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Increased Urinary Cystatin-C Levels Correlate with Reduced Renal Volumes in Neonates with Intrauterine Growth
Antonella Barbati1, Benito Cappuccini, Maria Cristina Aisa
1Department of Surgical and Biomedical Sciences, Section of Obstetrics and Gynecology, University of Perugia, Perugia, Italy.
Insights
Intrauterine growth retardation (IUGR) in neonates is linked to higher urinary Cystatin-C (Cys-C) levels, indicating reduced kidney size. This suggests Cys-C may serve as an early marker for long-term renal disease risk in IUGR infants.
Area of Science:
- Neonatal nephrology
- Biochemistry
- Medical diagnostics
Background:
- Intrauterine growth retardation (IUGR) impairs fetal kidney development, increasing risk for renal disease.
- Cystatin-C (Cys-C) is filtered by glomeruli and catabolized by tubules; urinary levels may rise with impaired tubular function or hyperfiltration.
- Reduced Cys-C degradation in tubular diseases or hyperfiltration could lead to increased urinary excretion.
Purpose of the Study:
- To assess urinary Cys-C excretion in neonates with IUGR compared to those adequate for gestational age (AGA).
- To correlate urinary Cys-C levels with renal volumes in IUGR and AGA neonates.
- To determine the clinical utility of urinary Cys-C as a marker for IUGR.
Main Methods:
- Urinary Cys-C levels were measured using an enzyme immunoassay (DetectX® Human Cystatin C kit).
- Renal and renal cortex volumes were assessed using ultrasound (Vocal II; GE Healthcare).
- Measurements were performed in neonates diagnosed with IUGR and AGA.
Main Results:
- Urinary Cys-C levels were significantly higher in IUGR neonates compared to AGA neonates.
- Higher urinary Cys-C levels were negatively correlated with reduced whole renal and renal cortex volumes.
- These findings suggest a link between elevated urinary Cys-C and diminished kidney size in IUGR.
Conclusions:
- Elevated urinary Cys-C in IUGR neonates is associated with smaller renal and renal cortex volumes.
- Urinary Cys-C may serve as a surrogate marker for nephron mass in neonates.
- Cys-C could be an early biomarker to identify IUGR infants at high risk for future renal disease and guide monitoring.
Background:
Exposure to intrauterine growth retardation (IUGR) can have a negative impact on nephrogenesis resulting in limited fetal kidney development and supporting the hypothesis that IUGR represents a risk for renal function and long-term renal disease. Cystatin-C (Cys-C), a strong inhibitor of cysteine proteinases, is freely filtered by the kidney glomerulus and is reabsorbed by the tubules, where it is almost totally catabolized; what remains is subsequently eliminated in urine. In tubular diseases and in hyperfiltration conditions, it seems reasonable to postulate that Cys-C degradation would decrease, and consequently an increase in its urinary elimination would be observed.
Objectives:
The aim of this study was to investigate the urinary excretion of Cys-C simultaneously with the assessment of renal volumes in adequate for gestational age (AGA) and IUGR neonates in order to identify its clinical value in IUGR.
Methods:
Urinary Cys-C levels were measured using the enzyme immunoassay DetectX® Human Cystatin C kit in IUGR and AGA neonates. Whole renal and renal cortex volumes were assessed with ultrasounds (Vocal II; Software, GE).
Results:
Urinary Cys-C levels in IUGR were significantly higher than those found in AGA and were negatively correlated to reduced whole renal and renal cortex volumes.
Conclusions:
The increased levels of Cys-C in the urine of neonates with IUGR were significantly associated with reduced renal/renal cortex volumes, suggesting that Cys-C could be taken as a surrogate of nephron mass. It also could be used as an early biochemical marker to identify IUGR neonates at high risk of developing long-term renal disease and to select patients for monitoring during childhood.
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