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Interpretive Handbook

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Test 35038 :
Cystatin C with Estimated GFR, Serum

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Cystatin C:

Cystatin C is a low molecular weight (13,250 kD) cysteine proteinase inhibitor that is produced by all nucleated cells and found in body fluids, including serum. Since it is formed at a constant rate and freely filtered by the kidneys, its serum concentration is inversely correlated with the glomerular filtration rate (GFR); that is, high values indicate low GFRs while lower values indicate higher GFRs, similar to creatinine.


The renal handling of cystatin C differs from creatinine. While both are freely filtered by glomeruli, once it is filtered, cystatin C, unlike creatinine, is reabsorbed and metabolized by proximal renal tubules. Thus, under normal conditions, cystatin C does not enter the final excreted urine to any significant degree.


The serum concentration of cystatin C remains unchanged with infections, inflammatory or neoplastic states, and is not affected by body mass, diet, or drugs. Thus, cystatin C may be a more reliable marker of renal function (GFR) than creatinine.


Estimated Glomerular Filtration Rate (GFR):

GFR can be estimated (eGFR) from serum cystatin C utilizing an equation which includes the age and gender of the patient. The CKD-EPI cystatin C equation was developed by Inker et al:(1) and demonstrated good correlation with measured iothalamate clearance in patients with all common causes of kidney disease, including kidney transplant recipients. Cystatin C eGFR may have advantages over creatinine eGFR in certain patient groups in whom muscle mass is abnormally high or low (for example quadriplegics, very elderly, or malnourished individuals). Blood levels of cystatin C also equilibrate more quickly than creatinine, and therefore, serum cystatin C may be more accurate than serum creatinine when kidney function is rapidly changing (for example amongst hospitalized individuals).

Useful For Suggests clinical disorders or settings where the test may be helpful

Cystatin C:

An index of glomerular filtration rate, especially in patients where serum creatinine may be misleading (eg, very obese, elderly, or malnourished patients)


Assessing renal function in patients suspected of having kidney disease


Monitoring treatment response in patients with kidney disease


Estimated Glomerular Filtration Rate (eGFR):

An index of GFR, especially in patients where serum creatinine may be misleading (eg, very obese, elderly, or malnourished patients); for such patients, use of CKD-EPI cystatin C equation is recommended to estimate GFR


Assessing renal function in patients suspected of having kidney disease


Monitoring treatment response in patients with kidney disease

Interpretation Provides information to assist in interpretation of the test results

Cystatin C:

Cystatin C inversely correlates with the glomerular filtration rate (GFR), that is elevated levels of cystatin C indicate decreased GFR. Cystatin C may provide more accurate assessment of GFR for very obese, elderly, or malnourished patients than creatinine. Cystatin C equation does not require patient ethnic data, and can be used for those patients with this information unavailable.


Due to immaturity of renal function, cystatin C levels are higher in neonates <3 months of age.(2)


Estimated Glomerular Filtration Rate (eGFR):

Chronic kidney disease (CKD) is defined as the presence of: persistent and usually progressive reduction in GFR (GFR <60 mL/min/1.73 m[2]) and/or albuminuria (>30 mg of urinary albumin per gram of urinary creatinine), regardless of GFR.


According to the National Kidney Foundation Kidney Disease Outcome Quality Initiative (K/DOQI) classification, among patients with CKD, irrespective of diagnosis, the stage of disease should be assigned based on the level of kidney function:




GFR mL/min/BSA


Kidney damage with normal or  increased GFR



Kidney damage with mild decrease in  GFR



Moderate decrease in GFR



Severe decrease in GFR



Kidney failure

<15 (or dialysis)

Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

Cystatin C:

Lipemic or frozen specimens, which become turbid after thawing, may interfere with the assay.


Estimated Glomerular Filtration Rate (eGFR):

eGFR is not a precise measure of GFR and can be influenced by nonrenal factors (eg, inflammation).

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.



0 days-22 years: no reference values established

23-29 years: 0.60-1.03 mg/dL

30-39 years: 0.64-1.12 mg/dL

40-49 years: 0.68-1.22 mg/dL

50-59 years: 0.72-1.32 mg/dL

60-69 years: 0.77-1.42 mg/dL

70-79 years: 0.82-1.52 mg/dL

>79 years: no reference values established


0 days-22 years: no reference values established

23-29 years: 0.57-0.90 mg/dL

30-39 years: 0.59-0.98 mg/dL

40-49 years: 0.62-1.07 mg/dL

50-59 years: 0.64-1.17 mg/dL

60-69 years: 0.66-1.26 mg/dL

70-80 years: 0.68-1.36 mg/dL

81-86 years: 0.70-1.45 mg/dL

>86 years: no reference values established



>60 mL/min/BSA

eGFR will not be calculated for patients under 18 years.

Clinical References Provides recommendations for further in-depth reading of a clinical nature

1. Inker LA, Schmid CH, Tighiouart H, et al: Estimating glomerular filtration rate from serum creatinine and cystatin C. N Engl J Med 2012 Jul;367(1):20-29

2. Buehrig CK, Larson TS, Bergert JH, et al: Cystatin C is superior to serum creatinine for the assessment of renal function. J Am Soc Nephrol 2001;12:194A

3. Grubb AO: Cystatin C - properties and use as a diagnostic marker. Adv Clin Chem 2000;35:63-99

4. Coll E, Botey A, Alvarez L, et al: Serum cystatin C as a new marker for noninvasive estimation of glomerular filtration rate and as a marker for early renal impairment. Am J Kidney Dis 2000 Jul;36(1):29-34

5. Flodin M, Jonsson AS, Hansson LO, et al: Evaluation of Gentian cystatin C reagent on Abbott Ci8200 and calculation of glomerular filtration rate expressed in mL/min/1.73 m(2) from the cystatin C values in mg/L. Scand J Clin Lab Invest 2007;67:560-567

6. Larsson A, Hansson LO, Flodin M, et al: Calibration of the Siemens cystatin C immunoassay has changed over time. Clin Chem 2011;57:777-778

7. Voskoboev NV, Larson TS, Rule AD, Lieske JC: Importance of cystatin C assay standardization. Clin Chem 2011 Aug;57(8):1209-1211

8. Nitsch D, Sandling JK, Byberg L et al: Fetal, developmental, and parental influences on cystatin C in childhood: the Uppsala Family Study. Am J Kidney Dis 2011 Jun;57(6):863-872

9. Voskoboev NV, Larson TS, Rule AD, Lieske JC: Analytic and clinical validation of a standardized cystatin C particle enhanced turbidimetric assay (PETIA) to estimate glomerular filtration rate. Clin Chem Lab Med 2012 Mar;50(9):1591-1596

10. Finney H, Newman DJ, Thakkar H, et al: Reference ranges for the plasma cystatin C and creatinine measurements in premature infants, neonates, and older children. Arch Dis Child 2000 Jan;82(1):71-75