Latar belakang. Komplikasi sindrom nefrotik (SN) yang sering telambat terdeteksi adalah gangguan ginjalakut (GnGA). Cystatin C serum dipertimbangkan menjadi pemeriksaan potensial pengganti kreatinin ...sebagaipenanda fungsi ginjal. Kadar cystatin C lebih mendekati nilai laju filtrasi glomerulus (LFG) dibandingkandengan kreatinin serum.Tujuan. Menentukan perbedaan LFG berdasarkan kadar kreatinin dan cystatin C serum pada SN anak.Metode. Penelitian potong lintang dilakukan dari Februari–Maret 2014 di unit rawat jalan dan rawat inapRSUP Dr. Hasan Sadikin Bandung, RSUD Kota Bandung, dan RSUD Cibabat Kota Cimahi. Subjek SNusia 1–14 tahun. Pemeriksaan kadar kreatinin dengan metode Jaffe dan cystatin C serum dengan particleenhancedturbidimetric immunoassay (PETIA). Uji statistik menggunakan McNemar dan uji t berpasangandan kemaknaan berdasarkan nilai p<0,05.Hasil. Terdapat 21 kasus SN yang terdiri atas 18 laki-laki dan 3 perempuan dengan rerata usia 6 tahun 3bulan. Nilai LFG berdasarkan kreatinin 137,86±27,07 ml/min/1,73 m2 dan LFG berdasarkan cystatin C73,59±12,49 ml/min/1,73 m2. Terdapat perbedaan signifikan antara LFG berdasarkan kadar kreatinin dancystatin C serum (p<0,01).Kesimpulan. Proporsi LFG cystatin C berdasarkan formula Filler lebih rendah dibandingkan kreatininberdasarkan formula Schwartz
Abstract
Background
To investigate the effect of changes in laboratory light intensity on chemistry and whole blood analysis.
Materials and Methods
The light intensity of the laboratory environment ...was measured and chemical and whole blood analysis was performed on 20 patient blood samples. The light intensity was then increased using projectors and re-measured, and the chemical and whole blood analyses were repeated. The values of the tests pre- and post-light increase were compared by statistical analysis using the Wilcoxon test.
Results
Increasing light from 195 to 1,168 lux significantly altered the results of the lipase, alkaline phosphatase, creatinine, and iron chemistry tests, (p<0.001 11.3%, p=0.003 2.2%, p=0.001 2% and p=<0.001 1.2%, respectively). There was also a significant difference in platelet count (p=<0.001 188%).
Conclusions
We show that the platelet count is sensitive to changes in laboratory light intensity at clinically unacceptable levels. The lipase, alkaline phosphatase, creatinine and iron tests are also sensitive to changes in laboratory light intensity, but at clinically acceptable levels.
Amaç: Perkütan nefrolitotripsi (PNL), ürolojinin son yıllarına damga vurmuş, pek çok merkezde uygulanabilen, morbiditesi ve mortalitesi son derece düşük bir tedavi yöntemi olarak karşımıza ...çıkmaktadır. Biz bu çalışmamızda, PNL öncesi serum kreatinin değerindeki yüksekliğin post operatif kanama durumuna etkisini araştırmayı amaçladık. Materyal ve Metod: Kliniğimizde PNL uygulanmış olan hastalar arasında üre ve kreatinin değerleri yüksek olan hastalar ayrıldı. Bu hastaların yaşları, taş boyutları, cinsiyetleri, tedavi öncesi hematokrit değerleri ve ek ko-morbiditeleri kaydedilerek hastaların bu değerlerine benzer değerleri olan hastalar ile diğer grup oluşturuldu. Serum kreatinin Araştırma Makalesi / Research Article 221 Şener ve ark. Cukurova Medical Journal değerleri yüksek olanlar Grup 1, normal olanlar ise Grup 2 olarak adlandırıldı. Hastaların beden kitle endeksi, taş boyutları, operasyon öncesi ve sonrası kreatin değeri, operasyon öncesi ve sonrası hematokrit değeri, preoperatif trombosit sayısı, koagülasyon parametreleri (aPTT, INR değerleri), trakt sayısı, operasyon süresi, preoperatif trombosit sayısı, taşsızlık oranları ve eritrosit transfüzyonu olup olmadığı kaydedilerek kıyaslandı. Bulgular: Gruplarda preoperatif kreatinin değerleri sırası ile Grup 1 ve 2 için 2,11 ± 0,44 ve 0,98 ± 0,27 idi. Taş boyutları 1. Grup için 29,41 ± 3,83 mm, 2. Grup için ise 29,49 ± 2,99 idi (p=0,317). Hastaların operasyon öncesi hematokrit değerleri 1 ve 2. Gruplar için sırasıyla 44,88 ± 5,61 ve 47,51 ± 4,61 idi (p=0,381). Bu değerler operasyon sonrası her iki grup için sırası ile 30,27 ± 7,01 ve 37,74 ± 7,11 idi (p=0,044). Sonuç: Çalışmamızda kreatinin değerlerinin PNL sonrası kanama için bir risk faktörü olduğu, serum kreatinin değerlerinin yüksekliği olan hastalarda, olmayanlara oranla hematokrit düşüşünün daha fazla olduğu görülmektedir.
Objective: Heart failure is the end stage of many cardiac disorders. Worsening heart failure causes high mortality in these patients. In the present study, we aimed to elucidate and compare the ...biochemical predictors of worsening heart failure.
Methods: One hundred one patients with heart failure were included in this study. Patients were divided into two groups according to their functional status. N-terminal pro-brain natriuretic peptide (NT-pro BNP), troponin T, serum and urine creatinine, blood urine nitrogen (BUN), eGFR, cystatin C, neutrophil gelatinase associated lipocalin (NGAL), C - reactive protein, hepatic transaminases and thyroid stimulating hormone levels were measured.
Results: NT-pro BNP, troponin T, serum creatinine, BUN, cystatin C and NGAL levels were significantly higher but urine creatinine level and eGFR was lower in decompensated heart failure patients. In univariate analysis, age, cystatin C, NGAL, NT-pro BNP and serum creatinine and eGFR predicted worsening heart failure (WHF). In multivariate analysis, cystatin C and NT-pro BNP variables were found to be significant in predicting WHF. However, eGFR were determined at the limit of significance (p=0.053) with an high odds ratio 3.173 (95% CI:0.983-10.240). Cystatin C and NT-pro BNP concentrations were predictors of worsening heart failure. In ROC analysis, cystatin C is a better predictor of decompensated heart failure compared with NT-pro BNP and other predictors, and has a sensitivity of 82% and a specificity of 63%.
Conclusion: This study revealed that cystatin C and NT-pro BNP were significant predictors of WHF, and cystatin C is slightly better predictor of WHF. Further studies are needed to confirm these results.
We describe an External Quality Assessment Scheme (EQAS) intended for reference (calibration) laboratories in laboratory medicine and supervised by the Scientific Division of the International ...Federation of Clinical Chemistry and Laboratory Medicine and the responsible Committee on Traceability in Laboratory Medicine. The official EQAS website, RELA (
), is open to interested parties. Information on all requirements for participation and results of surveys are published annually. As an additional feature, the identity of every participant in relation to the respective results is disclosed. The results of various groups of measurands (metabolites and substrates, enzymes, electrolytes, glycated hemoglobins, proteins, hormones, thyroid hormones, therapeutic drugs) are discussed in detail. The RELA system supports reference measurement laboratories preparing for accreditation according to ISO 17025 and ISO 15195. Participation in a scheme such as RELA is one of the requirements for listing of the services of a calibration laboratory by the Joint Committee on Traceability in Laboratory Medicine.
Abstrak
Renogram 99mTc-DTPA (diethylenetriamine pentacetic acid) memiliki beberapa kelebihan dalam mengukur laju filtrasi glomerulus (LFG). Cystatin-c digunakan sebagai petanda biologik baru untuk ...memperkirakan LFG. Tujuan penelitian ini adalah untuk menentukan korelasi nilai LFG antara renogram dengan cystatin-c dan kliren kreatinin pada pasien dengan penyakit ginjal kronis (PGK). Subjek penelitian adalah pasien PGK stadium dua berdasarkan hasil estimasi LFG dengan rumus Cockroft-Gault. Pasien yang memenuhi kriteria diperiksa renogram, kadar kreatinin serum, cystatin-c dan klirens kreatinin.Rerata LFG dari 30 orang subjek yang diperiksa dengan renogram, cystatin-c, creatinine clearance, Cockroft-Gault’s formula berturut turut adalah 64.96 ml/min/1.73m2 (SD 28.047), 53.37 ml/min/1.73m2 (SD 21.29), 58.09 ml/min/1.73m2 (SD 35.45), 46.00 ml/min/1.73m2 (SD 12.06). Korelasi antara renogram dengan cystatin-c dengan nilai r = 0.585 dan p = 0.0007, antara renogram dengan klirens kreatinin dengan nilai r = 0.388 dan p = 0.03) dan antara renogram dengan rumus Cockroft-Gault’s dengan nilai r = -0.029 dan p=0.87. Pada penelitian ini didapatkan hasil korelasi yang lebih baik antara renogram dengan cystatin-c dari pada antara renogram dengan klirens kreatinin dan antara renogram dengan rumus Cockroft-Gault’s. Lebih lanjut, cystain-c merupakan alternatif yang lebih baik untuk memperkirakan LFG jika metode pemeriksaan LFG yang mendekati teknik pemeriksaan yang ideal tidak tersedia.
Abstract
Renogram using 99mTc-DTPA (diethylenetriamine pentacetic acid) has advantages in the measurement of glomerular filtration rate (GFR). Serum cystatin-c was recently projected to be the new marker of estimated GFR. The aim of this study is to establish correlation between GFRs, derived from renogram with cystatin-c levels and creatinine clearances in chronic kidney disease patients.We put to study thirty consecutive stage two of chronic kidney disease patients assigned based on GFR estimation by Cockroft-Gault’s formula, taking into account the serum creatinine. Cystatin-c and creatinine clearance were performed to determine of GFR and renogram was included in this study. A total of thirty subjects, the mean of GFRs were taken from renogram, cystatin-c, creatinine clearance, Cockroft-Gault’s formula were 64.96 ml/min/1.73m2 (SD 28.047), 53.37 ml/min/1.73m2 (SD 21.29), 58.09 ml/min/1.73m2 (SD 35.45), 46.00 ml/min/1.73m2 (SD 12.06) respectively. A correlation between renogram with cystatin-c (r = 0.585 and p = 0.0007) and renogram with creatinine clearance (r = 0.388 and p = 0.03) and renogram with Cockroft-Gault’s formula (r = -0.029 and p=0.87). This study has shown that a better correlation between renogram with cystatin-c than with creatinine clearance or Cockroft-Gault’s formula. Furthermore, cystain-c would be better alternative method incase having problems to obtain a closest ideal methods for GFR.
Chronic kidney disease (CKD) is asymptomatic in the early stage. Kidney function might be lost 90% when the symptoms are overt. However, in case of early detection, progression of the disease can be ...prevented or delayed. If not detected it results in end stage renal disease. Therefore, the level of awareness about CKD should be increased. The role of medical laboratory is utmost important for the diagnosis and staging of CKD. In this paper, the main tasks of the laboratory specialists are described and the outlines are as follows.
• Creatinine assays should be traceable to internationally recognised reference materials and methods, specifically isotope dilution mass spectrometry.
• When reporting the creatinine result, eGFR should also be reported in adult (>18 years) population. A warning expression should be included in the report form if eGFR result is <60 mL/min/1.73 m
• eGFR values should be expressed quantitatively up to 90 mL/min/1.73 m
by CKD-EPI equation. Above 90 mL/ min/1.73 m
, eGFR values can be expressed quantitatively or >90 mL/min/1.73 m
• eGFR equations of the adult population should not be used for pediatric population. Different equations utilizing also patient height should be used. The enzymatic creatinine assay should be preferred. eGFR based on cystatin C can be used for confirmation in the pediatric population.
• Cystatin C measurements, at least when eGFR based on creatinine is not reliable and for confirmation should be encouraged.
• Proteinuria or albuminuria values should be measured in spot samples and reported in proportion to creatinine.
Recognition and Sensing of Creatinine Guinovart, Tomàs; Hernández-Alonso, Daniel; Adriaenssens, Louis ...
Angewandte Chemie,
February 12, 2016, Letnik:
128, Številka:
7
Journal Article
Recenzirano
Current methods for creatinine quantification suffer from significant drawbacks when aiming to combine accuracy, simplicity, and affordability. Here, an unprecedented synthetic receptor, an ...aryl‐substituted calix4pyrrole with a monophosphonate bridge, is reported that displays remarkable affinity for creatinine and the creatininium cation. The receptor works by including the guest in its deep and polar aromatic cavity and establishing directional interactions in three dimensions. When incorporated into a suitable polymeric membrane, this molecule acts as an ionophore. A highly sensitive and selective potentiometric sensor suitable for the determination of creatinine levels in biological fluids, such as urine or plasma, in an accurate, fast, simple, and cost‐effective way has thus been developed.
Kreatinin‐Quantifizierung: Ein Monophosphonat‐verbrückter Calix4pyrrol‐Kavitand komplexiert Kreatinin und das Kreatininium‐Kation. Wasserstoffbrücken zwischen dem Rezeptor und den polaren Gruppen des Gastmoleküls stabilisieren den Komplex. Die Verwendung des Rezeptors als Ionophor verbessert die Sensoreigenschaften ionenselektiver Elektroden und ermöglicht die Bestimmung der Kreatinin‐Konzentration in biologischen Proben.
Objective: Our aim was to determine whether cystatin C level has a superiority to creatinine to assess kidney functions in rapid decreases of glomerular filtration rate due to acute mercury exposure ...in children. Eight different glomerular filtration rate calculation formulas which have been used creatinine and/or cystatin C were also compared.
Methods: Serum urea, creatinine and cystatin C values of 39 mercury exposed children were measured. Glomerular filtration rates were calculated by eight different formulas. Patient group was divided into three subgroups according to mercury levels.
Results: Cystatin C and mercury levels of the patients were found significantly different from control group (p<0.001). There was not a significant difference in creatinine and urea values between two groups (p=0.913, p=0.236). There was not a significant difference between patient and control groups in GFR calculations which have been used serum creatinine and height or which have been used urea additional to them (p=0.069, p=0.559, p=0.424, p=0.945, respectively), but there was a significant difference between patient and control groups in GFR calculations which have been used cystatin C only or creatinine, urea and height in addition to this (p<0.001, p<0.001, p=0.042, p<0.001, respectively). In sugroup analysis, cystatin C results and the results of three GFR calculations of four GFR calculations which were used cystatin C were found different in control group according to subgroups but there was not a difference between subgroups.
Conclusion: Cystatin C level is a better indicator than creatinine to assess kidney functions in rapid decreases of glomerular filtration rate due to acute exposure of mercury. Formulas using cystatin C gave better results than formulas using creatinine and height in estimation of glomerular filtration rate.
Cilj terapije antagonistima vitamina K (varfarin) i novim oralnim antikoagulantnim lijekovima (NOAK-ima) jesu prevencija moždanog udara i drugih embolija kod bolesnika s nevalvularnom fibrilacijom ...atrija te liječenje i prevencija venske tromboembolije. Kod svih bolesnika potrebno je odrediti bubrežnu funkciju klirensom kreatina jer o tome ovise izbor i doziranje NOAK-a. Izuzetno je važno obratiti pozornost na starije bolesnike s brojnim pridruženim stanjima i interakcijama lijekova zbog velike učestalosti neuroloških simptoma i lošijeg ishoda. Oralno antikoagulantno liječenje izazov je, posebno u stanjima nenamjernog predoziranja lijeka, u krvarenjima ili u stanjima hitnoga prijeoperacijskog zbrinjavanja. Zbog sve većeg broja bolesnika koji uzimaju NOAK-e osnovana je 2015. godine ekspertna grupa specijalista hitne medicine koja je u listopadu 2015. održala u Zagrebu Konsenzusnu konferenciju radi donošenja postupnika za prijeoperacijsko zbrinjavanje i zbrinjavanje bolesnika u hitnim stanjima koji uzimaju NOAK-e u Hrvatskoj.
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