Thomas Anand Augustine, (2020) Assessment of Renal Function in Motor Complete Spinal Cord Injury Patients – Cystatin C as an Accurate Single Marker. Masters thesis, Christian Medical College, Vellore.
|
Text
201901120thomas_anand_augustine.pdf Download (2MB) | Preview |
Abstract
BACKGROUND: Spinal cord injury (SCI) patients with neurogenic lower urinary tract dysfunction develop renal complications as a result of altered urodynamics and recurrent infections. There is a need for monitoring GFR in this population of patients. At present, Serum Creatinine is used for estimating GFR. Among other factors that alter Serum Creatinine, loss of muscle mass is of interest in the current study. AIM OF THE STUDY: To show that Cystatin C is an accurate single marker to estimate GFR in motor complete SCI patients. OBJECTIVES: 1. To assess if Cystatin C is an accurate for estimating GFR in patients with SCI with no preserved motor power 2. To study if use of Serum creatinine for estimation of GFR SCI significantly overestimates GFR, thereby inaccurate and should be avoided in clinical practice. METHODOLOGY: Observational Cohort study. 30 persons with SCI (ASIA A and B) fulfilling the inclusion criteria were recruited. Previous studies with spinal cord injury were inclusive of patients with preserved motor function (ASIA C and D). By sampling only motor complete (ASIA A and B) patients, significant overestimate of GFR by Serum Creatinine due to muscle atrophy would be more evident. Serum Creatinine and Serum Cystatin C values were obtained, GFR was calculated based on currently used formulae. 24 hour urine for urine creatinine clearance was collected and GFR obtained was used as a reference value. A renal DTPA Tech99m scan was also done for estimating GFR using Gate's method in 10 subjects. RESULTS: Analysis with Bland - Altman plot method showed that GFR estimated with CKD EPI formulae from Serum Cystatin C was more accurate than Serum Creatinine, using 24 hour urine creatinine as a reference value. Estimated GFR using Serum Creatinine significantly (p < 0.0001) overestimated GFR when compared to 24 hour urine creatinine clearance by a mean difference of 50.6%. Estimated GFR using Serum Cystatin C showed a meagre mean difference of 0.5% when compared to 24 hour urine creatinine clearance with a p value of 0.91 (closer to 1, thus satisfying the null hypothesis that there isn’t much difference between the 2 methods) The renal scan GFR by Gate's method showed marked variability with 24 hour urine creatinine clearance in the 10 subjects that were tested. The mean difference in comparison to 24 hour urine creatinine clearance was 29.3 with a p value of 0.0187. CONCLUSION: Serum Cystatin C is an accurate marker for estimating GFR in SCI. Using Serum Creatinine overestimates GFR in SCI, hence inaccurate to use.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 201729054 |
| Uncontrolled Keywords: | Renal Function, Motor Complete Spinal Cord Injury Patients, Cystatin C, Accurate Single Marker. |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Subramani R |
| Date Deposited: | 04 Feb 2021 18:20 |
| Last Modified: | 04 Feb 2021 18:20 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13854 |
Actions (login required)
 |
View Item |
