First trimester serum Cystatin C level is a predictor of Preeclampsia: a prospective study

IntroductionThe pathogenesis of Preeclampsia (PE) remains enigmatic. A new concept of Shrunken Pore Syndrome (SPS) has been proposed, where in there is shrinking of pore size of the glomerulus. The ratio eGFRcystatin C / eGFRcreatinine < 0.6 is considered as SPS. Few studies show that SPS exists in pregnant ladies in the first trimester. A novel biomarker which can predict preeclampsia in the first trimester is the need of the hour. Hence this study was done. MethodCystatin C and creatinine levels were estimated during 11 to 13 weeks in all pregnant ladies. The GFR was calculated based on creatinine and cystatin C, and were assessed for SPS. Blood pressure was monitored and was managed appropriately, and statistically analysed. Results120 pregnant ladies were enrolled in our study. Out of 120, 91 ladies had SPS. 17 ladies developed preeclampsia during the follow up. The cystatin C levels were significantly higher in those who developed preeclampsia. A first trimester serum cystatin C value of 1.24mg/dl has shown to predict the occurrence of preeclampsia, with sensitivity of 94% and specificity of 74.8%. All 17 patients who had preeclampsia, had an evidence of SPS. First trimester serum cystatin C value was higher among those subsequently developed preeclampsia. DiscussionThere is a positive correlation between maternal first trimester serum cystatin C levels and development of preeclampsia. Assessment of Serum Cystatin C levels in the first trimester is a novel, cost effective biomarker to determine the risk of preeclampsia and improve the maternal, fetal and renal prognosis.