0006600239190COINV3.

CYSC2
Tina-quant Cystatin C Gen.2 Specific proteins
Order information
Analyzer(s) on which cobasc pack(s) can
be used
COBASINTEGRA400plus
06600239 190 Tina-quant Cystatin C Gen.2 (225 tests) System-ID 0775509
COBASINTEGRA800
04975901 191 C.f.a.s. Cystatin C (4 1 mL) System-ID 0775665
Cystatin C Control Set
04975936 190* Control I (low) (4 1 mL) System-ID 0769908
Control II (high) (4 1 mL) System-ID 0769916
Cystatin C Control Set Gen.2
Control 1 (3 1 mL) System-ID 0775614
06729371 190
Control 2 (3 1 mL) System-ID 0775622
Control 3 (3 1 mL) System-ID 0775630
20756350 322 NaCl Diluent 9 % (6 22 mL) System-ID 0756350
*Not for use in the US

English CystatinC equation for estimating GFR acc. to Horio M et al.:22

System information Male 96 SCysC1.324 0.996Age
Test CYSC2, testID 0139 Female 96 SCysC1.324 0.996Age 0.894
Intended use
In vitro test for the quantitative determination of cystatinC in human serum CystatinC equation for estimating GFR acc. to Grubb A et al.:23
and plasma on COBASINTEGRA systems. eGFR = 130 Cystatin C1.069 Age0.117 7
Summary1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20
Test principle5
Chronic kidney disease is a worldwide health problem that carries a
substantial risk for cardiovascular morbidity and death. Current guidelines Particle enhanced immunoturbidimetric assay
define chronic kidney disease as kidney damage or glomerular filtration rate Human cystatinC agglutinates with latex particles coated with anti-
(GFR) less than 60mL/min per 1.73m2 for 3months or more, regardless of cystatinC antibodies. The aggregate is determined turbidimetrically at
cause. GFR is the most frequently used criteria in the assessment of renal 552nm.
function.
Reagents - working solutions
Serum creatinine is the most commonly used marker for estimation of GFR.
However, it has become evident that the creatinine concentration is far from R1 Solution of polymers in MOPS-buffered saline; preservative,
ideal because it is significantly changed by other factors such as muscle stabilizers
mass, diet, gender, age and tubular secretion.
SR Latex particles in glycine buffer coated with anti-cystatinC
CystatinC is produced by all nucleated cells at a constant rate and the
production rate in humans is remarkably constant over the entire lifetime. antibodies (rabbit); preservative, stabilizers
Elimination from the circulation is almost entirely via glomerular filtration. R1 is in position B and SR is in position C.
For this reason the serum concentration of cystatinC is independent from
muscle mass and gender. There is a small dependency of cystatinC Precautions and warnings
concentration from age in the age range 1to 50years whereas the Pay attention to all precautions and warnings listed in
cystatinC concentration of healthy individuals >50years increases with Section1/Introduction of this Method Manual.
age. Therefore, cystatinC in plasma and serum has been proposed as a For USA: For prescription use only.
more sensitive marker for GFR in children and adults, and several studies,
as well as one meta analysis, have suggested that cystatinC is superior to Reagent handling
serum creatinine for estimation of GFR. Patient groups which benefit most Ready for use
are those with mild to moderate kidney disease and also those in acute COBASINTEGRA400plus analyzer:
renal failure, where toxic drugs have to be administered which are excreted
by glomerular filtration, especially elder people (>50years), children, Mix all brand new (nonpunctured) cobasc packs for 1minute on a
pregnant women with suspicion of pre-eclampsia, diabetics, people with cassette mixer before loading on the analyzer.
diseases of skeletal muscle and renal transplant recipients. Additionally COBASINTEGRA800 analyzer:
cystatinC has been discussed in recent literature as a prognostic marker After cobasc packs puncture, the analyzer automatically mixes the reagent
for acute heart failure. for 1minute.
As with creatinine several cystatinC based prediction equations for
calculation of GFR for adults and children have been published. It should be Storage and stability
noted that these formulas were evaluated with different cystatinC assays Shelf life at 28C See expiration date on
(particle-enhanced nephelometric immunoassay PENIA or particle
enhanced turbidimetric immunoassay PETIA) and may reveal inaccurate cobasc pack label
GFR results if an inappropriate combination of formula and assay is used. COBASINTEGRA400 plus system
CKD-EPI cystatinC equation for estimating GFR:21 On-board in use at 1015C 8weeks
Serum cystatinC 0.8mg/L: COBASINTEGRA800 system
Male 133 (Scys/0.8)0.499 0.996Age On-board in use at 8C 8weeks
Female 133 (Scys/0.8)0.499 0.996Age 0.932 Specimen collection and preparation7
For specimen collection and preparation only use suitable tubes or
Serum cystatinC >0.8mg/L: collection containers.
Male 133 (Scys/0.8)1.328 0.996Age Only the specimens listed below were tested and found acceptable.
Female 133 (Scys/0.8)1.328 0.996Age 0.932 Serum, collected using serum separating tubes
Plasma: Li-heparin plasma, K2-, K3-EDTA plasma

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Tina-quant Cystatin C Gen.2 Specific proteins

The sample types listed were tested with a selection of sample collection Antigen excess check No
tubes that were commercially available at the time of testing, i.e. not all
available tubes of all manufacturers were tested. Sample collection systems Predilution factor No
from various manufacturers may contain differing materials which could Unit mg/L
affect the test results in some cases. When processing samples in primary
tubes (sample collection systems), follow the instructions of the tube
manufacturer. Pipetting parameters
Centrifuge samples containing precipitates before performing the assay.
Diluent (H2O)
Blood collected in capillary blood collection tubes is unsuitable for use in
this assay.24 R1 154 L

Stability in serum: 7days at 4C25,26 Sample 2 L

7days at (20)(+20)C25 SR 34 L 20 L

24months at 25C27 Total volume 210 L

Stability in plasma: 6months at 20C28 Calibration

Frozen samples should be thawed carefully and mixed well before analysis. Calibrator C.f.a.s. CystatinC
Materials provided 1:1, 1:1.5, 1:2.58, 1:5.2, 1:9.35, and
See Reagents working solutions section for reagents. 0, performed automatically by the
instrument
Materials required (but not provided)
NaClDiluent9%, Cat.No.20756350 322, systemID0756350 for Calibration mode Spline
automatic postdilution and standard serial dilutions. NaClDiluent9% is Calibration replicate Duplicate recommended
placed in its predefined rack position and is stable for 4weeks onboard
COBASINTEGRA400plus/800analyzers. Calibration frequency Each lot and after 90days on-board
Assay and as required following quality
For optimum performance of the assay follow the directions given in this control procedures
document for the analyzer concerned. Refer to the appropriate operators Traceability: This method has been standardized against ERM-DA471/IFCC
manual for analyzerspecific assay instructions. reference material.
Application for serum/plasma Quality control
COBASINTEGRA400plus test definition Quality control CystatinC Control Set* or
Measuring mode Absorbance CystatinC Control Set Gen.2
Abs. calculation mode Endpoint Control interval 24hours and using a new cobasc
pack recommended
Reaction mode R1-S-SR
Control sequence User defined
Reaction direction Increase
Control after calibration Recommended
Wavelength A 552 nm
For quality control, use control materials as listed in the Order information
Calc. first/last 35/69 section. In addition, other suitable control material can be used.
Typical prozone effect > 20 mg/L The control intervals and limits should be adapted to each laboratorys
Antigen excess check No individual requirements. Values obtained should fall within the defined
limits. Each laboratory should establish corrective measures to be taken if
Predilution factor No values fall outside the defined limits.
Unit mg/L Follow the applicable government regulations and local guidelines for
quality control.
*Not for use in the US
Pipetting parameters Calculation
Diluent (H2O) COBASINTEGRAanalyzers automatically calculate the analyte
concentration of each sample. For more details, please refer to Data
R1 154 L Analysis in the Online Help (COBASINTEGRA400plus/800 analyzers).
Sample 2 L Limitations - interference
SR 34 L 20 L It has been reported that cystatinC serum concentrations are not affected
Total volume 210 L by standardized high-dose corticosteroid therapy but may be increased in
patients with impaired renal function receiving corticosteroids.29
Levels of cystatinC are sensitive to changes in thyroid function and should
COBASINTEGRA800 test definition not be used without knowledge of the patient's thyroid status.30
Criterion: Recovery within 0.100mg/L of initial values of samples
Measuring mode Absorbance 1.00mg/L and within 10% for samples >1.00mg/L.
Abs. calculation mode Endpoint Icterus:31 No significant interference up to an Iindex of 60 for conjugated
Reaction mode R1-S-SR and unconjugated bilirubin (approximate conjugated and unconjugated
bilirubin concentration: 1026mol/L or 60mg/dL).
Reaction direction Increase Hemolysis:31 No significant interference up to an Hindex of 1000
Wavelength A 552 nm (approximate hemoglobin concentration: 621mol/L or 1000mg/dL).
Calc. first/last 46/98 Lipemia (Intralipid):31 No significant interference up to an Lindex of 1000.
There is poor correlation between the Lindex (corresponds to turbidity) and
Typical prozone effect > 20 mg/L triglycerides concentration.

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Tina-quant Cystatin C Gen.2 Specific proteins

Rheumatoid factors <1200IU/mL do not interfere. Repeatability Mean SD CV

High dose hookeffect: No false result occurs up to a cystatinC mg/L mg/L %
concentration of 12mg/L. Control 1 0.915 0.015 1.7
Drugs: No interference was found at therapeutic concentrations using
common drug panels.32,33 Control 2 1.75 0.02 1.0
In very rare cases, gammopathy, in particular type IgM (Waldenstrms Control 3 4.10 0.04 1.1
macroglobulinemia), may cause unreliable results.34 Human serum 1 0.519 0.016 3.1
For diagnostic purposes, the results should always be assessed in
conjunction with the patients medical history, clinical examination and other Human serum 2 2.78 0.03 1.1
findings. Human serum 3 6.39 0.09 1.5
ACTION REQUIRED
Special Wash Programming: The use of special wash steps is mandatory Intermediate precision Mean SD CV
when certain test combinations are run together on COBASINTEGRA mg/L mg/L %
analyzers. Refer to the CLEAN Method Sheet for further instructions and for
the latest version of the Extra wash cycle list. Control 1 0.915 0.019 2.0
Where required, special wash/carry-over evasion programming must Control 2 1.75 0.03 1.7
be implemented prior to reporting results with this test.
Control 3 4.10 0.07 1.7
Limits and ranges
Measuring range Human serum 1 0.519 0.016 3.1
0.40-6.80mg/L Human serum 2 2.78 0.05 1.8
Determine samples having higher concentrations via the rerun function. Human serum 3 6.39 0.11 1.7
Dilution of samples via the rerun function is a 1:2 dilution. Results from
samples diluted using the rerun function are automatically multiplied by a Method comparison
factor of2. CystatinC values for human serum samples obtained on a
Lower limits of measurement COBASINTEGRA800 analyzer(y) were compared with those determined
using the same reagent on a Roche/Hitachi cobasc501 analyzer(x).
Limit of Blank , Limit of Detection and Limit of Quantitation
Sample size (n) = 132
Limit of Blank =0.30mg/L
Passing/Bablok35 Linear regression
Limit of Detection =0.40mg/L
y = 1.015x - 0.051 mg/L y = 1.017x - 0.059 mg/L
Limit of Quantitation =0.40mg/L
= 0.980 r = 0.999
The Limit of Blank, Limit of Detection and Limit of Quantitation were
determined in accordance with the CLSI (Clinical and Laboratory Standards The sample concentrations were between 0.430 and 6.67mg/L.
Institute) EP17A2 requirements. CystatinC values for human serum samples obtained on a
The Limit of Blank is the 95th percentile value from n60 measurements of COBASINTEGRA800 analyzer(y) were compared with those determined
analytefree samples over several independent series. The Limit of Blank using the same reagent on a COBASINTEGRA400analyzer(x).
corresponds to the concentration below which analytefree samples are Sample size (n) = 130
found with a probability of 95%.
The Limit of Detection is determined based on the Limit of Blank and the Passing/Bablok35 Linear regression
standard deviation of low concentration samples. y = 1.032x - 0.035 mg/L y = 1.035x - 0.047 mg/L
The Limit of Detection corresponds to the lowest analyte concentration
which can be detected (value above the Limit of Blank with a probability of = 0.975 r = 0.999
95%). The sample concentrations were between 0.410 and 6.65mg/L.
The Limit of Quantitation is the lowest analyte concentration that can be References
reproducibly measured with a total error of 30%. It has been determined
using low concentration cystatinC samples. 1 Levey AS, Coresh J, Balk E, et al. National Kidney Foundation practice
guidelines for chronic kidney disease: evaluation, classification, and
Expected values28 stratification. Ann Intern Med 2003;139:137-147.
Aliquots of samples from a reference panel containing healthy subjects 2 Rule AD, Larson TS, Bergstralh EJ, et al. Using serum creatinine to
were analyzed. Study participants with an eGFR >80(mL/min/1.73m2) estimate glomerular filtration rate: accuracy in good health and in
were included in this study (273samples). The age of the study population chronic kidney disease. Ann Intern Med 2004;141:929-937.
ranged from 21 to 77years.
The analysis of the data with the 2.5% and the 97.5% percentile gave a 3 Wasen E, Isoaho R, Mattila K, et al. Estimation of glomerular filtration
cystatinC range from 0.61mg/L to 0.95mg/L. rate in the elderly: a comparison of creatinine based formulae with
serum Cystatin C. J Intern Med 2004;256:70-78.
Each laboratory should investigate the transferability of the expected values
to its own patient population and if necessary determine its own reference 4 Levey AS, Coresh JK. DOQI clinical practice guidelines on chronic
ranges. kidney disease. Guideline 4. Estimation of GFR. Am J Kidney Dis
2002;39 (suppl1):76-92.
Specific performance data
5 Kyhse-Andersen J, Schmidt C, Nordin G, et al. Serum Cystatin C,
Representative performance data on the analyzers are given below. determined by a rapid, automated particle-enhanced turbidimetric
Results obtained in individual laboratories may differ. method, is a better marker than serum creatinine for glomerular
Precision filtration rate. Clin Chem 1994;40(10):1921-1926.
Repeatability and intermediate precision were determined using human 6 Grubb A, Simonsen O, Sturfelt G, et al. Serum concentration of
samples and controls in accordance with the CLSI (Clinical and Laboratory Cystatin C, factor D and 2-microglobulin as a measure of glomerular
Standards Institute) EP5 requirements (2aliquots per run, 2runs per day, filtration rate. Acta Med Scand 1985;218(5):499-503.
21days). The following results were obtained: 7 Jung K, Jung M. Cystatin C: a promising marker of glomerular filtration
rate to replace creatinine. Nephron 1995;70(3):370-371.

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Tina-quant Cystatin C Gen.2 Specific proteins

8 Newman DJ, Thakkar H, Edwards RG, et al. Serum Cystatin C 29 Bkenkamp A, van Wijk JAE, Lentze ML, et.al. Effect of Corticosteroid
measured by automated immunoassay: a more sensitive marker of Therapy on Serum Cystatin C and 2-Microglobulin Concentrations.
changes in GFR than serum creatinine. Kidney Int 1995;47(1):312-318. Clin Chem 2002;48:1123-1126.
9 Mussap M, Dalla Vestra M, Fioretto P, et al. Cystatin C is a more 30 Wiesli P, Schwegler B, Spinas AS, et al. Serum Cystatin C is sensitive
sensitive marker than creatinine for the estimation of GFR in type 2 to small changes in thyroid function Clin Chim Acta 2003;338(1):87-90.
diabetic patients. Kidney Int. 2002;61:1453-1461. 31 Glick MR, Ryder KW, Jackson SA. Graphical Comparisons of
10 Dharnidharka VR, Kwon C, Stevens G. Serum cystatin C is superior to Interferences in Clinical Chemistry Instrumentation.
serum creatinine as a marker of kidney function: a meta analysis. Am J ClinChem1986;32:470-475.
Kidney Dis 2002 Aug;40(2):221-226. 32 Breuer J. Report on the Symposium Drug effects in Clinical Chemistry
11 Risch L, Drexel H, Huber AR. Differences in glomerular filtration rate Methods. Eur J Clin Chem Clin Biochem 1996;34:385-386.
estimates by two cystatin C-based equations. Clinical Chemistry 33 Sonntag O, Scholer A. Drug interference in clinical chemistry:
2005;51:2211-2212. recommendation of drugs and their concentrations to be used in drug
12 Grubb A, Nyman U, Bjork J, et al. Simple Cystatin C-Based prediction interference studies. Ann Clin Biochem 2001;38:376-385.
equations for glomerular filtration rate compared with the modification 34 Bakker AJ, Mcke M. Gammopathy interference in clinical chemistry
of diet in renal disease prediction equation for adults and the Schwartz assays: mechanisms, detection and prevention.
and the Counahan-Barratt prediction equations for children. Clinical ClinChemLabMed2007;45(9):1240-1243.
Chemistry 2005;51:1420-1431.
35 Bablok W, Passing H, Bender R, et al. A general regression procedure
13 Hoek FJ, Kemperman FA, Krediet RT. A comparison between Cystatin for method transformation. Application of linear regression procedures
C, plasma creatinine and the Cockcroft and Gault formula for the for method comparison studies in clinical chemistry, Part III. J Clin
estimation of glomerular filtration rate. Nephrol Dial Transplant Chem Clin Biochem 1988 Nov;26(11):783-790.
2003;18:2034-2031.
A point (period/stop) is always used in this Method Sheet as the decimal
14 Lassus J, Harjola VP, Sund R, et al. Prognostic value of Cystatin C in separator to mark the border between the integral and the fractional parts of
acute heart failure in relation to other markers of renal function and NT- a decimal numeral. Separators for thousands are not used.
proBNP. European Heart Journal (February)
doi:10.1093/eurheart/ehl507. Symbols
15 Strevens H, Wide-Swensson D, Torffvit O, et al. Serum Cystatin C for Roche Diagnostics uses the following symbols and signs in addition to
assessment of glomerular filtration rate in pregnant and non-pregnant those listed in the ISO 152231 standard.
women. Indications of altered filtration process in pregnancy. Scand J
Clin Lab Invest 2002;62:141-148. Contents of kit
16 Andersen TB, Eskild-Jensen A, Frokiaer J, et al. Measuring glomerular Volume after reconstitution or mixing
filtration rate in children; can Cystatin C replace established methods?
Pediatr Nephrol 2009;24:929-41. GTIN Global Trade Item Number
17 Grubb A, Nyman U, Bjrk,J Improved estimation of glomerular filtration FOR US CUSTOMERS ONLY: LIMITED WARRANTY
rate (GFR) by comparison of eGFR (cystatin C) and eGFR (creatinine.). Roche Diagnostics warrants that this product will meet the specifications
Scand J Clin Lab Invest 2012;72:73-77.
stated in the labeling when used in accordance with such labeling and will
18 Filler G, Huang S-HS, Yasin A.. The usefulness of Cystatin C and be free from defects in material and workmanship until the expiration date
related formulae in pediatrics. Clin Chem Lab Med
2012;50(12):2081-2091. printed on the label. THIS LIMITED WARRANTY IS IN LIEU OF ANY
OTHER WARRANTY, EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED
19 Grubb A. Cystatin C- and creatinine-based GFR-prediction equations
for children and adults. Clinical Biochemistry 2011;44:501-502. WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR
PURPOSE. IN NO EVENT SHALL ROCHE DIAGNOSTICS BE LIABLE
20 Rollins G. Predicting risk of ESRD in Diabetics, Clinical Laboratrory
Strategies, Jan.2013,1-4. FOR INCIDENTAL, INDIRECT, SPECIAL OR CONSEQUENTIAL
DAMAGES.
21 Leseley A, Inker M.D., Christopher H, et al, Estimating Glomerular
COBAS, COBASC, COBASINTEGRA and TINAQUANT are trademarks of Roche.
Filtration Rate from Serum Creatinine and Cystatin C. N Engl J Med
2012;367:20-29. All other product names and trademarks are the property of their respective owners.
Additions, deletions or changes are indicated by a change bar in the margin.
22 Horio M, Imai E, Yasuda Y, et al. GFR Estimation Using Standardized 2015, Roche Diagnostics
Serum Cystation C in Japan. Am J Kidney Dis 2013;61(2):197-203
23 Grubb A, Horio M, Hansson LO, et al. Generation of a New Cystatin C-
Based Estimating Equation for Glomerular Filtration Rate Using Seven
Assays Standardized to the International Calibrator.Clin Chem 2014, in Roche Diagnostics GmbH, SandhoferStrasse116, D-68305 Mannheim
press. www.roche.com
24 van Deutekom AW, Zur B, van Wijk JAE, et al. Measurement of cystatin Distribution in USA by:
C in capillary blood samples in pediatric patients. Clin Biochem Roche Diagnostics, Indianapolis, IN
US Customer Technical Support 1-800-428-2336
2010;43:335-337.
25 Erlandsen EJ, Randers E, Kristensen JH. Evaluation of the Dade
Behring N Latex Cystatin C assay on the Dade Behring Nephelometer
II System. Scand J Clin Lab Invest 1999;59:1-8.
26 Mussap M, Ruzzante N, Varagnolo M, et al. Quantitative Automated
Particle-Enhanced Immunonephelometric Assay for the Routinary
Measurement of Human Cystatin C. Clin Chem Lab Med
1998;36(11):859-865.
27 Gislefoss RE, Grimsrud TK, Morkrid L. Stability of selected serum
proteins after long-term storage in the Janus Serum Bank. Clin Chem
Lab Med 2009;47(5):596-603.
28 Data on file at Roche Diagnostics.

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