Case Control Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6573-6579
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6573
Role of cystatin C and renal resistive index in assessment of renal function in patients with liver cirrhosis
Đorđe Ćulafić, Miloš Štulić, Radmila Obrenović, Danijela Miletić, Dragana Mijač, Milica Stojković, Marija Jovanović, Milica Ćulafić
Đorđe Ćulafić, Danijela Miletić, Dragana Mijač, Milica Stojković, MilošŠtulić, Clinic of Gastroenterology and Hepatology, Clinical Center of Serbia, and School of Medicine, University of Belgrade, 11000 Belgrade, Serbia
Radmila Obrenović, Institute of Medical Biochemistry, Clinical Center of Serbia, 11000 Belgrade, Serbia
Marija Jovanović, Milica Ćulafić, Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, 11000 Belgrade, Serbia
Author contributions: Ćulafić Đ and Štulić M contributed equally to this work; Ćulafić Đ and Štulić M designed the research; Ćulafić Đ, Štulić M, Miletić D, Mijač D and Stojković M performed the research; Obrenović R performed the biochemical analysis; Jovanović M and Ćulafić M analyzed the data; Ćulafić Đ, Štulić M and Ćulafić M wrote the paper.
Supported by Ministry of Education, Science and Technological Development, Belgrade, Republic of Serbia, Project No. 175036
Correspondence to: Milica Ćulafić, MSc, Department of Pharmacokinetics and Clinical Pharmacy, Faculty of Pharmacy, University of Belgrade, Vojvode Stepe 450 Street, 11000 Belgrade, Serbia. milica.culafic@gmail.com
Telephone: +381-11-3951375 Fax: +381-11-3951373
Received: January 1, 2014
Revised: February 18, 2014
Accepted: March 19, 2014
Published online: June 7, 2014
Abstract

AIM: To evaluate the clinical significance of cystatin C and renal resistive index for the determination of renal function in patients with liver cirrhosis.

METHODS: We conducted a study of 63 patients with liver cirrhosis. A control group comprised of 30 age and gender-matched healthy persons. Serum cystatin C was determined in all study subjects and renal Doppler ultrasonography was made. Estimated glomerular filtration rate from serum creatinine (GFRCr) and cystatin C (GFRCys) was calculated.

RESULTS: We confirmed significant differences in values of cystatin C between patients with different stages of liver cirrhosis according to Child-Pugh (P = 0.01), and a significant correlation with model of end stage liver disease (MELD) score (rs = 0.527, P < 0.001). More patients with decreased glomerular filtration rate were identified based on GFRCys than on GFRCr (P < 0.001). Significantly higher renal resistive index was noted in Child-Pugh C than in A (P < 0.001) and B stage (P = 0.001). Also, a significant correlation between renal resistive index and MELD score was observed (rs = 0.607, P < 0.001). Renal resistive index correlated significantly with cystatin C (rs = 0.283, P = 0.028) and showed a negative correlation with GFRCys (rs = -0.31, P = 0.016).

CONCLUSION: Cystatin C may be a more reliable marker for assessment of liver insufficiency. Additionally, cystatin C and renal resistive index represent sensitive indicators of renal dysfunction in patients with liver cirrhosis.

Keywords: Liver cirrhosis, Cystatin C, Renal resistive index

Core tip: Early diagnosis of renal dysfunction is important to prevent serious complications. We conducted a study of 63 patients with liver cirrhosis and 30 healthy controls. Serum cystatin C (CysC) was measured and renal Doppler ultrasonography was performed. More patients with decreased glomerular filtration rate (GFR) were identified based on CysC GFR than on creatinine GFR. Higher renal resistive index in advanced disease by Child-Pugh and model of end stage liver disease was noticed. Renal resistive index (RRI) correlated with CysC and negatively correlated with glomerular filtration rate from serum cystatin C. Cystatin C may be a more reliable marker for liver insufficiency assessment. CysC and RRI represent sensitive indicators of renal dysfunction in liver cirrhosis.