Effects of glucocorticoid immunosuppression on serum cystatin C concentrations in renal transplant patients.
Effects of glucocorticoid immunosuppression on serum cystatin C concentrations in renal transplant patients.
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DOI：
10.1093/clinchem/47.11.2055
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发表时间：
2001-11
影响因子：
9.3
通讯作者：
L. Risch;R. Herklotz;A. Blumberg;A. Huber
中科院分区：
文献类型：
--
作者：
L. Risch;R. Herklotz;A. Blumberg;A. Huber
胱抑素C是一种非糖基化碱性蛋白（13.36 kDa），可在多种生物体液中发现（1）。血清胱抑素C浓度不受性别、炎症或瘦组织质量的影响，被认为主要由肾小球滤过率（GFR）决定（2）（3）（4）（5）。胱抑素C已被描述为满足理想GFR标志物的许多特征（例如，以恒定速率内源性产生，在肾小球中自由过滤，在肾小管中既不重吸收也不分泌，不经肾外消除），并且据报道至少与常用的血清肌酐一样准确以检测各种患者组中的肾功能受损，包括肾移植患者（6）（7）（8）（9）（10）（11）（12）（13）（14）（15）（16）（17）（18）（19）（20）（21）（22）（23）（24）。尽管如此，Bokenkamp等人（25）报告称，肾移植儿童中的胱抑素C高于其他肾脏病变但GFR相当的儿童，表明肾移植患者中胱抑素C低估了GFR。这一发现表明免疫抑制是一个主要的影响因素，因为所有患者都接受了泼尼松龙和环孢素A药物治疗。有趣的是，泼尼松龙和环孢菌素A都不被认为会改变胱抑素C的浓度，因为没有发现胱抑素C的剂量依赖性增加。相反，Bjarnadottir等人（26）的体外研究描述了暴露于地塞米松的HeLa细胞中胱抑素C产生的剂量依赖性增加。为了进一步阐明这些发现，我们在一个肾移植患者队列中进行了一项巢式病例对照研究，这些患者在1年期间进行了前瞻性监测（20）。本研究的目的是阐明...
Cystatin C is a nonglycosylated basic protein (13.36 kDa) and can be found in a variety of biologic fluids (1). Cystatin C serum concentration is not influenced by gender, inflammation, or lean tissue mass and is regarded to be mainly determined by glomerular filtration rate (GFR) (2)(3)(4)(5). Cystatin C has been described as meeting many of the characteristics of an ideal GFR marker (e.g., endogenously produced at a constant rate, freely filtered in the glomerulus, neither reabsorbed nor secreted in the renal tubule, not extrarenally eliminated) and has been reported to be at least as accurate as the commonly used serum creatinine to detect impaired renal function in various patient groups, including renal transplant patients (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24). Despite this, Bokenkamp et al. (25) reported that cystatin C is higher in children with renal transplants than in children with other renal pathologies but comparable GFRs, suggesting an underestimation of GFRs by cystatin C in renal transplant patients. This finding suggested immunosuppression as a major influencing factor because all patients had received prednisolone and cyclosporin A medication. Interestingly, neither prednisolone nor cyclosporin A was believed to change cystatin C concentrations because no dose-dependent increase of cystatin C was found. In contrast, an in vitro study by Bjarnadottir et al. (26) described a dose-dependent increase of cystatin C production in HeLa cells exposed to dexamethasone. To further clarify these findings, we conducted a nested case-control study in a cohort of renal transplant patients who were prospectively monitored during a 1-year period (20). The present study aimed to elucidate the influence of …