| Ability of cystatin C to detect acute changes in glomerular filtration rate provoked by hyperglycaemia in uncomplicated Type 1 diabetes. | |
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MedLine Citation:
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PMID: 21059087 Owner: NLM Status: In-Process |
Abstract/OtherAbstract:
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AIMS: Systematic study of hyperfiltration in diabetic nephropathy has been hindered by the lack of a simple glomerular filtration rate (GFR) measure that is accurate in this range of renal function. Serum cystatin C (GFR(CYSTATIN C) ) reflects long-term trends in GFR in normal or elevated ranges. To test whether it can reflect acute changes, we examined the impact of clamped hyperglycaemia on GFR(CYSTATIN C) and GFR(INULIN) in subjects with Type 1 diabetes. METHODS: GFR(INULIN) and GFR(CYSTATIN C) were measured in 32 normotensive, normoalbuminuric subjects during clamped euglycaemia and hyperglycaemia. For comparison, GFR(MDRD) was estimated according to the four-variable equation. RESULTS: During clamped euglycaemia, agreement between GFR(CYSTATIN C) and GFR(INULIN) was excellent, with mean bias +1.9 (90% distribution -29 to +31) ml min(-1) 1.73 m(-2), while GFR(MDRD) had mean bias +11.4 (-45 to +51) ml min(-1) 1.73 m(-2). With exposure to clamped hyperglycaemia, the mean increase in GFR(CYSTATIN C) (+17.5 ± 13.5 ml min(-1) 1.73 m(-2) ) reflected that observed with GFR(INULIN) (+15.3 ± 28.1 ml min(-1) 1.73 m(-2), P = 0.74), while GFR(MDRD) demonstrated a mean decline of -4.4 ± 33.6 ml min(-1) 1.73 m(-2) (P = 0.01). In all 24 subjects in whom GFR(INULIN) increased in response to hyperglycaemia, GFR(CYSTATIN C) reflected a concordant change (sensitivity, 100%) while GFR(MDRD) increased in 10/24 (sensitivity, 42%). In the eight remaining subjects, specificity was 25 and 75% for GFR(CYSTATIN C) and GFR(MDRD), respectively. CONCLUSION: GFR(CYSTATIN C) reflects normal and elevated renal function better than GFR(MDRD) even under the acute influences of hyperglycaemia, suggesting a role for cystatin C in clinical practice and research for the study of early renal function changes in Type 1 diabetes. |
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Authors:
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D Z I Cherney; E B Sochett; M G Dekker; B A Perkins |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Diabetic medicine : a journal of the British Diabetic Association Volume: 27 ISSN: 1464-5491 ISO Abbreviation: Diabet. Med. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-09 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8500858 Medline TA: Diabet Med Country: England |
Other Details:
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Languages: eng Pagination: 1358-65 Citation Subset: IM |
Copyright Information:
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© 2010 The Authors. Diabetic Medicine © 2010 Diabetes UK. |
Affiliation:
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Division of Nephrology, University Health Network, Hospital for Sick Children, University of Toronto, ON, Canada. david.cherney@uhn.on.ca |
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