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BMC Neurology
Published in: BMC Neurology 1/2014

Open Access 01-12-2014 | Research article

Cystatin C, a novel indicator of renal function, reflects severity of cerebral microbleeds

Authors: Mi-Young Oh, Hyon Lee, Joon Soon Kim, Wi-Sun Ryu, Seung-Hoon Lee, Sang-Bae Ko, Chulho Kim, Chang Hun Kim, Byung-Woo Yoon

Published in: BMC Neurology | Issue 1/2014

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Abstract

Background

Chronic renal insufficiency, diagnosed using creatinine based estimated glomerular filtration rate (GFR) or microalbumiuria, has been associated with the presence of cerebral microbleeds (CMBs). Cystatin C has been shown to be a more sensitive renal indicator than conventional renal markers. Under the assumption that similar pathologic mechanisms of the small vessel exist in the brain and kidney, we hypothesized that the levels of cystatin C may delineate the relationship between CMBs and renal insufficiency by detecting subclinical kidney dysfunction, which may be underestimated by other indicators, and thus reflect the severity of CMBs more accurately.

Methods

Data was prospectively collected for 683 patients with ischemic stroke. The severity of CMBs was categorized by the number of lesions. Patients were divided into quartiles of cystatin C, estimated GFR and microalbumin/creatinine ratios. Ordinal logistic regression analysis was used to examine the association of each renal indicator with CMBs.

Results

In models including both quartiles of cystatin C and estimated GFR, only cystatin C quartiles were significant (the highest vs. the lowest, adjusted OR, 1.88; 95% CI 1.05-3.38; p = 0.03) in contrast to estimated GFR (the highest vs. the lowest, adjusted OR, 1.28; 95% CI 0.38-4.36; p = 0.70). A model including both quartiles of cystatin C and microalbumin/creatinine ratio also showed that only cystatin C quartiles was associated with CMBs (the highest vs. the lowest, adjusted OR, 2.06; 95% CI 1.07-3.94; p = 0.03). These associations were also observed in the logistic models using log transformed-cystatin C, albumin/creatinine ratio and estimated GFR as continuous variables. Cystatin C was a significant indicator of deep or infratenorial CMBs, but not strictly lobar CMBs. In addition, cystatin C showed the greatest significance in c-statistics for the presence of CMBs (AUC = 0.73 ± 0.03; 95% CI 0.66-0.76; p = 0.02).

Conclusion

Cystatin C may be the most sensitive indicator of CMB severity among the renal disease markers.
Appendix
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Metadata
Title
Cystatin C, a novel indicator of renal function, reflects severity of cerebral microbleeds
Authors
Mi-Young Oh
Hyon Lee
Joon Soon Kim
Wi-Sun Ryu
Seung-Hoon Lee
Sang-Bae Ko
Chulho Kim
Chang Hun Kim
Byung-Woo Yoon
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Neurology / Issue 1/2014
Electronic ISSN: 1471-2377
DOI
https://doi.org/10.1186/1471-2377-14-127

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