Q: Systemic Glucocorticoids usually increase plasma creatinine. Which other test can be performed to estimate the actual glomerular filtration rate (GFR)?
Answer: Serum cystatin C
Systemic glucocorticoids usually increase plasma creatinine. Although it may not increase GFR, it may yield an inaccurate estimate, as many GFR formulae use Creatinine.
Serum cystatin C is a biomarker that may provide a more accurate estimate. It is a protein produced by all cells, filtered by the kidneys, and then broken down; its blood level reflects kidney function. It is usually not affected by muscle mass, age, gender, or ethnicity. Cystatin C is preferable in older adults, obese patients, and those with poor nutrition.
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References:
1. Andreev E, Koopman M, Arisz L. A rise in plasma creatinine that is not a sign of renal failure: which drugs can be responsible? J Intern Med 1999; 246:247.
2. Liang S, Shi M, Bai Y, et al. The effect of glucocorticoids on serum cystatin C in identifying acute kidney injury: a propensity-matched cohort study. BMC Nephrol 2020; 21:519.
3. Benoit SW, Ciccia EA, Devarajan P. Cystatin C as a biomarker of chronic kidney disease: latest developments. Expert Rev Mol Diagn. 2020 Oct;20(10):1019-1026. doi: 10.1080/14737159.2020.1768849. Epub 2020 May 25. PMID: 32450046; PMCID: PMC7657956.
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