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. 2021 Oct;53(10):2041-2049.
doi: 10.1007/s11255-021-02957-w. Epub 2021 Jul 16.

Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy

Mike Wenzel  1   2 , Hang Yu  3 , Annemarie Uhlig  4 , Christoph Würnschimmel  5   6 , Manuel Wallbach  7 , Andreas Becker  8 , Margit Fisch  3 , Felix K H Chun  8 , Christian P Meyer  3 , Marianne Leitsmann  4
Affiliations

Cystatin C predicts renal function impairment after partial or radical tumor nephrectomy

Mike Wenzel et al. Int Urol Nephrol. 2021 Oct.

Abstract

Purpose: To test the value of preoperative and postoperative cystatin C (CysC) as a predictor on kidney function after partial (PN) or radical nephrectomy (RN) in renal cell carcinoma (RCC) patients with normal preoperative renal function.

Methods: From 01/2011 to 12/2014, 195 consecutive RCC patients with a preoperative estimated glomerular filtration rate (eGFR) > 60 ml/min/1.73m2 underwent surgical RCC treatment with either PN or RN. Logistic and linear regression models tested for the effect of CysC as a predictor of new-onset chronic kidney disease in follow-up (eGFR < 60 ml/min/1.73m2). Moreover, postoperative CysC and creatinine values were compared for kidney function estimation.

Results: Of 195 patients, 129 (66.2%) underwent PN. In postoperative and in follow-up setting (median 14 months, IQR 10-20), rates of eGFR < 60 ml/min/1.73m2 were 55.9 and 30.2%. In multivariable logistic regression models, preoperative CysC [odds ratio (OR): 18.3] and RN (OR: 13.5) were independent predictors for a reduced eGFR < 60 ml/min/1.73m2 in follow-up (both p < 0.01), while creatinine was not. In multivariable linear regression models, a difference of the preoperative CysC level of 0.1 mg/dl estimated an eGFR decline in follow-up of about 5.8 ml/min/1.73m2. Finally, we observed a plateau of postoperative creatinine values in the range of 1.2-1.3 mg/dl, when graphically depicted vs. postoperative CysC values ('creatinine blind area').

Conclusion: Preoperative CysC predicts renal function impairment following RCC surgery. Furthermore, CysC might be superior to creatinine for renal function monitoring in the early postoperative setting.

Keywords: Acute kidney injury; Cystatin C; GFR; Nephrectomy; Renal cell carcinoma.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Loess plots depicting the relationship between postoperative cystatin c level and postoperative creatinine level in A all examined patients and in B patients with acute kidney injury (AKI) after kidney surgery for renal cell carcinoma
Fig. 2
Fig. 2
Loess plots depicting the relationship between postoperative cystatin c level and postoperative creatinine level in A patients aged ≥ 50 years in B patients aged ≥ 60 years C patients aged ≥ 70 years and D patients aged < 50 years after kidney surgery for renal cell carcinoma
See this image and copyright information in PMC

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