Abstract Objectives COVID-19 in it is more severe form is characterized by a hyperinflammatory condition, hypercoagulation state and the appearance of pulmonary microembolism. In this study we wanted ...to correlate levels of D-Dimer, protein C, protein S and antithrombin 3 with severity of disease and clinical outcome. Methods We included 134 of patients who were divided in 3 groups regarding oxygen support (high flow oxygen therapy, mechanical ventilation and oxygen supplementation with nasal cannula or mask). Results Concentration of D-Dimer, and activity of protein C and antithrombin 3 are presented as mean±SD and differed significantly between patients on mechanical ventilation (3.26 ± 1.15 mg/L, 86 ± 22.55 %, 81.21 ± 17.61 %)/HFNO (2.35 ± 1.68 mg/L, 109.6 ± 26.96 %, 94.67 ± 17.49 %)/BNC (1.37 ± 1.17 mg/L, 116.92 ± 28.16 %, 103.29 ± 15.63 %) with p<0.001 for all parameters. Mortality in oxygen group was 10.9 %, in HFNC group 40.7 % and in mechanical ventilated group 80 %. Conclusions determination of anticoagulant factors in COVID-19 patients may indicate which of them are at increased risk of developing severe disease, venous thromboembolism and fatal clinical outcome.
U Kliničkoj bolnici Dubrava u Zagrebu prvi je put u Hrvatskoj ugrađen novi sustav za krvožilni pristup kod bolesnika koji se liječi kroničnom hemodijalizom. Radi se o kombinaciji centralnoga venskog ...katetera i grafta engleskog naziva Hemodialysis Reliable Outflow (HeRO) device, skraćenog naziva HeRO-graft. Glavna je indikacija za primjenu ovoga krvožilnog pristupa okluzija ili značajna stenoza centralnih vena. Iz literature se doznaje da ovaj krvožilni pristup ima značajne prednosti u odnosu na tunelirani centralni venski kateter koji bi trebao biti zadnja opcija kod bolesnika koji zahtijevaju trajno nadomještanje izgubljene bubrežne funkcije. Za razliku od tuneliranih
katetera ovaj je sustav u potpunosti smješten potkožno, što ga čini otpornijim na infekcije. Do sada su u Kliničkoj bolnici Dubrava ugrađena dva HeRO-grafta za hemodijalizu i prema prvim iskustvima potrebna je detaljna obrada kandidata za ovu proceduru. Potrebno je dobro poznavati indikacije i kontraindikacije te je nužna suradnja više timova: nefrološkog, anesteziološkog, radiološkog i kirurškog. Osobito je potrebno obratiti pažnju na stanje arterijske cirkulacije okrajine koja se koristi za ovaj krvožilni pristup kako bi se izbjegle moguće ishemijske komplikacije. Kod obaju naših bolesnika postupak ugradnje protekao je uredno te smo započeli s korištenjem HeRO-grafta za potrebe hemodijalize.
Cilj: Ispitati pojavnost znakova ishemijske periferne arterijske bolesti (PAB), ulkusa nogu (UN) i amputacija nogu (AN) u bolesnika liječenih kroničnom intermitentnom hemodijalizom (HD) te njihovu ...povezanost s drugim kliničkim i laboratorijskim parametrima. Metode: U presječno istraživanje, provedeno od siječnja do svibnja
2023. godine, uključeno je 329 bolesnika iz 5 HD centara. Osim anamneze, pregleda dokumentacije te kliničkog pregleda (posebice pulzacija), praćeni su i zadnji laboratorijski nalazi bolesnika određivani u rutinskoj kliničkoj praksi. Za ispitivanje neovisnih rizičnih čimbenika za UN te AN korištena je multivarijatna logistička regresija. Rezultati: Uključeno je 202 muškarca (61,4%), 119 bolesnika s dijabetesom (36,2%), medijana HD liječenja 40 mjeseci. PAB nogu imalo je 98 (27,8%) bolesnika, UN 42 (12,8%), a AN 40 (12,2%) bolesnika. UN bolesnici imali su češće PAB, dijabetes, ishemijsku srčanu bolest, češće su bili pušači, češće su imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu te češće amputacije i hipoalbuminemiju. AN bolesnici češće su imali PAB, dijabetes, ulkuse nogu, češće su bili pušači i imali odsutne ili oslabljene pulzacije na svim lokalizacijama nogu i hipoalbuminemiju te su bili značajno mlađi i viši. U multivarijatnoj logističkoj regresiji kao nezavisni čimbenici rizika za UN nađeni su: PAB, dijabetes, duži HD staž i hipoalbuminemija. Nezavisni rizični čimbenici za AN bili su: PAB, UN, dijabetes, pušenje, mlađa dob i hipoalbuminemija. Zaključak: učestalost znakova PAB-a veća je u HD bolesnika u usporedbi s općom populacijom, a dijabetes, pušenje i dužina liječenja HD-om dodatni su rizični čimbenici. Potrebna su prospektivna istraživanja te kliničko praćenje statusa nogu u ovih bolesnika radi sprječavanja komplikacija.
Abstract
Background and Aims
Kidneys are often damaged in paraproteinemic conditions. Paraproteins are monoclonal immunoglobulins or immunoglobulin fractions that are produced by a clonal population ...of B- or plasma cell lineage and can cause a variety of histological patterns of kidney injury, such as light chain (AL) amyloidosis or light chain cast nephropathy (LCCN). Monoclonal gammopathy of renal significance (MGRS) represents a group of disorders in which a monoclonal immunoglobulin secreted by B- or plasma cell clone causes renal damage. By definition, these disorders do not meet diagnostic criteria for overt, symptomatic multiple myeloma or a lymphoproliferative disorder, but in contrast to monoclonal gammopathy of undetermined significance (MGUS) there is evidence of end-organ damage that can warrant therapy.
Method
All patients with paraproteinemic kidney disease were identified by retrospective review of the Hospital Register of kidney biopsies done at Department of Nephrology and Dialysis, in Dubrava University Hospital, Zagreb, from 2009 until 2018. Every kidney biopsy was analyzed by light, immunofluorescent and electron microscopy. Laboratory findings, including serum protein electrophoresis, serum free light chain level and immunofixation of serum proteins, were done for every patient. Clinical and histologic features of patients and features of underlying hematological conditions were analyzed.
Results
We identified 47 patients (3,28% of all biopsies that were done in that period) with kidney disease with clear hematological background. The mean patients' age at the time of the biopsy was 63 years and 27 of them were females. Two patients had signs of direct infiltration of kidneys with malignant lymphomic cells (non-Hodgkin lymphoma) and were excluded from the analysis. Clinical presentation of the patients at the time of biopsy were: proteinuria in 85% of patients, full nephrotic syndrome in 55%, azotemia in 66% of patients (80% had acute kidney injury of unclear etiology) and hematuria in 12,7%. Most common histologic patterns of kidney injury were AL amyloidosis (45%) and LCCN (30%) but additionally 7 different histological patterns were found: light chain depostion disease, light chain proxymal tubulopathy, fibrillary and imunotactoid glomerulopathy, proliferative glomerulonephritis with monoclonal immunoglobulin deposition, crioglobulinemic glomerulopathy type I and tubulointerstitial damage caused by immunoglobulin deposition. Figure 1 shows main features of patients with AL amyloidosis and cast LCCN.
Conclusion
Kidney disease can be initial presentation of an underlying paraproteinemia and, as our data showed, can clinicaly present with acute kidney injury, nephrotic or subnephrotic range proteinuria or full nephrotic syndrome. Variety of histologic patterns of kidney injury were described and AL amyloidosis and LCCN were the most common histological findings. Detailed hematologic workup should follow kidney biopsy in order to determine the exact nature and extension of the disease and therefore the most appropriate therapy.
Figure 1.
Clinical features of the patients with AL amyloidosis and light chain cast nephropathy (LCCN) with underlying paraproteinemic conditions.
Histologic pattern
No. of patients
ProteinuriaNo. (%)
Nephrotic syndrome No. (%)
Acute kidney injury No. (%)
Multiple myeloma No. (%)
MGRS No. (%)
AL amyloidosis
21
21 (100)
14 (66,6)
9 (43)
6 (29)
15 (71)
LCCN
14
10 (71)
7 (50)
10 (71)
10 (71)
4 (29)
Background. High sensitive troponin I
(hsTnI) and high sensitive troponin T
(hsTnT) are markers of cardiac damage.
Cardiomyocyte necrosis increases its
blood levels. It is known that dialysis is
...cardiotoxic and that results in lack of contractility
of certain myocardial segments.
Tis mechanism is primarily due to hypo
perfusion of the myocardium during dialysis.
Te dialysis itself increases cardiovascular
(CV) risk in patients by many different
mechanisms. It has been proven that
the incidence of heart failure is much more
frequent in patients on hemodialysis than
in healthy population.
Te aim of this pilot study was to investigate
the presence of troponin T molecules
and troponin I in dialysate and compare
their concentrations.
Materials and Methods. Te study included
5 anuric patients (4M) on hemodialysis.
Te dialysate samples were sampled for
each patient three times during a dialysis
cycle. Te frst sample was taken afer thirty
minutes, the second sample was taken
in the middle of dialysis (120 minutes) and
the third sample was taken thirty minutes
before the end of dialysis. Te value of hsTnI
was measured using a high-sensitivity
test on the Immuno-enzymatic analyzer
Abbott Architest i1000SR. According to
CLSI EP15-A2 protocol verifcation of
hsTnT chemiluminescent micro-particle
immunoassay on the analytical platform
Roche cobas e411 was performed.
Results. Altogether 15 samples (three for
each patient) were processed. hsTnT was
detected in all 15 samples (13.42 ± 1.18
ng / L), while hsTnI was detected in only 8
samples (0.14 ± 0.16 ng / L). To test the difference
in detectability between hsTnT and
hsTnI, chi square test was used and the difference
was statistically signifcant (Yates
chi-square 6.708, p = 0.009).
Conclusion. Te presence of troponin
molecules in dialysate was determined for
the frst time in scientifc literature. Tis
study has confrmed that TnT is present in
all dialysate samples and that its concentration
is stable in dialysate. TnI concentrations
were detectable in signifcantly lower
concentrations.
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