Evaluation of malnutrition in patients with chronic liver disease, Comparison of Cystatin C and other glomerular filtration rate measurement methods in the evaluation of kidney functions in patients with chronic liver disease

Chronic liver disease is one of the common cause of morbidity and mortality which threatening public health in our country as well as all over the world. One of the major factor which determines the prognosis of the chronic liver disease is complications and these patients are usually develop severe malnutrition which clinicians are usually missed. In this group of patients, nutritional deficiency develops, which is often ignored by most clinicians and progresses with loss of fat and muscle mass. Muscle originated creatinine and creatinine clearance in 24-hour urine are often used in daily practice for evaluation of renal function and an ideal marker to show loss of renal reserve still was not found . Glomerular filtration rate measurement methods through the exojen clearance markers (inulin, 99mTc-DTPA, 51Cr-EDTA, iyotalamat, iyohexol etc.) are difficult and expensive methods. This has led to a discussion of the safety of muscle-induced creatinine and creatinine clearance in patients with chronic liver disease. Cystatin c is an endogenous serine protease inhibitor. Cystatin c can be synthesized in many tissues in the body. It completely enters the ultrafiltrate and> 99% of cystatin c is reabsorbed through tubular reabsorption. This molecule does not undergo tubular secretion like creatinine. These properties are the advantages of cystatin c to determine the glomerular filtration rate. In our study, physical and biochemical markers of malnutrition were examined in patients with chronic liver disease and significant decline was observed especially on Child C group patients. Serum levels of cystatin c were measured with higher in patients group than healthy populationsThere was no statistically significant difference between cystatin c levels according to the Child and MELD scores of the patients . In our study also significant positive correlation was found between the levels of cystatin c and microalbuminuria in cirrhosis patients. Therefore, even if creatinine and creatinine clearance are normal in patients with liver cirrhosis, higher serum cystatin c levels may be a warning for clinicians in terms of decreased renal parenchymal functional reserve. The data obtained in our study indicate that cystatin c can be used as a more reliable marker in the evaluation of renal function in patients with moderate and advanced stage chronic liver disease.