Post-kidney transplant (KTx) with primary allograft function, comparison of Serum creatinine with Serum Cystatin-C, and measured urinary creatinine clearance (mCrCl) with MDRD-4 eGFR and MDRD-4 eGFR eGFRCysC
Ashokkumar Jain1, Nasrollah Ghahramani2, Umar Farook2, Thomas Butler1, Johnny Hong1.
1Department of Surgery, Division of Transplant Surgery, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States; 2Department of Medicine, Division of Nephrology, Penn State Health Milton S. Hershey Medical Center, Hershey, PA, United States
Aim of the study.
1) compare immediate post-KTx serum creatinine with serum Cystatin-C.
2) To compare urinary mCrCl with MDRD-4 eGFR and
3) To compare urinary mCrCl with MDRD-4 eGFR eGFRCysC
Method: Post-KTx with primary renal function, urine was collected through a Foley catheter at every 12-hour interval to measure urinary creatine clearance in 14 consenting subjects after institutional review board approval.
Serum creatinine levels were compared with serum cystatin C levels, and MDRD-4 eGFR was compared with measured urinary clearance and MDRD-4 eGFR-Cystatin-C
Results:
1) Measured urinary clearance values were much higher than MDRD4-eGFR-
2) Mean serum Cystatin-C levels were lower by 58%, 54%, 41%, 35%, 26%, 14%, and 0.5% at every 12-hour intervals from 0.5 to 3.5 days post-KTx and were similar by day 4 (Figure 1).
This was highly significant for the first 48 hours post-KTx. (p-value <0.05) (Figure and Table 1).
3) Similarly, at the corresponding time points, MDRD-4 eGFR, Cystatin-c.
Was much lower than MDRD-4 eGFR
Conclusion:
1) Immediate post-KTx MDRD-4 eGFR formulae underestimate measured urinary creatinine clearance.
2) Serum CysC levels were lower than serum creatinine and
3) corresponding MDRD-4 eGFR were lower than MDRD-4 eGFR CysC.
Medications that require dose adjustment with renal function are often inappropriately under-dosed.
More prospective studies, including radioisotope clearance, are necessary.
[1] Kidney Implantation. function, Drug-dosing
