Bertalan Fodor

On-line haemodiafiltration versus haemodialysis: stable haematocrit with less erythropoietin and improvement of other relevant blood parameters.

Background: Controlled randomised studies to prove improved cardiovascular stability and improved anaemia management during on-line haemodiafiltration (oHDF) are scarce. Methods: 70 patients were treated with both haemodialysis (HD) and oHDF in a cross-over design during 2 × 24 weeks at a dialysis dose of eKt/V≧1.2. Patients randomised into group A started on HD and switched over to oHDF, whereas patients in group B began with oHDF and were treated with HD afterwards. Intradialytic morbid events (IME), such as symptomatic hypotension or muscle cramps, were noted in case of appearance. Blood parameters reflecting anaemic status, phosphate status, lipid metabolism, oxidative stress, and accumulation of advanced glycation end products were recorded either monthly or at the end of each study phase. Results: The mean incidence of IME was 0.15 IME per treatment, and there was no statistical difference between oHDF and HD. A higher haematocrit (oHDF 31.5% vs. HD 30.5%, p < 0.01) at a lower erythropoietin dose (oHDF 4,913 vs. HD 5,492 IU/week, p = 0.02) was found during oHDF, when the sequence of HD and oHDF had not been taken into account. For the study groups, the results were less distinct: in group A, a higher haematocrit (HD 30.4% vs. oHDF 32.0%, p < 0.01) at a comparable erythropoietin dose (HD 5,421 vs. oHDF 5,187 IU/week, ns) was observed during oHDF, whereas in group B an identical haematocrit (oHDF 30.8% vs. HD 30.7%, ns) was achieved at a reduced erythropoietin dose (oHDF 4,622 vs. HD 5,568 IU/week, p < 0.01). During oHDF, lower levels of free and protein-bound pentosidine and of serum phosphate were found. Conclusion: In contrast to other studies, no benefit regarding cardiovascular stability for oHDF was found, but oHDF could well offer a potential benefit regarding anaemia correction, inflammation, oxidative stress, lipid profiles, and calcium-phosphate product.

Association between the occurrence of the anticardiolipin IgM and mite allergen-specific IgE antibodies in children with extrinsic type of atopic eczema/dermatitis syndrome

Background:  As the literature has only controversial data on the role of nonallergen‐specific antibodies in atopic eczema dermatitis syndrome, the authors investigated the link between the occurrence of the antiphospholipid [anticardiolipin (ACL), anti‐β2‐glycoprotein I] and allergen‐specific immunoglobulin E (IgE) antibodies in 72 children with atopic eczema/dermatitis syndrome (AEDS).

New trends in the laboratory diagnostics of proteinuria and albuminuria

According to current clinical trials, albumin excretion is an early indicator of cardiovascular damage. While proteinuria is considered as a marker of kidney function, albuminuria indicates cardiovascular risk first of all. Sensitivity of the previous laboratory tests does not meet the clinical requirements, and the error of urine collection makes the results misleading. For that reason recent guidelines suggest to calculate albumin/creatinine (ACR) and protein/creatinine (PCR) measured from the first morning urine. For the clinical diagnosis of albuminuria the sensitive immunoturbidimetric assays are suggested. Albumin dipsticks are not recommended for the measurement of albuminuria. Wide-range urinary protein reagents are also available with high sensitivity, while serum reagents are not applicable (Biuret). The traceability of calibrator to a reference material is a critical requirement. Proteinuria and albuminuria of a patient should be monitored in the same laboratory, using a fixed method and cut-off value. Albumin/creatinine value should be reported together with gender-dependent reference range.Ujabb klinikai vizsgalatok szerint az albuminuria a cardiovascularis betegsegek korai markere. Mig a proteinuria elsősorban a vesefunkcio-romlas, az albuminuria a cardiovascularis riziko parametere. A regebbi laboratoriumi tesztek erzekenysege nem megfelelő, es a 24 oras vizeletgyűjtes pontatlansaga is sok bizonytalansagot okoz. Ezert a mai nemzetkozi iranyelvek 24 oras gyűjtes helyett a reggeli első vizeletből az albumin/kreatinin (ACR) es protein/kreatinin (PCR) meghatarozasat javasoljak. Klinikai laboratoriumok szamara javasolhatok az ujabb, nagy erzekenysegű immunkemiai vizeletalbumin-reagensek. Az albuminspecifi kus tesztcsikok az albuminuria fokanak meghatarozasara nem eleg erzekenyek. A vizeletfeherje-meghatarozashoz szinten leteznek nagy erzekenysegű, szeles meresi tartomanyu reagensek, igy erre nem alkalmazhatok a szerumfeherje-reagensek (peldaul Biuret). A modszervalasztas sarkalatos pontja, hogy a kalibrator nemzetkozi referensanyagra visszavezethető legyen. Mindezekből kovetkezik, hogy egy beteg ACR- vagy PCR-erteke az adott modszert es dontesi hatarerteket alkalmazo ugyanazon laboratoriumban kovethető jol. A laboratoriumi leleten az albumin/kreatinin referenciatartomanyat nemenkent kell megadni. Kulcsszavak: albuminuria, ACR, proteinuria, cardiovascularis betegseg, kreatinin New trends in the laboratory diagnostics of proteinuria and albuminuria According to current clinical trials, albumin excretion is an early indicator of cardiovascular damage. While proteinuria is considered as a marker of kidney function, albuminuria indicates cardiovascular risk fi rst of all. Sensitivity of the previous laboratory tests does not meet the clinical requirements, and the error of urine collection makes the results misleading. For that reason recent guidelines suggest to calculate albumin/creatinine (ACR) and protein/creatinine (PCR) measured from the fi rst morning urine. For the clinical diagnosis of albuminuria the sensitive immunoturbidimetric assays are suggested. Albumin dipsticks are not recommended for the measurement of albuminuria. Wide-range urinary protein reagents are also available with high sensitivity, while serum reagents are not applicable (Biuret). The traceability of calibrator to a reference material is a critical requirement. Proteinuria and albuminuria of a patient should be monitored in the same laboratory, using a fi xed method and cut-off value. Albumin/creatinine value should be reported together with gender-dependent reference range.

Challenge and limitations in determination of serum creatinine

Since 2006 clinical guidelines have recommended that the estimated glomerular filtration rate should be calculated from serum creatinine for the early detection of chronic kidney disease. These brought into the limelight the limitations of the Jaffe method and for comparability of test results the different routine creatinine methods need to be harmonized. The disadvantage of the kinetic Jaffe creatinine determination is its low specificity. This was improved by the enzymatic, compensated-Jaffe and high resolution liquid chromatographic assays introduced in the last decade. Creatinine values determined by the new methods are more accurate, but give lower creatinine values, therefore the glomerular filtration rate would be overestimated, if the new creatinine results were applied in the previous formulae (4-variables Modification of Diet in Renal Disease-186, Cockcroft-Gault, Quadratic). Because of the new creatinine methods estimation of the glomerular filtration rate and classification in chronic kidney disease staging became uncertain. Therefore the 4-variables Modification of Diet in Renal Disease-186 formula has been adjusted in 2006 and for the new creatinine methods (traceable to the isotope-dilution mass spectrometry) only the new Modification of Diet in Renal Disease-175 formula is advised. Authors compare the diagnostic value and limitations of the creatinine methods.The cardiovascular state and life quality of patients suffering from chronic renal insufficiency is primarily determined by their haemostatic status. Renal anemia can positively be diagnosed if the glomerular filtration rate diminishes significantly (<60 ml/min/1,73 m 2 ). Other causes of anemia besides renal insufficiency can be excluded in these instances. The primary aim of erythropoietin treatment is to abolish the transfusion demand of patients suffering from renal insufficiency as this could lead to antibody formation and the transduction of viral infections. In case the existence of renal anemia is proved, the target values must be determined. A target value of >11 g/dl hemoglobin should be achieved for at least 85% of the patients in order to get an average hemoglobin level of 12-12,5 g/dl for the whole patient population. During the treatment of renal anemia regulating the iron metabolism of patients is of primary importance. A >5% rate of the hypochromic red blood cells in the blood circulation implies iron deficiency; but a value above 10% positively indicates iron deficiency. The transferric saturation values under 20% indicate functional iron deficiency and this indicator is a good means of following iron treatment. In the case of patients receiving dialysis parenteral input is advised because of poor iron absorption. In national clinical practice several erythropoietin products are available (erythropoietin-alpha, erythropoietin-beta, alpha-darbepoetin and continuous erythropoietin receptor activator, a new product now being introduced). When selecting the appropriate treatment strategy for each patient, the application method, the effect range and cost efficiency of the selected erythropoietin product must be taken into consideration.

Új irányzatok a proteinuria és albuminuria laboratóriumi diagnosztikájában@@@New trends in the laboratory diagnostics of proteinuria and albuminuria

According to current clinical trials, albumin excretion is an early indicator of cardiovascular damage. While proteinuria is considered as a marker of kidney function, albuminuria indicates cardiovascular risk first of all. Sensitivity of the previous laboratory tests does not meet the clinical requirements, and the error of urine collection makes the results misleading. For that reason recent guidelines suggest to calculate albumin/creatinine (ACR) and protein/creatinine (PCR) measured from the first morning urine. For the clinical diagnosis of albuminuria the sensitive immunoturbidimetric assays are suggested. Albumin dipsticks are not recommended for the measurement of albuminuria. Wide-range urinary protein reagents are also available with high sensitivity, while serum reagents are not applicable (Biuret). The traceability of calibrator to a reference material is a critical requirement. Proteinuria and albuminuria of a patient should be monitored in the same laboratory, using a fixed method and cut-off value. Albumin/creatinine value should be reported together with gender-dependent reference range.Ujabb klinikai vizsgalatok szerint az albuminuria a cardiovascularis betegsegek korai markere. Mig a proteinuria elsősorban a vesefunkcio-romlas, az albuminuria a cardiovascularis riziko parametere. A regebbi laboratoriumi tesztek erzekenysege nem megfelelő, es a 24 oras vizeletgyűjtes pontatlansaga is sok bizonytalansagot okoz. Ezert a mai nemzetkozi iranyelvek 24 oras gyűjtes helyett a reggeli első vizeletből az albumin/kreatinin (ACR) es protein/kreatinin (PCR) meghatarozasat javasoljak. Klinikai laboratoriumok szamara javasolhatok az ujabb, nagy erzekenysegű immunkemiai vizeletalbumin-reagensek. Az albuminspecifi kus tesztcsikok az albuminuria fokanak meghatarozasara nem eleg erzekenyek. A vizeletfeherje-meghatarozashoz szinten leteznek nagy erzekenysegű, szeles meresi tartomanyu reagensek, igy erre nem alkalmazhatok a szerumfeherje-reagensek (peldaul Biuret). A modszervalasztas sarkalatos pontja, hogy a kalibrator nemzetkozi referensanyagra visszavezethető legyen. Mindezekből kovetkezik, hogy egy beteg ACR- vagy PCR-erteke az adott modszert es dontesi hatarerteket alkalmazo ugyanazon laboratoriumban kovethető jol. A laboratoriumi leleten az albumin/kreatinin referenciatartomanyat nemenkent kell megadni. Kulcsszavak: albuminuria, ACR, proteinuria, cardiovascularis betegseg, kreatinin New trends in the laboratory diagnostics of proteinuria and albuminuria According to current clinical trials, albumin excretion is an early indicator of cardiovascular damage. While proteinuria is considered as a marker of kidney function, albuminuria indicates cardiovascular risk fi rst of all. Sensitivity of the previous laboratory tests does not meet the clinical requirements, and the error of urine collection makes the results misleading. For that reason recent guidelines suggest to calculate albumin/creatinine (ACR) and protein/creatinine (PCR) measured from the fi rst morning urine. For the clinical diagnosis of albuminuria the sensitive immunoturbidimetric assays are suggested. Albumin dipsticks are not recommended for the measurement of albuminuria. Wide-range urinary protein reagents are also available with high sensitivity, while serum reagents are not applicable (Biuret). The traceability of calibrator to a reference material is a critical requirement. Proteinuria and albuminuria of a patient should be monitored in the same laboratory, using a fi xed method and cut-off value. Albumin/creatinine value should be reported together with gender-dependent reference range.