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Li YX, Li Y, Bao SY, Xue N, Ding XQ, Fang Y. The application of new complex indicators in the detection of urine. BMC Nephrol 2023; 24:45. [PMID: 36849937 PMCID: PMC9972632 DOI: 10.1186/s12882-023-03087-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/15/2023] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Accurate diagnosis and assessment of hematuria is crucial for the early detection of chronic kidney disease(CKD). As instability of urinary RBC count (URBC) often results with clinical uncertainty, therefore new urinary indexes are demanded to improve the accuracy of diagnosis of hematuria. In this study, we aimed to investigate the benefit of applying new complex indicators based on random urine red blood cell counts confirmed in hematuric kidney diseases. METHODS All patients enrolled underwent renal biopsy, and their clinical information was collected. Urinary and blood biomedical indexes were implemented with red blood cell counts to derive complex indicators. Patients were divided into two groups (hematuria-dominant renal histologic lesions and non-hematuria-dominant renal histologic lesions) based on their renal pathological manifestations. The target index was determined by comparing the predictive capabilities of the candidate parameters for hematuric kidney diseases. Hematuria stratification was divided into four categories based on the scale of complex indicators and distributional features. The practicality of the new complex indicators was demonstrated by fitting candidate parameters to models comprising demographic information. RESULTS A total of 1,066 cases (678 hematuria-dominant renal histologic lesions) were included in this study, with a mean age of 44.9 ± 15 years. In differentiating hematuria-dominant renal histologic lesion from the non-hematuria-dominant renal histologic lesion, the AUC value of "The ratio of the random URBC to 24-h albumin excretion" was 0.76, higher than the standard approach of Lg (URBC) [AUC = 0.744] (95% Confidence interval (CI) 0.712 ~ 0.776). The odds ratio of hematuria-dominant renal histologic lesion (Type I) increased from Q2 (3.81, 95% CI 2.66 ~ 5.50) to Q4 (14.17, 95% CI 9.09 ~ 22.72). The predictive model, composed of stratification of new composite indexes, basic demographic characteristics, and biochemical parameters, performed best with AUC value of 0.869 (95% CI 0.856-0.905). CONCLUSION The new urinary complex indicators improved the diagnostic accuracy of hematuria and may serve as a useful parameter for screening hematuric kidney diseases.
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Affiliation(s)
- Ying-Xiang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China
| | - Yang Li
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney Disease, Shanghai, 200032, China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, 200032, China.,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China
| | - Si-Yu Bao
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China
| | - Ning Xue
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney Disease, Shanghai, 200032, China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, 200032, China.,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China
| | - Xiao-Qiang Ding
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China.,Shanghai Medical Center of Kidney Disease, Shanghai, 200032, China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, 200032, China.,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China
| | - Yi Fang
- Department of Nephrology, Zhongshan Hospital, Fudan University, 111 Yixueyuan Road, Shanghai, 200032, China. .,Shanghai Medical Center of Kidney Disease, Shanghai, 200032, China. .,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, 200032, China. .,Shanghai Key laboratory of Kidney and Blood Purification, Shanghai, 200032, China.
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Manlhiot C, McCrindle BW, Menjak IB, Yoon H, Holtby HM, Brandão LR, Chan AK, Schwartz SM, Sivarajan VB, Crawford-Lean L, Foreman C, Caldarone CA, Van Arsdell GS, Gruenwald CE. Longer blood storage is associated with suboptimal outcomes in high-risk pediatric cardiac surgery. Ann Thorac Surg 2011; 93:1563-9. [PMID: 22137242 DOI: 10.1016/j.athoracsur.2011.08.075] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Revised: 08/17/2011] [Accepted: 08/24/2011] [Indexed: 01/06/2023]
Abstract
BACKGROUND The negative effects of long-term storage of allogeneic red blood cells (RBCs) on outcomes in adult cardiac surgery have been established, but evidence of a similar effect in pediatric cardiac surgery is limited. METHODS The weighted average duration of storage for RBC units used in 1,225 pediatric cardiac operations was determined. Operations were divided into high RBC use (more than 4 units or more than 150 mL/kg) or low RBC use. For both categories, associations between storage duration and surgical outcomes, adjusted for relevant patient characteristics, were evaluated. RESULTS High RBC use was associated with higher surgical complexity. Storage duration for patients who received low RBC volumes was not associated with surgical outcomes. For patients with high RBC transfusion volumes, longer storage duration (per day) was associated with higher odds of bleeding complications (odds ratio 1.029, p=0.07), renal insufficiency (odds ratio 1.085, p=0.001), higher inotrope score after surgery (12 to 24 hours +0.08, p=0.002; 24 to 48 hours +0.07, p<0.001), greater chest tube drainage (24 hours +1.5 mL/kg, p<0.001), longer postoperative hospitalization (+0.3 days p=0.02), and increased in-hospital mortality (odds ratio 1.054, p=0.03). Effects of RBC transfusions on postoperative bleeding were greatest for storage duration longer than 14 days. CONCLUSIONS The freshest RBC units available should be used for pediatric cardiac operations expected to require more than 4 units or more than 150 mL/kg of allogeneic RBC transfusions, with no units more than 14 days old being transfused whenever possible.
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Affiliation(s)
- Cedric Manlhiot
- Labatt Family Heart Centre, Department of Pediatrics, University of Toronto, The Hospital for Sick Children, Toronto, Ontario, Canada
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Han V, Serrano K, Devine DV. A comparative study of common techniques used to measure haemolysis in stored red cell concentrates. Vox Sang 2009; 98:116-23. [PMID: 19719459 DOI: 10.1111/j.1423-0410.2009.01249.x] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES There is no standardized method of measuring the parameters for haemolysis determination of red cell concentrate (RCC). Three haemoglobin quantification methods (automated analyser, Harboe and Drabkin's) and two methods of haematocrit measurement (automated analyser and microcapillary centrifugation) were evaluated for use with RCC. MATERIALS AND METHODS Twenty stored RCC were assayed for total haemoglobin, supernatant haemoglobin and haematocrit. RESULTS Drabkin's and Harboe methods were linear (r(2) > or = 0.995) over 0.015-220 g/l haemoglobin. Overestimation by Drabkin's increased from 0% at 220 g/l to 137% at 0.015 g/l haemoglobin. Harboe values generally stayed within 6% of expected while haematology analyser values had a maximum 11% underestimation above 10 g/l. Analyser total haemoglobin was significantly lower (202 +/- 22 g/l) than Drabkin's (224 +/- 24 g/l) and Harboe (222 +/- 22 g/l) values. Haematocrit was greater via the analyser (65.7 +/- 5.7%) than with microcapillary centrifugation (59.3 +/- 5.7%). CONCLUSIONS Harboe and Drabkin's methods are suitable for measuring total haemoglobin and supernatant haemoglobin in RCC. The analyser gave higher haematocrit values (11% on average) than did microcapillary centrifugation.
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Affiliation(s)
- V Han
- Canadian Blood Services, Research and Development and the Centre for Blood Research, University of British Columbia, Vancouver, Canada
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Luten M, Roerdinkholder-Stoelwinder B, Rombout-Sestrienkova E, de Grip WJ, Bos HJ, Bosman GJCGM. Red cell concentrates of hemochromatosis patients comply with the storage guidelines for transfusion purposes. Transfusion 2007; 48:436-41. [PMID: 18067509 DOI: 10.1111/j.1537-2995.2007.01547.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Therapeutic phlebotomy is the preferred treatment for iron overload associated with hemochromatosis. In the Netherlands, red blood cell concentrates (RCCs) from hemochromatosis patients are not used for transfusion purposes. In this study, their storage performance was compared with that of control donors as a first step in the evaluation of their potential usefulness for transfusion. STUDY DESIGN AND METHODS RCCs were obtained from hemochromatosis patients and regular donors, either by apheresis or by whole-blood collection, and stored up to 50 days under routine Dutch blood bank conditions. Weekly samples were taken for determination of hematologic, biophysical, and biochemical variables. RESULTS Most variables displayed the same storage-related changes in RCCs originating from hemochromatosis patients as in those from regular donors. In all RCCs, hemolysis remained well below the guideline limit of 0.8 percent for up to 6 weeks of storage, and the glucose concentration remained above the required 5 mmol per L up to 5 weeks of storage. After 4 weeks of storage, the mean ATP level remained above the required limit of 75 percent of the starting value in all RCCs as well. The major difference was a larger mean cell volume in hereditary hemochromatosis RBCs up to 50 days of storage. CONCLUSIONS RCCs from hemochromatosis patients comply with the in vitro quality requirements for transfusion. This paves the way for the final step, namely, the establishment of the 24-hour RBC posttransfusion recovery.
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Affiliation(s)
- Marleen Luten
- Department of Research and Education, Sanquin Blood Bank Southeast Region, Nijmegen, The Netherlands
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Zimrin AB, Hess JR. Planning for pandemic influenza: effect of a pandemic on the supply and demand for blood products in the United States. Transfusion 2007; 47:1071-9. [PMID: 17524099 DOI: 10.1111/j.1537-2995.2007.01225.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Influenza causes episodic pandemics when viral antigens shift in ways that elude herd immunity. Avian influenza A H5N1, currently epizootic in bird populations in Asia and Europe, appears to have pandemic potential. STUDY DESIGN AND METHODS The virology of influenza, the history of the 1918 pandemic, and the structure of the health care and the blood transfusion systems are briefly reviewed. Morbidity and mortality experience from the 1918 pandemic are projected onto the current health care structure to predict points of failure that are likely in a modern pandemic. RESULTS Blood donor centers are likely to experience loss of donors, workers, and reliable transport of specimens to national testing laboratories and degradation of response times from national testing labs. Transfusion services are likely to experience critical losses of workers and of reagent red cells (RBCs) that will make their automated procedures unworkable. Loss of medical directors, supervisors, and lead technicians may make alternative procedures unworkable as well. CONCLUSIONS Lower blood collection capacity and transfusion service support capability will reduce the availability of RBCs and especially of platelets. Plans for rationing medical care need to take the vulnerability of the blood transfusion system into account.
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Affiliation(s)
- Ann B Zimrin
- Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Hess JR, Rugg N, Joines AD, Gormas JF, Pratt PG, Silberstein EB, Greenwalt TJ. Buffering and dilution in red blood cell storage. Transfusion 2006; 46:50-4. [PMID: 16398730 DOI: 10.1111/j.1537-2995.2005.00672.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Red blood cell (RBC) storage solutions work in a narrow pH range between 7.2 and 6.4. While keeping RBC within that pH range, ATP production can be increased by buffering or dilution. STUDY DESIGN AND METHODS In the first study, 12 units of packed CP2D RBCs were pooled in groups of four, re-aliquoted, and added to one of four additive solutions (ASs): AS-3, 110 mL; EAS-61, 170 mL; EAS-78, 170 mL; or EAS-81, 110 mL. EAS-78 and -81 contain bicarbonate. Units were sampled approximately weekly for 10 weeks for biochemical measures. In the second study, 12 volunteers donated RBCs for measures of (51)Cr in vivo recovery after 6 or 8 weeks of storage in EAS-81. RESULTS RBCs stored in the higher-volume or buffered ASs had higher RBC ATP concentrations. The combination had an additive effect. Hemolysis was reduced in dilute ASs and less so with buffering. RBCs stored for 8 weeks (n=6) in EAS-81 exhibited 87+/- 2 percent 24-hour (51)Cr in vivo recovery and 0.4+/- 0.2 percent hemolysis. CONCLUSIONS It is possible to store RBCs for 8 weeks in buffered conventional volume ASs. Combining buffering and increased AS volume improves stored RBC characteristics further.
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Affiliation(s)
- J R Hess
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Hess JR, Rugg N, Knapp AD, Gormas JF, Hill HR, Oliver CK, Lippert LE, Greenwalt TJ. The role of electrolytes and pH in RBC ASs. Transfusion 2001; 41:1045-51. [PMID: 11493737 DOI: 10.1046/j.1537-2995.2001.41081045.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Experimental additive solutions (EASs) containing saline, adenine, glucose, mannitol and disodium phosphate can support RBCs for 9 or 10 weeks if used in 200- or 300-mL volumes. The effects of variations in the electrolyte composition and volume of EASs were explored. STUDY DESIGN AND METHODS In three four-arm studies, 24 RBC units were pooled in groups of 4 and realiquoted as test units to ensure that all donors were equally represented in each study arm. In Study 1, units were stored for 11 weeks in EAS containing 0, 10, 20, or 30 mmol per L of sodium bicarbonate. In Study 2, units were stored for 9 weeks in EAS containing 26, 50, 100, or 150 mmol per L of sodium chloride. In Study 3, units were stored in 100 or 200 mL of AS-3 or EAS-61. RBC ATP concentrations and hemolysis were measured weekly. RESULTS Increasing the sodium bicarbonate content of EASs increased the pH throughout storage and increased RBC ATP concentrations in the later phases of storage, but it had no effect on hemolysis. Increased sodium chloride content of EASs led to lower RBC ATP concentrations and increased hemolysis. In EAS-61, RBC ATP concentrations were increased throughout storage, and hemolysis was lower than that of RBCs stored in AS-3. CONCLUSION RBC ATP synthesis is highly dependent on the pH of the AS. Hemolysis is affected by the salt content and volume of the AS.
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Affiliation(s)
- J R Hess
- Blood Research Detachment, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
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Hess JR, Rugg N, Knapp AD, Gormas JF, Silberstein EB, Greenwalt TJ. Successful storage of RBCs for 10 weeks in a new additive solution. Transfusion 2000; 40:1012-6. [PMID: 10960531 DOI: 10.1046/j.1537-2995.2000.40081012.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND The effect of storing packed RBCs suspended in 300 mL of an alkaline, experimental additive solution (EAS 64) was explored. STUDY DESIGN AND METHODS RBC units prepared from blood collected from healthy donors into CPD were WBC reduced and stored for 10 weeks under blood bank conditions after the addition of 300 mL of EAS 64 (adenine, 2 mM:; dextrose, 50 mM:; mannitol, 20 mM:; NaCl, 75 mM:; Na(2)HPO(4), 9 mM:). For comparison, non-WBC-reduced units from the same donors were stored in a different additive solution (AS-1, Baxter Healthcare) for 6 weeks. Standard methods were used for the in vitro assays. The 24-hour in vivo recoveries were measured by using (51)Cr- and (99m)Tc-labeled RBCs. RESULTS Mean recovery in the EAS 64 units after 10 weeks was 84 +/- 8 percent, the same as in the AS-1 units stored for 6 weeks. For EAS 64 and AS-1 units, respectively, the ATP of the RBCs was 85 percent and 64 percent of the initial value, hemolysis was 0.43 percent and 0.63 percent, supernatant potassium was 24 mEq per L and 44 mEq per L, and the morphologic index was 98 and 71. CONCLUSION RBCs suspended in 300 mL of EAS 64 can be stored satisfactorily for 10 weeks. Longer RBC storage should reduce outdating, increase availability of transfusions in remote locations, and improve the efficiency of autologous donor programs.
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Affiliation(s)
- J R Hess
- Blood Research Detachment, Walter Reed Army Institute of Research, Washington, DC 20307-5100, USA.
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