Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Assessment of renal function in persons with motor complete spinal cord injury—cystatin C as an accurate single marker

Spinal Cord (2024)Cite this article

Subjects

Abstract

Study design

Observational cohort.

Aim

To show that Cystatin C is an accurate single marker to estimate GFR in motor complete persons with SCI.

Objectives

To assess if Cystatin C is an accurate for estimating GFR in persons with SCI with no preserved motor power. To study if use of Serum creatinine for estimation of GFR in this population significantly overestimates GFR, thereby inaccurate.

Setting

Tertiary care hospital and Medical College, Vellore, South India.

Methods

30 persons with SCI (ASIA A and B) fulfilling the inclusion criteria were recruited. Serum Creatinine and Serum Cystatin C values were obtained, and eGFR was calculated based on available formulae. 24-h urine for urine creatinine clearance-based eGFR was used as a reference value.

Results

Analysis with a Bland-Atman plot showed that eGFR estimated with Serum Cystatin C was more accurate than Serum Creatinine, using 24-h urine creatinine as a reference value. eGFR using Serum Creatinine significantly overestimated GFR by over 50.6%. Estimated GFR using Serum Cystatin C showed a meager mean difference of 0.5% from the reference 24-h urine creatinine clearance (mean difference of –2.56%).

Conclusion

Serum Cystatin C is a much more accurate marker for estimating GFR in SCI, compared to serum Creatinine which overestimates GFR.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Fig. 1: Cr GFR1: CKD–EPI creatinine – (ml/min/1.73m2).
Fig. 2: CrGFR 2: Creatinine- Cockcroft Gault GFR (with Body wt.) – (ml/min/1.73m2).
Fig. 3: CysGFR 1: CKD–EPI Cystatin C - (ml/min/1.73m2).

Similar content being viewed by others

Data availability

Data analysed is present in the article. Additional data are available from the corresponding author on reasonable request.

References

  1. Weld KJ, Dmochowski RR. Effect of bladder management on urological complications in spinal cord injured patients. J Urol. 2000;163:768–72.

    Article  CAS  PubMed  Google Scholar 

  2. Rehberg PB. Studies on kidney function: the rate of filtration and reabsorption in the human kidney. Biochem J. 1926;20:447–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Garcia-Arguello LY, O’Horo JC, Farrell A, Blakney R, Sohail MR, Evans CT, et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord. 2017;55:526–34.

    Article  CAS  PubMed  Google Scholar 

  4. Kern H, Hofer C, Mödlin M, Mayr W, Vindigni V, Zampieri S, et al. Stable muscle atrophy in long-term paraplegics with complete upper motor neuron lesion from 3- to 20-year SCI. Spinal Cord. 2008;46:293–304.

    Article  CAS  PubMed  Google Scholar 

  5. Castro MJ, Apple DF Jr, Staron RS, Campos GE, Dudley GA. Influence of complete spinal cord injury on skeletal muscle within 6 mo of injury [Internet]. [cited 2018 Mar 20]. Available from: https://www.physiology.org/doi/pdf/10.1152/jappl.1999.86.1.350

  6. Greenwell MW, Mangold TM, Tolley EA, Wall BM. Kidney disease as a predictor of mortality in chronic spinal cord injury. Am J Kidney Dis. 2007;49:383–93.

    Article  CAS  PubMed  Google Scholar 

  7. Fischer MJ, Krishnamoorthi VR, Smith BM, Evans CT, St. Andre JR, Ganesh S, et al. Prevalence of chronic kidney disease in patients with spinal cord injuries/disorders. Am J Nephrol. 2012;36:542–8.

    Article  PubMed  Google Scholar 

  8. Filler G, Bökenkamp A, Hofmann W, Le Bricon T, Martínez-Brú C, Grubb A. Cystatin C as a marker of GFR—history, indications, and future research. Clin Biochem. 2005;38:1–8.

    Article  CAS  PubMed  Google Scholar 

  9. Erlandsen EJ, Hansen RM, Randers E, Petersen LE, Abrahamsen J, Johannesen IL. Estimating the glomerular filtration rate using serum cystatin C levels in patients with spinal cord injuries. Spinal Cord. 2012;50:778–83.

    Article  CAS  PubMed  Google Scholar 

  10. Jenkins MA, Brown DJ, Ierino FL, Ratnaike SI. Cystatin C for estimation of glomerular filtration rate in patients with spinal cord injury. Ann Clin Biochem. 2003;40(Jul):364–8.

    Article  CAS  PubMed  Google Scholar 

  11. Thomassen SA, Johannesen IL, Erlandsen EJ, Abrahamsen J, Randers E. Serum cystatin C as a marker of the renal function in patients with spinal cord injury. Spinal Cord. 2002;40:524–8.

    Article  CAS  PubMed  Google Scholar 

  12. Kaufman DP, Basit H, Knohl SJ. Physiology, Glomerular Filtration Rate (GFR). StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019. http://www.ncbi.nlm.nih.gov/books/NBK500032/

    Google Scholar 

  13. Quanjer PH, Capderou A, Mazicioglu MM, Aggarwal AN, Banik SD, Popovic S, et al. All-age relationship between arm span and height in different ethnic groups. Eur Respir J. 2014;44:905–12.

    Article  PubMed  Google Scholar 

  14. International_Stds_Diagram_Worksheet.pdf [Internet]. [cited 2018 Mar 21]. Available from: http://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf

  15. Euser AM, Dekker FW, le Cessie S. A practical approach to Bland-Altman plots and variation coefficients for log transformed variables. J Clin Epidemiol. 2008;61:978–82.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

Dr. Santosh Varughese for initially guiding the process of the study, Dr. Julie Hephzibah(Nuclear medicine) for allowing a trial of assessment with Renogram studies although its data has not been included in the I am thankful to the institution and the department for permitting the study. I would like to acknowledge all the participants in this study who cooperated through the process of evaluation.

Funding

Institutional fluid research grant, Christian Medical College Vellore.

Author information

Authors and Affiliations

  1. Department of Physical Medicine and Rehabilitation, Christian Medical College Vellore, Vellore, India

    Thomas Anand Augustine & Henry Prakash M

  2. Department of Nephrology, Christian Medical College Vellore, Vellore, India

    Suceena Alexander

  3. Department of Biostatistics, Christian Medical College Vellore, Vellore, India

    Mahasampath Gowri S

Authors
  1. Thomas Anand Augustine
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry Prakash M
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Suceena Alexander
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Mahasampath Gowri S
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Thomas Anand Augustine was involved with research and study design, data collection & analysis, interpretation and conclusion, preparation of manuscript and administration. Henry Prakash M was involved with research and study design, interpretation and conclusion, preparation of manuscript, review of manuscript, guide and critical revision and administration. Suceena Alexander was involved with research and study design, interpretation and conclusion, review of manuscript, guide and critical revision. Mahasampath Gowri was involved with research and study design, interpretation and conclusion and data analysis.

Corresponding author

Correspondence to Henry Prakash M.

Ethics declarations

Competing interests

The authors declare no competing interests.

Ethical approval

Approved by Institutional Research Board (IRB), Christian Medical College, Vellore IRB Min no. 11341 dated 4.06.2018. I certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Augustine, T.A., M, H.P., Alexander, S. et al. Assessment of renal function in persons with motor complete spinal cord injury—cystatin C as an accurate single marker. Spinal Cord (2024). https://doi.org/10.1038/s41393-024-00973-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1038/s41393-024-00973-y

Search

Advanced search

Quick links