title: Serum cystatin C in advanced liver cirrhosis and different stages of the hepatorenal syndrome.
abstract: OBJECTIVE
  The hepatorenal syndrome (HRS) is classified into two types (HRS-2 and HRS-1) based on mild or high serum creatinine elevations. Although it has been identified as an early marker of renal dysfunction, data are lacking about cystatin C across the wide range of renal changes in end-stage liver disease. This study investigates serum cystatin C and creatinine in patients with advanced liver cirrhosis and classic HRS throughout its whole spectrum.
  
  
  METHODS
  Serum cystatin C immunonephelometric measurements were obtained from 65 Child-Pugh C patients: 32 with normal creatinine, 17 with HRS-2 and 16 with HRS-1. The glomerular filtration rate (GFR) was estimated according to modification of diet in renal disease (MDRD) and the Hoek formulae (creatinine- and cystatin C-based, respectively) with staging of renal dysfunction severity into an increasing order from 1 to 5.
  
  
  RESULTS
  Early HRS was identified by the raised cystatin C in 56.3% of patients having normal creatinine. Cystatin C correlated significantly with creatinine in HRS-2 (r=0.74; p<0.001) and showed a significantly lower multiplication ratio (folds of rise) compared to creatinine in HRS-1 patients (p<0.01). There was no satisfactory agreement between MDRD and Hoek GFR staging (k=0.29).
  
  
  CONCLUSIONS
  The 'early' HRS identified by a rise in cystatin C in cases with advanced cirrhosis was found to be common and can be added to the already classified two types, as type-3 HRS. Compared to creatinine, cystatin C provides no better information in HRS-2, and underestimates the renal deterioration in HRS-1. Further studies are required to determine the course of the early HRS.
authors: Department of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut, Egypt. mahabarakat2001@yahoo.com
authors: Maha
authors: M
authors: Barakat
authors: Mohamed
authors: M
authors: Khalil
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D003404:Creatinine / Q000097:blood; D055316:Cystatin C / Q000097:blood*; D018450:Disease Progression; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006530:Hepatorenal Syndrome / Q000097:blood* / Q000175:diagnosis / Q000209:etiology; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D011379:Prognosis; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D015415:Biomarkers; D055316:Cystatin C; D003404:Creatinine