Cystatin C: the need to know it in the preventive care of kidney damage

EDUMECENTRO 2023;15:e2559

RESEARCH PAPER

 

Cystatin C: the need to know it in the preventive care of kidney damage

Cistatina C: la necesidad de su conocimiento en la atención preventiva de daño renal

 

Adialys Alemán Zamora1* https://orcid.org/0000-0002-2212-9150
Lutgarda María Pérez de Alejo Rodriguez1 https://orcid.org/0000-0001-8853-6499
Yusimí Gonzales Álvarez1 https://orcid.org/0000-0001-9418-6851
Carmen Xiomara Moré Chang2 https://orcid.org/0000-0002-9766-3905

 

1 University of Medical Sciences of Villa Clara. University Teaching Hospital: "Arnaldo Milián Castro". Santa Clara. Cuba.
2 University of Medical Sciences of Villa Clara. Municipal Directorate of Health. Santa Clara. Cuba.

 

*Corresponding author. Email: lutgardapr@infomed.sld.cu

 

 

ABSTRACT

Knowledge and updating on Cystatin C as a marker of early kidney damage is extremely necessary for health professionals with a view to improving early diagnosis of kidney disease. The authors carried out an updated bibliographical review through various scientific studies, which allowed us to inform that even when for the evaluation of renal function one of the most widely used conventional blood markers is creatinine, the Cystatin C blood study is not subjected to different sources of biological variability, nor to factors dependent on the patient, so it would be ideal to take it into account as a marker of early renal function.

MeSH: Cystatin C; creatinine; glomerular filtration rate; education, medical.

RESUMEN

El conocimiento y actualización sobre la Cistatina C como marcador de daño renal precoz es en extremo necesario para los profesionales de la salud con vistas a mejorar el diagnóstico temprano de enfermedad renal. Las autoras realizaron una revisión bibliográfica actualizada a través de varios estudios científicos, lo que permitió poder informar que aun cuando para la evaluación de la función renal uno de los marcadores sanguíneos convencionales más utilizados es la creatinina, el estudio sanguíneo de Cistatina C no está sometido a diferentes fuentes de variabilidad biológica, ni a factores dependientes del paciente, por lo que sería idóneo tenerlo en cuenta como marcador de función renal precoz.

DeSC: Cistatina C; creatinina; tasa de filtración glomerular; educación médica.

 

 

Submitted: 29/11/2022
Accepted: 22/01/2023

 

 

The authors consider it essential to emphasize the importance of knowledge of the content that is presented here for medical education in general and particularly primary health care in its preventive dimension.

Chronic kidney disease is a serious, silent, and progressive condition; It consists of a decrease in kidney function that generally does not present symptoms in its initial stages. It can significantly reduce life expectancy as kidney function declines, and progress to its most severe form, known as end-stage renal disease, in which damage and deterioration of kidney function progress to the point of requiring dialysis. hemodialysis or kidney transplant. This disease, therefore, presents prevalence and incidence rates that continue to grow every year in Cuba. In addition, the disease has a strong impact on the quality of life of people who suffer from it and their families.(1) The objective of this research paper is to alert health professionals about the importance of knowing the content offered here in function of making the arsenal more accurate for its diagnosis from early stages.

As it is known, the presence of chronic kidney disease must be established based on altered renal damage markers and/or decreased renal function level (according to the glomerular filtration value), all this added to the existence of alterations in the clinical evaluation of the patient. The disease in its early stages must be detected through laboratory tests that are early markers of the disease. For example:

A: urine studies:

  • The presence of microalbuminuria.
  • Changes in urinary sediment (presence of leukocytes, red blood cells, casts, etc.).(1)

B: blood studies:

  • creatinine a, and based on the value found, the glomerular filtration rate is calculated.(1)
  • Serum Cystatin C: this stands as an early marker for the diagnosis of chronic kidney disease, where its effects are observed more quickly than creatinine (especially in initial stages).(2)

The literature(3) describes two other blood tests that report early kidney damage when they are elevated: the determination of neutrophil gelatinase associated with lipocaine (N-GAL), and procalcitonin (PCT) which is a polypeptide identical to a prohormone of the calcitonin that also increases during the acute phase of infections such as sepsis, meningitis, etc.

However, Cystatin C has been shown to be one of the parameters that most accurately provides early evidence of kidney damage, and at the same time constitutes a possible prognostic indicator of great importance; hence the value of considering it when diagnosing kidney disease. This blood analyte is a protein (non-glycosylated with a molecular weight of 13.3 kDa, consisting of a single chain of 120 amino acids with two disulfide bridges) with a stable plasma concentration and exclusively renal elimination. Physiologically, it has a shorter half-life than creatinine, it is freely filtered by the glomerulus and is reabsorbed in the proximal tubule where it is completely catabolized by the tubular cells, so it does not return to the bloodstream.

Its concentration is not influenced by age, sex or protein intake and is more sensitive to small changes in glomerular filtration.(2) In the absence of tubular damage, its concentration in urine is very low. A high serum level of Cystatin C corresponds to a decreased glomerular filtration rate (GFR) and therefore to renal dysfunction.

On the other hand, a GFR of less than 60 mL/min/1.73m2 represents the loss of more than 50% of normal kidney function in adults, and below this level the prevalence of the complications of chronic kidney disease increases. Cystatin C levels can be affected by thyroid dysfunction and steroid use.(4,5,6)

For these reasons, the authors consider from their professional experience that this research paper is a way of illustrating health professionals about the advances in recent years on how to improve the early diagnosis of chronic kidney disease with Cystatin C, compared to with other conventional analytes used in clinical practice today.

It is possible to improve the care and prognosis of chronic kidney disease through early detection plans in the population at risk. To achieve this, close coordination and collaboration between primary health care and the Nephrology service is necessary for the development of preventive activity.

 

BIBLIOGRAFIC REFERENCES

1. Martínez Pérez de Alejo L, Moré Chang CX, Rodríguez Viera R, Dupuy Nuñez JC. Estudios de laboratorio clínico para la detección de la enfermedad renal crónica en grupos poblacionales de riesgo. MEDISAN [Internet]. 2016 [citado 10/11/2022];20(1):[aprox. 12 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1029-30192016000100008

2. Miguel Morales M, Agramonte Llanes OM, Urrutia Febles Y, Fundora Cedeño M. Cistatina C: marcador de laboratorio precoz de enfermedad renal en pacientes con drepanocitosis. Rev Cubana Hematol Inmunol Hemoter [Internet]. 2018 [citado 10/11/2022];34(2):[aprox. 8 p.] Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S0864-02892018000200003

3. Lunar Solé I, Serrano Puebla W, Caviedes Robles N, José Antonio Trujillo J, Rendón Bartolozzi C. Estudios de imágenes y pruebas funcionales renales. Arch Vene Puer Ped [Internet]. 2011 [citado 10/11/2022];74(1):[aprox. 13 p.]. Disponible en: http://ve.scielo.org/scielo.php?script=sci_arttext&pid=S0004-06492011000100009

4. Ramírez López L, Albarracín Suárez L, Castillo Zaraza D, Bueno Sánchez J. Cistatina c vs. marcadores convencionales de función renal: una actualización. Rev Salud Uninorte [Internet]. 2019 [citado 10/11/2022];35(1):[aprox. 12 p.]. Disponible en: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-55522019000100110

5. Salazar García M, Parra Ortega I, Martínez- Arias M, Benavides Badillo A. Cistatina C como prueba de rutina para evaluar la función renal en pacientes pediátricos. Acta Bio Clín Latinoam [Internet]. 2015 [citado 10/11/2022]; 49(2):[aprox. 8 p.]. Disponible en: http://www.scielo.org.ar/pdf/abcl/v49n2/v49n2a02.pdf

6. American Diabetes Association. Chronic Kidney Disease and Risk management: Standards of Medical Care in Diabetes 2022. Diabetes Care [Internet]. 2022 [citado 10/11/2022];45(suppl.1):[aprox. 10 p.]. Disponible en: https://doi.org/10.2337/dc22-S011

 

 

Declaration of interests

The authors declare no conflict of interest.

 

 

Contribution of the authors

Adialys Alemán Zamora: conceived the original idea, participated in the review of the bibliography and in the preparation of the article.
Lutgarda María Pérez de Alejo Rodriguez, Yusimí Gonzales Álvarez and Carmen Xiomara Moré Chang, prepared the article and approved its final version.

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