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Seger C, Kessler A, Taibon J. Establishing metrological traceability for small molecule measurands in laboratory medicine. Clin Chem Lab Med 2023; 61:1890-1901. [PMID: 36622091 DOI: 10.1515/cclm-2022-0995] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/14/2022] [Indexed: 01/10/2023]
Abstract
For molecules that can be well described metrologically in the sense of the definition of measurands, and which can also be recorded analytically as individual substances, reference measurement service traceability to a metrologically sound foundation is a necessity. The establishment of traceability chains must be initiated by National Metrology Institutes (NMIs) according to applicable standards; they are at the top and leading position in this concept. If NMIs are not in the position to take up this task, alternative approaches must be sought. Traceability initiatives established by in vitro device industry or academia must meet the quality standards of NMIs. Adherence to International Organization for Standardization (ISO) procedure 15193 must be a matter of course for the establishment of reference measurement procedures (RMPs). Certified reference material (CRM) characterization must be thorough, e.g., by the application of quantitative nuclear magnetic resonance measurements and by adherence to ISO 15194. Both for RMPs and CRMs Joint Committee for Traceability in Laboratory Medicine (JCTLM) listing must be the ultimate goal. Results must be shared in a transparent manner to allow other stakeholders including NMIs to reproduce and disseminate the reference measurement procedures.
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Affiliation(s)
- Christoph Seger
- Labordiagnostic St. Gallen West AG, St. Gallen, Switzerland
- Institute of Pharmacy, CCB - Centrum of Chemistry and Biomedicine, CMBI - Center for Molecular Biosciences, University of Innsbruck, Innsbruck, Austria
| | - Anja Kessler
- Stiftung für Pathobiochemie und Molekulare Diagnostik, Bonn, Germany
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Mistry J, Biswas M, Sarkar S, Ghosh S. Antidiabetic activity of mango peel extract and mangiferin in alloxan-induced diabetic rats. FUTURE JOURNAL OF PHARMACEUTICAL SCIENCES 2023. [DOI: 10.1186/s43094-023-00472-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
Abstract
Background
In diabetic animals, there is a significant increase in plasma glucose, serum total cholesterol, triglyceride, and low-density lipoprotein levels, and decreased body weight, liver and muscle glycogen, and high-density lipoprotein. Effective treatment of diabetes mellitus is not yet known, even though the management of diabetes mellitus is considered a global concern. Plants and herbs have played an important role in the healthcare of many societies throughout history. Today’s researchers are investigating the potential for using these nonpharmaceutical approaches to treat and control diabetes, either in conjunction with standard treatments or as an alternative to them. Herbal formulations are favored because to lower cost and fewer side effects compared to other methods for alleviating diabetes and its consequences. In ethnomedicinal practices, different parts of Mangifera indica are used to treatment of diabetes. The present investigation was undertaken to evaluate the antidiabetic activity of an ethanolic extract of Mangifera indica and mangiferin in alloxan-induced diabetic rats. This experiment was conducted in a set of two with four groups of animals namely control (Tc), treatment alloxan (Ta), treatment extract (Tae), and treatment mangiferin (Tam). To develop diabetes, Wistar rats treated with 150 mg/kg b.w. of alloxan monohydrate were injected intraperitoneally. Tae and Tam’s groups received a freshly prepared single dose of extract and mangiferin in distilled water via the oral route. All experimental groups received laboratory pallet feed diet and drinking water ad libitum. Diabetic rats were treated for 21 days with an ethanolic extract of mango peel and pure mangiferin orally daily at rates of 200 mg/kg b.w. and 20 mg/kg b.w.
Results
An alloxan-induced diabetic rat treated with mango peel extract and mangiferin significantly improved the overhead impact due to diabetes. There was a significant (p < 0.05) body weight loss in the alloxan-induced diabetic rats (Ta), whereas animals given mango peel extract and mangiferin showed a significant increase in body weight from 2 weeks onwards in comparison with control. Alloxan-induced rats (Ta) group have higher blood glucose levels and are significantly different (p < 0.01) from the control group. Mango peel extract and mangiferin significantly reduced the levels of fasting glucose after 21 days of treatment in comparison with diabetic animals. Mango peel extract and mangiferin influence the glycogen synthesis pathway in diabetes groups by increasing glycogen levels in muscle and liver. mango peel extract and mangiferin were found to have a nonsignificant impact on plasma cholesterol and HDL levels compared with the control group. Mango peel extract was found to have a significant difference (p < 0.05) in LDL levels compared with the control group. Mangiferin was found to have a significant difference (p < 0.05) in triglyceride and VLDL levels when compared with the control group. Histopathological examination of the pancreas in rats with type I diabetes caused by alloxan found that therapy with an ethanolic extract of mango peel and mangiferin restored beta cell function as well as rejuvenation of Islets of Langerhans.
Conclusions
Mango peel extract and mangiferin have antidiabetic, glycogenesis, and hypolipidemic properties when administered to alloxan-induced diabetic rats.
Graphical abstract
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Jassam N, Weykamp C, Thomas A, Secchiero S, Sciacovelli L, Plebani M, Thelen M, Cobbaert C, Perich C, Ricós C, Paula FA, Barth JH. Post-standardization of routine creatinine assays: are they suitable for clinical applications. Ann Clin Biochem 2016; 54:386-394. [DOI: 10.1177/0004563216664541] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Reliable serum creatinine measurements are of vital importance for the correct classification of chronic kidney disease and early identification of kidney injury. The National Kidney Disease Education Programme working group and other groups have defined clinically acceptable analytical limits for creatinine methods. The aim of this study was to re-evaluate the performance of routine creatinine methods in the light of these defined limits so as to assess their suitability for clinical practice. Method In collaboration with the Dutch External Quality Assurance scheme, six frozen commutable samples, with a creatinine concentration ranging from 80 to 239 μmol/L and traceable to isotope dilution mass spectrometry, were circulated to 91 laboratories in four European countries for creatinine measurement and estimated glomerular filtration rate calculation. Two out of the six samples were spiked with glucose to give high and low final concentrations of glucose. Results Results from 89 laboratories were analysed for bias, imprecision (%CV) for each creatinine assay and total error for estimated glomerular filtration rate. The participating laboratories used analytical instruments from four manufacturers; Abbott, Beckman, Roche and Siemens. All enzymatic methods in this study complied with the National Kidney Disease Education Programme working group recommended limits of bias of 5% above a creatinine concentration of 100 μmol/L. They also did not show any evidence of interference from glucose. In addition, they also showed compliance with the clinically recommended %CV of ≤4% across the analytical range. In contrast, the Jaffe methods showed variable performance with regard to the interference of glucose and unsatisfactory bias and precision. Conclusion Jaffe-based creatinine methods still exhibit considerable analytical variability in terms of bias, imprecision and lack of specificity, and this variability brings into question their clinical utility. We believe that clinical laboratories and manufacturers should work together to phase out the use of relatively non-specific Jaffe methods and replace them with more specific methods that are enzyme based.
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Affiliation(s)
- Nuthar Jassam
- Department of Clinical Biochemistry, Harrogate District Foundation Trust, Harrogate, UK
| | - Cas Weykamp
- SKML and Department of Clinical Chemistry, Queen Beatrix Hospital, Winterswijk, the Netherlands
| | - Annette Thomas
- WEQAS, Cardiff and Vale University Health Board, Cardiff, UK
| | - Sandra Secchiero
- Biomedical Research Center, Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Laura Sciacovelli
- Biomedical Research Center, Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Mario Plebani
- Biomedical Research Center, Department of Laboratory Medicine, University Hospital of Padova, Padova, Italy
| | - Marc Thelen
- SKML and Department for Clinical Chemistry, Amphia Hospital, Breda, the Netherlands
| | - Christa Cobbaert
- SKML and Department of Clinical Chemistry, Leiden University Medical Center, Leiden, the Netherlands
| | - Carmen Perich
- Quality Coordinator of Clinical Laboratory, Hospital Vall d’Hebron, Barcelona, Spain
| | - Carmen Ricós
- Spanish Society of Clinical Chemistry and Molecular Pathology (SEQC), Analytical Quality Commission, Barcelona, Spain
| | - Faria A Paula
- Department of Epidemiology, Unity of External Quality Assessment, National Health Institute Doutor Ricardo Jorge, Lisbon, Portugal
| | - Julian H Barth
- Department of Clinical Biochemistry, Leeds Teaching Hospitals Trust, Leeds, UK
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Schmidt RL, Straseski JA, Raphael KL, Adams AH, Lehman CM. A Risk Assessment of the Jaffe vs Enzymatic Method for Creatinine Measurement in an Outpatient Population. PLoS One 2015; 10:e0143205. [PMID: 26599086 PMCID: PMC4657986 DOI: 10.1371/journal.pone.0143205] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/02/2015] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Jaffe and enzymatic methods are the two most common methods for measuring serum creatinine. The Jaffe method is less expensive than the enzymatic method but is also more susceptible to interferences. Interferences can lead to misdiagnosis but interferences may vary by patient population. The overall risk associated with the Jaffe method depends on the probability of misclassification and the consequences of misclassification. This study assessed the risk associated with the Jaffe method in an outpatient population. We analyzed the discordance rate in the estimated glomerular filtration rate based on serum creatinine measurements obtained by the Jaffe and enzymatic method. METHODS Method comparison and risk analysis. Five hundred twenty-nine eGFRs obtained by the Jaffe and enzymatic method were compared at four clinical decision limits. We determined the probability of discordance and the consequence of misclassification at each decision limit to evaluate the overall risk. RESULTS We obtained 529 paired observations. Of these, 29 (5.5%) were discordant with respect to one of the decision limits (i.e. 15, 30, 45 or 60 ml/min/1.73m2). The magnitude of the differences (Jaffe result minus enzymatic result) were significant relative to analytical variation in 21 of the 29 (72%) of the discordant results. The magnitude of the differences were not significant relative to biological variation. The risk associated with misclassification was greatest at the 60 ml/min/1.73m2 decision limit because the probability of misclassification and the potential for adverse outcomes were greatest at that decision limit. CONCLUSION The Jaffe method is subject to bias due to interfering substances (loss of analytical specificity). The risk of misclassification is greatest at the 60 ml/min/1.73m2 decision limit; however, the risk of misclassification due to bias is much less than the risk of misclassification due to biological variation. The Jaffe method may pose low risk in selected populations if eGFR results near the 60 ml/min/1.73m2 decision limit are interpreted with caution.
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Affiliation(s)
- Robert L. Schmidt
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
- * E-mail:
| | - Joely A. Straseski
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Kalani L. Raphael
- Department of Internal Medicine, Division of Nephrology, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Austin H. Adams
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
| | - Christopher M. Lehman
- Department of Pathology and ARUP Laboratories, University of Utah Health Sciences Center, Salt Lake City, Utah, United States of America
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Ghys L, Paepe D, Smets P, Lefebvre H, Delanghe J, Daminet S. Cystatin C: a new renal marker and its potential use in small animal medicine. J Vet Intern Med 2014; 28:1152-64. [PMID: 24814357 PMCID: PMC4857948 DOI: 10.1111/jvim.12366] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/27/2014] [Accepted: 03/18/2014] [Indexed: 01/01/2023] Open
Abstract
The occurrence of chronic kidney disease is underestimated in both human and veterinary medicine. Glomerular filtration rate (GFR) is considered the gold standard for evaluating kidney function. However, GFR assessment is time-consuming and labor-intensive and therefore not routinely used in practice. The commonly used indirect GFR markers, serum creatinine (sCr) and urea, are not sufficiently sensitive or specific to detect early renal dysfunction. Serum cystatin C (sCysC), a proteinase inhibitor, has most of the properties required for an endogenous GFR marker. In human medicine, numerous studies have evaluated its potential use as a GFR marker in several populations. In veterinary medicine, this marker is gaining interest. The measurement is easy, which makes it an interesting parameter for clinical use. This review summarizes current knowledge about cystatin C (CysC) in humans, dogs, and cats, including its history, assays, relationship with GFR, and biological and clinical variations in both human and veterinary medicine.
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Affiliation(s)
- L. Ghys
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - D. Paepe
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - P. Smets
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | - H. Lefebvre
- Clinical Research UnitNational Veterinary School of ToulouseToulouse Cedex 3France
| | - J. Delanghe
- Department of Clinical Chemistry, Microbiology and ImmunologyFaculty of Health Medicine and Life SciencesGhent UniversityGhentBelgium
| | - S. Daminet
- Department of Medicine and Clinical Biology of Small AnimalsFaculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
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Selvin E, Juraschek SP, Eckfeldt J, Levey AS, Inker LA, Coresh J. Calibration of cystatin C in the National Health and Nutrition Examination Surveys (NHANES). Am J Kidney Dis 2012. [PMID: 23177702 DOI: 10.1053/j.ajkd.2012.09.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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A multicentric evaluation of IDMS-traceable creatinine enzymatic assays. Clin Chim Acta 2011; 412:2070-5. [PMID: 21803031 DOI: 10.1016/j.cca.2011.07.012] [Citation(s) in RCA: 89] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Revised: 07/12/2011] [Accepted: 07/13/2011] [Indexed: 11/22/2022]
Abstract
Chronic kidney disease definition is based on glomerular filtration rate (GFR) estimations which are derived from creatinine-based equations. The accuracy of GFR estimation is thus largely dependent of those of serum creatinine assays. International recommendations highlight the need for traceable creatinine assays. The French Society of Clinical Biochemistry conducted a study for measuring accuracy of creatinine enzymatic methods. This evaluation involved 25 clinical laboratories. Creatinine was measured in serum pools ranging from 35.9±0.9 μmol/L to 174.5±3.1 μmol/L (IDMS determination) using 12 creatinine enzymatic methods. For all creatinine values greater than 74.4±1.4 μmol/L, the bias and imprecision did not exceed 5% and 5.9%, respectively. For the lowest value (35.9±0.9 μmol/L), the bias ranged from -1.8 to 9.9% (with one exception). At this level, the imprecision ranged from 1.9 to 7.8%. The true performances of the assays (couples of bias and relative standard deviation), were evaluated using Monte-Carlo simulations. Most of the assays fall within the maximum Total Error of 12% at all concentrations. This study demonstrates substantial improvements in the calibration, traceability and precision of the enzymatic methods, reaching the NKDEP recommendations. Moreover, most of these assays allowed accurate creatinine measurements for creatinine levels lower than 40 μmol/L.
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Odaira M, Tomiyama H, Matsumoto C, Yamada J, Yoshida M, Shiina K, Nagata M, Yamashina A. Association of serum cystatin C with pulse wave velocity, but not pressure wave reflection, in subjects with normal renal function or mild chronic kidney disease. Am J Hypertens 2010; 23:967-73. [PMID: 20489688 DOI: 10.1038/ajh.2010.100] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This prospective cross-sectional study was conducted to clarify whether serum cystatin C levels might be associated with not only arterial stiffness, but also the pressure wave reflection, in middle-aged Japanese subjects with normal renal function or mild chronic kidney disease (CKD) (stage 1 or 2 CKD) (i.e., creatinine-based estimate of the glomerular filtration rate (eGFRcr) > or =60 ml/min/1.73 m(2) plus a result of the urine dipstick test for proteinuria of <1+). METHODS In 2,904 Japanese subjects (45 +/- 9 years old), the brachial-ankle pulse wave velocity (baPWV), radial augmentation index adjusted to a heart rate of 75 beats/min (rAI75), and serum cystatin C levels were measured. RESULTS Multivariate linear regression analysis demonstrated that the serum cystatin C levels were significantly correlated with the baPWV (standardized coefficient = 0.04, P < 0.01) even after adjustments for confounding variables, but not with the AI75 (standardized coefficient = 0.01, P = 0.71). adjusted values of the baPWV, but not those of rAI75, were higher in subjects with serum cystatin C levels in the highest tertile than in those with serum cystatin levels in the intermediate or lowest tertile. CONCLUSION In middle-aged Japanese subjects with normal renal function or mild CKD (stage 1 or 2 CKD) (eGFRcr >60 ml/min/1.73 m(2) plus a result of the urine dipstick test for proteinuria of <1+), the serum cystatin C levels may reflect facet of cardiovascular risk associated with arterial stiffness, but not that associated with the pressure wave reflection.
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Endre ZH, Pickering JW. Outcome definitions in non-dialysis intervention and prevention trials in acute kidney injury (AKI). Nephrol Dial Transplant 2009; 25:107-18. [PMID: 19812232 DOI: 10.1093/ndt/gfp501] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The risk, injury, failure, loss-of-function, end-stage-renal-failure (RIFLE) and acute kidney injury network (AKIN) consensus definitions of acute kidney injury (AKI) were established in part to facilitate comparison of trials. Contrast-induced nephropathy (CIN) has traditionally used a less demanding definition. OBJECTIVES To review use of RIFLE and AKIN as AKI trial outcome variables and contrast these with outcomes for CIN. METHODS We conducted a search of PubMed from 1 January 2005 to 31 December 2008 and 9 trial registries for randomized control trials for preventional or interventional treatment of AKI and CIN. RESULTS RIFLE or AKIN were outcome variables in 36% (n = 8) of the published (n = 22) and 18% (n = 4) of the current (n = 22) AKI trials. RIFLE was used to triage to intervention in three trials. The urine output definition of RIFLE and AKIN was an outcome in only two trials. In 18% (n = 8) of AKI trials, the CIN definition (increase in serum creatinine of > or =25% and/or > or =44 micromol/l) was the primary outcome. This was also the primary outcome in 56% (n = 13) of published (n = 12) and current (n = 11) CIN trials. Three published CIN trials used RIFLE or AKIN as an outcome (13%). The duration over which outcomes were determined varied from 24 h to 7 days. CONCLUSIONS Considerable heterogeneity remains in outcome variables of AKI and CIN clinical trials. Even when the RIFLE or AKIN criteria were used, they were not applied consistently. There is a need for further consensus on surrogate outcome variables.
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Affiliation(s)
- Zoltán H Endre
- Department of Medicine, Christchurch Kidney Research Group, University of Otago, Christchurch, New Zealand.
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Performance characteristics of laboratory testing and clinical outcomes. Clin Chim Acta 2009; 404:41-5. [PMID: 19306856 DOI: 10.1016/j.cca.2009.03.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2009] [Accepted: 03/10/2009] [Indexed: 11/24/2022]
Abstract
In order to demonstrate the relationship between performance characteristics of laboratory tests and clinical outcomes, diabetes seems to represent a paradigmatic disease: diagnosis, monitoring of therapeutic efficacy and prognosis are adequately achieved by means of laboratory testing. Starting from a simple molecule, glucose, used for the diagnosis of diabetes, continuing with creatinine, used for monitoring renal function in diabetic patients and concluding with cardiac troponins, a recognised gold standard for the diagnosis and risk stratification of cardiovascular diseases, several criticisms may be stressed considering the current methodological state-of-the art. Finally, an often overlooked aspect of performance, the analytical interferences, being responsible of unexpected results, that in turn depend from unknown or undisclosed factors will be discussed, concerning in particular, in our paper, the macroprolactin and the heterophilic antibodies aspects.
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