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ORIGINAL ARTICLE
Year : 2017  |  Volume : 29  |  Issue : 3  |  Page : 105-111

Creatinine, cystatin, and combined-based equations in assessment of renal functions in type 2 diabetic Egyptian patients


Department of Internal Medicine, Faculty of Medicine, Cairo University, Egypt

Correspondence Address:
Amr M Shaker
Internal Medicine Kaser Alainy Hospital, Kaser Alainy Street, Cairo 11562
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejim.ejim_26_17

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Background Diabetic nephropathy is the principal single cause of end-stage renal disease. The most important parameter in the clinical evaluation of kidney function is the glomerular filtration rate (GFR), which is generally accepted as the best overall index of kidney function; GFR remains the cornerstone of the clinical evaluation of overall kidney function. Our study was performed to compare between estimated GFR equations based on serum creatinine and/or cystatin C performance in relation to measured GFR using radionuclide study and degree of proteinuria. Patients and methods In our cross-sectional study, 80 adult type 2 diabetic patients, with diabetic nephropathy and proteinuria more than 300 mg/24 h, were included after application of inclusion and exclusion criteria, and subjected to history taking, clinical examination, and laboratory investigation including serum creatinine, cystatin C, 24-h urinary protein/creatinine clearance, and renal isotope technetium-99m-diethylene triamine pentaacetic acid scanning. Results There was a linear correlation between serum creatinine and cystatin C (r=0.867, P=0.000). Cystatin C was better correlated (r=−0.781, P=0.000) with isotopically measured GFR than creatinine (r=−0.106, P=0.348). Cystatin C was better than creatinine in all estimated GFR equations tested in our study [Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) Cr 2009, CKD-EPI Cr-Cys 2012, CKD-EPI Cys 2012]. The best performance among all equations tested when compared with isotopically measured GFR was the CKD-EPI Cr-Cyst 2012 (r=0.816, P=0.000). Cystatin C showed a significant negative correlation with hemoglobin level, a finding that could not be established with serum creatinine; there was no significant association of creatinine or cystatin with the level of proteinuria. Conclusion In patients with early overt diabetic nephropathy, serum cystatin C showed a significantly stronger correlation than creatinine with isotopically measured GFR, and among the studied equations for GFR estimation the CKD-EPI Cr-Cyst 2012 equation performed best.


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