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Cystatin C, a novel indicator of renal function, reflects severity of cerebral microbleeds

Cited 20 time in Web of Science Cited 15 time in Scopus
Authors
Oh, Mi-Young; Lee, Hyon; Kim, Joon Soon; Ryu, Wi-Sun; Lee, Seung-Hoon; Ko, Sang-Bae; Kim, Chulho; Kim, Chang Hun; Yoon, Byung-Woo
Issue Date
2014-06-12
Publisher
BioMed Central
Citation
BMC Neurology 2014, 14:127
Keywords
Cystatin CEstimated glomerular filtration rateMicroalbuminuriaCerebral microbleeds
Abstract
Background: Chronic renal insufficiency, diagnosed using creatinine based estimated glomerular filtration rate (GFR) or microalbumiuria, has been associated with the presence of cerebral microbleeds (CMBs). Cystatin C has been shown to be a more sensitive renal indicator than conventional renal markers. Under the assumption that similar pathologic mechanisms of the small vessel exist in the brain and kidney, we hypothesized that the levels of cystatin C may delineate the relationship between CMBs and renal insufficiency by detecting subclinical kidney dysfunction, which may be underestimated by other indicators, and thus reflect the severity of CMBs more accurately.
Methods: Data was prospectively collected for 683 patients with ischemic stroke. The severity of CMBs was categorized by the number of lesions. Patients were divided into quartiles of cystatin C, estimated GFR and microalbumin/creatinine ratios. Ordinal logistic regression analysis was used to examine the association of each renal indicator with CMBs.
Results: In models including both quartiles of cystatin C and estimated GFR, only cystatin C quartiles were significant (the highest vs. the lowest, adjusted OR, 1.88; 95% CI 1.05-3.38; p = 0.03) in contrast to estimated GFR (the highest vs. the lowest, adjusted OR, 1.28; 95% CI 0.38-4.36; p = 0.70). A model including both quartiles of cystatin C and microalbumin/creatinine ratio also showed that only cystatin C quartiles was associated with CMBs (the highest vs. the lowest, adjusted OR, 2.06; 95% CI 1.07-3.94; p = 0.03). These associations were also observed in the logistic models using log transformed-cystatin C, albumin/creatinine ratio and estimated GFR as continuous variables. Cystatin C was a significant indicator of deep or infratenorial CMBs, but not strictly lobar CMBs. In addition, cystatin C showed the greatest significance in c-statistics for the presence of CMBs (AUC = 0.73 ± 0.03; 95% CI 0.66-0.76; p = 0.02).
Conclusion: Cystatin C may be the most sensitive indicator of CMB severity among the renal disease markers.
ISSN
1471-2377
Language
English
URI
http://hdl.handle.net/10371/92434
DOI
https://doi.org/10.1186/1471-2377-14-127
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College of Medicine/School of Medicine (의과대학/대학원)Dept. of Neurology (신경과학교실)Journal Papers (저널논문_신경과학교실)
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