CysC is a useful marker for detecting significant renal dysfunction in these patients.
authors.affiliation: Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
authors.forename: Dong Jin
authors.initials: DJ
authors.lastname: Kim
authors.forename: Hyun Seok
authors.initials: HS
authors.lastname: Kang
authors.forename: Hyuk Soon
authors.initials: HS
authors.lastname: Choi
authors.forename: Hye Jin
authors.initials: HJ
authors.lastname: Cho
authors.forename: Eun Sun
authors.initials: ES
authors.lastname: Kim
authors.forename: Bora
authors.initials: B
authors.lastname: Keum
authors.forename: Hyonggin
authors.initials: H
authors.lastname: An
authors.forename: Ji Hoon
authors.initials: JH
authors.lastname: Kim
authors.forename: Yeon Seok
authors.initials: YS
authors.lastname: Seo
authors.forename: Yong Sik
authors.initials: YS
authors.lastname: Kim
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.forename: Yoon Tae
authors.initials: YT
authors.lastname: Jeen
authors.forename: Hong Sik
authors.initials: HS
authors.lastname: Lee
authors.forename: Soon Ho
authors.initials: SH
authors.lastname: Um
authors.forename: Chang Duck
authors.initials: CD
authors.lastname: Kim
authors.forename: Ho Sang
authors.initials: HS
authors.lastname: Ryu
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism; D007677:Kidney Function Tests; D008103:Liver Cirrhosis / Q000150:complications* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012372:ROC Curve; D012720:Severity of Illness Index; D016284:Technetium Tc 99m Pentetate
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine; D016284:Technetium Tc 99m Pentetate