The Prognostic Value of Cystatin C and Urinary NGAL in Patients With the Cardiorenal Syndrome

Abstract

Congestive heart failure (CHF) is a common disease and leads to numerous deaths in Canada annually. Part of the reason is due to the high prevalence of renal dysfunction in this patient population, a comorbidity that acts as an independent risk factor for the progression of cardiovascular disease and therefore dramatically increases morbidity and mortality. The phenomenon linking the interaction between these two vital organ systems is called the cardiorenal syndrome. Further understanding of the pathophysiology as well as the ability to predict the development of cardiorenal syndrome in patients with CHF can aid clinicians in guiding therapy towards prevention, and optimizing patient management. To further the understanding of this disease, as well as risk stratify patients with CHF it is important to look at novel biomarkers like serum cystatin C and urinary neutrophil gelatinase-associated lipocalin (NGAL). Cystatin C has been shown to be a robust measure of renal function as it is not subjected to many of the limitations that exist for creatinine. NGAL is a marker of renal tubular injury and levels in both urine and serum are quickly increased when the renal tubules are damaged. By looking at the predictive value and pattern of both of these biomarkers in the development and progression of renal dysfunction in ambulatory CHF patients, we can identify individuals with greater risks of adverse events as well as further our understanding in the development of the cardiorenal syndrome.