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After filtration, Cystatin C is reabsorbed and catabolized by the tubular epithelial cells, with only small amounts excreted in the urine. Cystatin C levels are therefore measured not in the urine, but in the bloodstream. Equations have been developed linking estimated GFR to serum cystatin C levels. [15]
The GFR, however, does not reveal the source of the kidney disease. This is accomplished by urinalysis, measurement of urine protein excretion, kidney imaging, and, if necessary, kidney biopsy. [1] Much of renal physiology is studied at the level of the nephron – the smallest functional unit of the kidney
Levey is known for developing the most widely used equations to estimate GFR (renal function) globally.He pioneered work with the MDRD Study Equation, [1] led the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI), which pooled measured kidney function CKD data from studies all over the world to develop equations to estimate kidney function from serum creatinine, cystatin C, and ...
Many laboratories will automatically calculate eGFR when a creatinine test is requested. Algorithms to estimate GFR from creatinine concentration and other parameters are discussed in the renal function article. Unfortunately, the MDRD Study equation was developed in people with chronic kidney disease, and its major limitations are imprecision ...
Cystatin C is a protein that is freely filtered in the glomeruli before it is reabsorbed and catabolized in the renal tubular cells. Its serum level is independent of muscle mass, making more accurate at estimating GFR than creatinine serum levels. [citation needed]
Several single nucleotide polymorphisms have been associated with altered cystatin C levels. [93] Cystatin C is a non-glycosylated, basic protein (isoelectric point at pH 9.3). The crystal structure of cystatin C is characterized by a short alpha helix and a long alpha helix which lies across a large antiparallel, five-stranded beta sheet.
Screening should include calculation of the estimated GFR (eGFR) from the serum creatinine level, and measurement of urine albumin-to-creatinine ratio (ACR) in a first-morning urine specimen (this reflects the amount of a protein called albumin in the urine), as well as a urine dipstick screen for hematuria. [55]
Urine protein/creatinine ratio is a widely used initial method to estimate daily protein excretion in urine. [1] [2] [3] Since the diagnosis and management of proteinuric renal diseases and the staging of chronic kidney disease depend on accurate identification and quantitation of proteinuria, [4] [1] the implementation of the 24-hour urine collection is the most accurate procedure in practice ...