Evaluation of Renal Function Biomarkers in Pre-Eclampsia: Insights from a Comparative Study in Zaria
Main Article Content
Abstract
Background: Preeclampsia is a major cause of maternal and foetal morbidity worldwide, often accompanied by renal dysfunction. Traditional markers such as serum creatinine have limited sensitivity in pregnancy. Cystatin C and uric acid have emerged as potential alternative biomarkers; however, comparative data from sub-Saharan Africa remain scarce. The study aimed to evaluate and compare the diagnostic performance of serum cystatin C, uric acid, and creatinine as renal function biomarkers in preeclamptic women in Zaria, Nigeria.
Methods: A cross-sectional comparative study was conducted at Ahmadu Bello University Teaching Hospital involving 135 preeclamptic women and 135 healthy pregnant controls (>20 weeks gestation). Serum cystatin C concentrations was measured using ELISA, while uric acid and creatinine were determined using an automated chemistry analyser. Data were analysed using SPSS 25.0 and MedCalc software. Group comparisons were performed using independent t-tests or appropriate non-parametric equivalents. Pearson's correlation was used to assess inter-biomarker relationships. Receiver operating characteristic (ROC) analysis was used to evaluate diagnostic performance.
Results: Mean serum cystatin C (1.49 ± 0.35 mg/L), uric acid (282.39 ± 108.92 µmol/L), and median creatinine [82.30 µmol/L (IQR: 96.0)] were significantly higher in preeclamptic women compared to controls (all p < 0.001). Cystatin C demonstrated the highest diagnostic accuracy (AUC 0.953, sensitivity 99.2%, specificity 73.0%), followed by uric acid (AUC 0.891, sensitivity 73.3%, specificity 96.3%). Creatinine showed the lowest diagnostic value (AUC 0.665). Positive correlations were observed, strongest between cystatin C and uric acid (r = 0.397, p < 0.001), suggesting shared pathophysiological pathways involving glomerular dysfunction and endothelial injury.
Conclusion: Cystatin C is a highly sensitive biomarker for detecting renal dysfunction in preeclampsia, outperforming uric acid and creatinine. Uric acid's high specificity supports its adjunctive use, while creatinine remains less reliable for early detection. A multi-marker approach may enhance diagnostic accuracy and improve maternal care in resource-limited settings.
Downloads
Article Details
Issue
Section
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
How to Cite
References
1. Yang Y, Ray I Le, Zhu J, Zhang J, Hua J, Reilly M. Preeclampsia Prevalence , Risk Factors , and Pregnancy Outcomes in Sweden and China. JAMA Netw Open. 2021;4(5):1–14.
2.Wagner LK. Diagnosis and Management of Preeclampsia. Am Fam Physician. 2004;70(12):2317–2324.
3.Bainbridge SA, Roberts JM. Uric Acid as a Pathogenic Factor in Preeclampsia. Placenta. 2012; 29(412):1–9.
4.Yakasai IA, Morhason-bello IO. Risk fasctors for pre-eclampsia among women at ante-natal booking in Kano, Northern Nigeria. Heal care low Resour settings. 2013;1(12):46–49.
5.Niraula A, Lamsal M, Baral N, Majhi S, Khan SA, Basnet P, et al. Cystatin-C as a Marker for Renal Impairment in Preeclampsia. J Biomarkers. 2017;20(17):1–7.
6. Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PF. WHO analysis of causes of maternal death: asystematic review. Lancet. 2006;367(9516):1066-74.
7. Oladapo OT, Adetoro OO, Ekele BA, Chama C, Etuk SJ, Aboyeji AP, et al. When getting there is not enough: a nationwide cross-sectional study of 998 maternal deaths and 1451 near-misses in public tertiary hospitals in a low-income country. BJOG. 2016;123(6):928-38.
8.Odetola TD. Health care utilization among rural women of child-bearing age: a Nigerian experience. Pan Afr Med J. 2015;20:151.
9.Ambad R, Dhok A. The role of serum urea , creatinine , uric acid in diagnosis of pre- eclampsia and eclampsia. Int J Med Bio S 2019; 2 (5) :9–13.
10.Ezeani I, Njoku O, Adikwu B. Serum Uric Acid Levels and Pregnancy Outcome in Pre-eclampsia: Implications for Management. Ethiop J Health Sci. 2022;32(7):555-563. doi:10.4314/ejhs.v32i7.3.
11.Franceschini N, Qiu C, Barrow DA, Williams MA. Cystatin C and preeclampsia: A case control study. Ren Fail. 2008;30(1):89–95.
12.Wantania J, Winarto A. The comparison of creatinine and cystatin C value in preeclampsia severity and neonatal outcome. Maj Obstet Ginekol. 2018;24(3):84-85
13.Akaba GO, Anyang UI, Ekele BA. Prevalence and materno-fetal outcomes of preeclampsia / eclampsia amongst pregnant women at a teaching hospital in north- central Nigeria : a retrospective cross- sectional s tudy. Clin Hypertens . 2021;27(20):1–10.
14.Thilaganathan B, Wormald B, Zanardini C, Sheldon J, Ralphs S, Papageorghiou AT. Early- pregnancy multiple serum biomarker screening for preeclampsia and small-for-gestational-age. Obstet Gynecol. 2010;115(6):1233-8.
15.Hameed J, Sofia, Maria, Batool S, Zareen R, Mangi NZ Diagnostic Value of Serum Cystatin-C and Uric Acid in Predicting Renal Impairment in Pre- Eclampsia. Pak J Med Dent. 2024;13(4): 11-20. Doi: https://doi.org/10.36283/ziun-pjmd13-4/003
16.Yarmurad, Marwa Basim; Ali, Miami Abdul Hassan. Assessment of Renal Function in Women with Preeclampsia by Measuring of Serum Cystatin C Level. Mustansiriya Medical Journal 23(2):p 90-94, Jul–Dec 2024. | DOI: 10.4103/mj.mj_4_24
17.Odutayo A, Hladunewich M, Kim SJ, Cattran D, Poutanen S, Darling EK, et al. Cystatin C and acute kidney injury in preeclampsia. Pregnancy Hypertens. 2012;2(4):308-12.
18.Bello FA, Olayemi O, Aimakhu CO, Adekunle AO. Serum uric acid and renal function in women with preeclampsia in Ibadan, Nigeria. Afr J Med Med Sci. 2010;39(4):305-10.
19.Zhou X, Xiang J, Jin Y, Li X, Shen X. Diagnostic value of combined cystatin C and uric acid in predicting preeclampsia: a systematic review and meta- analysis. BMC Pregnancy Childbirth. 2020;20:519.
20.Fatima Alshannag, Radwa M. M. Zaki, Eman Hemida, Mustafa M. M. ElBakry, and Amani F. H. Noureldeen. Endostatin and Cystatin C as Potential Biomarkers for Early Prediction of Preeclampsia. ACS Omega 20238(45), 42776-42786. DOI:10.1021/acsomega. 3c05586.