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Area of Science:

  • Nephrology
  • Clinical Chemistry
  • Geriatrics

Background:

  • Serum creatinine (Scr) and creatinine-based estimated glomerular filtration rate (eGFRcr) are standard for assessing kidney function.
  • Non-glomerular filtration rate determinants can influence Scr levels, potentially leading to inaccurate GFR estimations.
  • This report focuses on elderly patients with normal Scr but elevated serum cystatin C (Scys).

Observation:

  • Case 1: A 102-year-old woman with Scr 0.45 mg/dl and elevated Scys (1.55 mg/l) showed eGFRcr variability, classifying her into four CKD stages.
  • Case 2: An 88-year-old man with Scr 0.93 mg/dl and elevated Scys (1.55 mg/l) had a measured GFR (mGFR) of 44 ml/min/1.73 m², with four of five eGFRcr equations overestimating his kidney function.

Findings:

  • Elevated Scys with normal Scr can lead to significant overestimation of GFR using standard eGFRcr equations.
  • The choice of GFR estimating equation and filtration marker critically impacts kidney function classification, especially in the elderly.
  • Non-GFR determinants affecting Scr highlight limitations of relying solely on creatinine-based assessments.

Implications:

  • Accurate GFR assessment in elderly patients requires understanding the limitations of Scr and eGFRcr.
  • Cystatin C-based equations may offer improved GFR accuracy in specific patient populations.
  • Precise GFR evaluation is crucial for appropriate drug dosing and contrast agent use, preventing potential patient harm.