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Original

Is Cystatin C more sensitive than creatinine in detecting early chronic allograft nephropathy?

F. Ortiz, A. Harmoinen, T. Paavonen, P. Koskinen, C. Grönhagen-Riska and E. Honkanen

Volume 70 (2008) p. 18 - 25

Abstract

F. Ortiz¹, A. Harmoinen², T. Paavonen³, P. Koskinen¹, C. Grönhagen-Riska¹ and E. Honkanen¹

¹Division of Nephrology, Department on Medicine, Helsinki University Central Hospital, Helsinki, ²Department on Chemistry, Savonlinna Central Hospital, Savonlinna, and ³Department of Pathology, Tampere University Central Hospital, Tampere, Finland
Background: Cystatin C (CyC) has been suggested as a more accurate indicator of renal function than creatinine (Crea). CyC performance against graft histopathology has not been investigated. Aim: To compare CyC and Crea-based methods as predictors of chronic allograft damage index (CADI). Material and methods: 105 protocol biopsies obtained at 6 months post-transplantation were classified with Banff´97 and CADI. CyC and Crea were measured concomitantly. Histology was correlated to CyC, Crea, their reciprocals, CyC-estimated GFR (Larsson), Cockroft and Gault (C&G) and abbreviated MDRD using Kendall’s t. The area under ROC curve (ROC-auc),sensitivity/specificity, positive and negative predictive values were calculated at CADI cut-off of 2. Results: Mild histological changes were best revealed by Crea, although with modest sensitivity/ specificity. A Crea threshold of 111 µmol/l distinguished 74% of the patients with CADI > 2 and excluded this condition in 66%. For Crea, ROC-auc was 0.72 (p<0.001). Crea and 1/Crea correlated best to CADI, chronic allograft nephropathy, chronic inflammation, tubular atrophy, vascular changes and glomerulopathy. Neither C&G nor MDRD improved Crea performance alone. CyC and Larsson formula performed the same (ROC-auc 0.67). A CyC threshold of 1.12 mg/l distinguished 69% of the patients with CADI > 2 and excluded it in 60%. Significant t correlation was found between CyC, 1/CyC and Larsson with CADI, chronic inflammation, tubular atrophy and chronic vascular changes. Conclusions: CyC, 1/CyC and Larsson-estimated GFR did not offer significant advantages over Crea in predicting mild histological allograft changes. Protocol biopsy provides information that cannot be sensitively predicted by biochemical measurements used in clinical practice.Correspondence to:
E. Honkanen, MD, PhD

Chief Physician of the Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Kasarmikatu 11-13, 00130 Helsinki, Finland
Email: [email protected]

Original

Henoch-Schoenlein nephritis in adults – clinical features and outcomes in Finnish patients

V. Rauta, T. Törnroth and C. Grönhagen-Riska

Volume 58 (2002) p. 1 - 8

Abstract

V. Rauta, T. Törnroth and C. Grönhagen-Riska

Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
Background: Henoch-Schoenlein purpura (HSP) is a small vessel vasculitis that often involves the kidneys. It affects many more children than adults. Few studies on HSP nephritis (HSN) in adult patients have been reported. One aim of the study described here was to determine clinical features in adults diagnosed at a single center as suffering from HSN. Other aims were to record outcomes of the disease and factors associated with its progression. Methods: Between 1980 and 1995, 42 adults attending our clinic were diagnosed consecutively, by means of renal biopsy, as suffering from HSN. Data on 38 patients with a follow-up period of at least a year were subsequently analyzed to determine whether any clinical, laboratory or histopathological variable was associated with the progression of HSN. Results: The mean age of the patients on biopsy was 42.0 years (SD 16.5). Eighteen of the 38 patients were male. Eleven of the 38 patients had isolated hematuria as an indication for renal biopsy and 25 had Ccr ³ 85 ml/min on diagnosis. Eight patients exhibited progression of HSN, 3 to end-stage renal failure (ESRF), during a mean follow-up time of 6.1 years (SD 4.3). Renal survival 10 years after renal biopsy was 91%. No histopathological findings were associated with poor outcome. The only factor statistically significantly related to the progression of HSN was a level of proteinuria greater than 1.0 g/24 h (p < 0.05). Hypertension and level of renal function were not significant prognostic factors either, except in a subgroup of 25 patients with initially normal renal function on diagnosis (p < 0.05 in both). In this subgroup, lower serum albumin levels were also found to be predictive for the progression of HSN. Conclusions: HSN is rare in adults and outcomes are unpredictable. However, any adult with purpura and persistent urinary abnormalities should undergo renal biopsy to determine a diagnosis; all patients suffering from HSN should be carefully monitored to determine whether the condition progresses. Attention should be paid especially to the degree of proteinuria, and also to hypertension in early stages of the disease.Correspondence to:
Dr. C. Grönhagen-Riska, Huch, PB 341, FIN-00029, Finland
Email: [email protected]

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