Uso della cistatina C nella diagnosi di insufficienza renale acuta in terapia intensiva

Timing to detect early stage of renal impairment is extremely important especially in the therapeutic management of complex illness. In acute condition, the absence of a reliable biomarker and the reliance on serum Cr (sCr) makes the diagnosis and consequently the institution of therapy markedly delayed. Recently, the research interest on serum CysC role in ICU-population has been stopped after the presumed association of CysC with inflammatory biomarkers in non-critical-ill patients. We retrospectively reviewed all laboratoristical data referral to 1000 patients (611 male, mean age 64,3) admitted in ICU or Post-Cardiac-Surgery-Intensive-Care-Unit (PCSICU). PCSICU population was submitted to extracorporeal circulation during cardiac surgical intervention. 3993 samples tested contemporaneously for sCr, CysC and C-Reactive-Protein (CRP) were selected. Renal replacement therapy and known thyreopathy were exclusion criteria. No correlation between CysC vs CRP and sCr vs CRP were found, neither in ICU nor in PCSICU . Moreover we observed the well-known correlation between sCr and CysC in all our population. Our results are encouraging to resume the use of CysC to monitoring renal function in critical-ill patients. Multicenter large study in ICU-population is needed to definitive approve or not serum CysC in early AKI diagnosis.