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Šavuk A, Svaguša T, Trkulja V, Radeljak A, Rudan D, Kudumija B, Doko S, Kovačević L, Pezić MM, Ćorić V, Matić I, Prkačin I. Effect of low-flux and high-flux dialysis membrane on plasma concentrations of cardiac troponin I. Biomark Med 2021; 15:1479-1486. [PMID: 34668400 DOI: 10.2217/bmm-2021-0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Cardiac troponin I (cTnI) concentration stability during dialysis have not been fully elucidated. The aim is to evaluate the effect of a single dialysis session on plasma cTnI. Patients & methods: From 122 consecutive anuric adult patients (75 [61.5%] men, age 27-86 years, median 67) on chronic hemodialysis blood samples for cTnI measurement were taken before and after a dialysis. Results: Dialysis had no effect on high-flux membranes (geometric means ratio = 0.99, 0.94-1.05, df 119, t = -0.19, multiplicity adjusted p = 0.847), but cTnI levels were higher after dialysis in patients on low-flux membranes (geometric means ratio = 1.14, 1.02-1.27, df 119, t = 2.59, adjusted p = 0.021). Conclusion: Dialysis session using low-flux membranes might increase the plasma cTnI.
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Affiliation(s)
- Ana Šavuk
- Department of Nephrology & Dialysis, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Tomo Svaguša
- Department of Cardiovascular Diseases, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Andrea Radeljak
- Department of Medical Biochemistry & Laboratory Medicine, Reference Center of The Ministry of Health of The Republic of Croatia for the Development & Application of Biological Reference Intervals for Medical Biochemical Tests, Merkur University Hospital, Zagreb, Croatia
| | - Diana Rudan
- Department of Cardiovascular Diseases, Clinical Hospital Dubrava, Zagreb, Croatia
| | | | - Slava Doko
- Public Health Centre Zagreb-East, Zagreb, Croatia
| | - Lucija Kovačević
- Department of Radiology, Clinical Hospital Center Zagreb, Zagreb, Croatia
| | - Mija M Pezić
- Department of Internal Medicine, General Hospital Vinkovci, Vinkovci, Croatia
| | - Valentina Ćorić
- Department of Internal Medicine, General Hospital Vinkovci, Vinkovci, Croatia
| | - Ivica Matić
- School of Nursing Mlinarska, Zagreb, Croatia
| | - Ingrid Prkačin
- Department of Internal Medicine, Clinical Hospital Merkur, Zagreb, Croatia
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Zagorec N, Šavuk A, Horvatić I, Kasumović D, Brechelmacher A, Tišljar M, Šenjug P, Galešić Ljubanović D, Galesic K. P0463KIDNEY INVOLVEMENT IN PARAPROTEINEMIC DISEASES - ANALYSIS OF THE SINGLE CENTER REGISTER OF KIDNEY BIOPSIES. Nephrol Dial Transplant 2020. [DOI: 10.1093/ndt/gfaa142.p0463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Nikola Zagorec
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
| | - Ana Šavuk
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
| | - Ivica Horvatić
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Dino Kasumović
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
| | - Ana Brechelmacher
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
| | - Miroslav Tišljar
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
| | - Petar Šenjug
- Dubrava University Hospital, Department of Pathology, Unit for Nephropathology and Electron Microscopy, Zagreb, Croatia
| | - Danica Galešić Ljubanović
- University of Zagreb, School of Medicine, Zagreb, Croatia
- Dubrava University Hospital, Department of Pathology, Unit for Nephropathology and Electron Microscopy, Zagreb, Croatia
| | - Kresimir Galesic
- Dubrava University Hospital, Department of Nephrology and Dialysis, Zagreb, Croatia
- University of Zagreb, School of Medicine, Zagreb, Croatia
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