The 2024 Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for chronic kidney disease (CKD) evaluation and management bring important updates, particularly for European laboratories. These guidelines emphasize the need for harmonization in CKD testing, promoting the use of regional equations. In Europe, the European Kidney Function Consortium (EKFC) equation is particularly suited for European populations, particularly compared to the CKD-EPI 2021 race-free equation. A significant focus is placed on the combined use of creatinine and cystatin C to estimate glomerular filtration rate (eGFRcr-cys), improving diagnostic accuracy. In situations where eGFR may be inaccurate or clinically insufficient, the guidelines encourage the use of measured GFR (mGFR) through exogenous markers like iohexol. These guidelines emphasize the need to standardize creatinine and cystatin C measurements, ensure traceability to international reference materials, and adopt harmonized reporting practices. The recommendations also highlight the importance of incorporating risk prediction models, such as the Kidney Failure Risk Equation (KFRE), into routine clinical practice to better tailor patient care. This article provides a European perspective on how these KDIGO updates should be implemented in clinical laboratories to enhance CKD diagnosis and management, ensuring consistency across the continent.

• MeSH
• Renal Insufficiency, Chronic * diagnosis   therapy   MeSH
• Cystatin C blood   MeSH
• Glomerular Filtration Rate * MeSH
• Laboratories, Clinical MeSH
• Creatinine blood   MeSH
• Humans MeSH
• Practice Guidelines as Topic * MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Geographicals
• Europe MeSH

Panel odborníků (PO) z České republiky a Slovenské republiky s přispěním profesora C. Borghi z Boloňské univerzity projednal klinický postup pro vyšetřování a léčbu hyperurikemie (HU) u pacientů se zvýšeným kardiovaskulárním (KV) rizikem. Vzhledem k tomu, že zvýšená hladina kyseliny močové (KM) modifikuje KV-riziko, je potřeba ji považovat za významný modifikující faktor KV-rizika a identifikovat pacienty, u nichž může její terapeutické snížení zlepšit KV-parametry. Absence selekce vhodných pacientů je zřejmě důvodem dosavadních nejednotných výsledků studií, které hodnotily klinické výsledky antihyperurikemické léčby. Panel odborníků navrhuje léčit HU danou zvýšením aktivity xantinoxidázy (XO), která je spojena se zvýšením KV-rizika, nikoliv HU vzniklou v důsledku snížené renální exkrece KM, která není z KV-hlediska tak riziková. Pro odlišení navrhuje PO používat nový index poměru sérové hladiny KM a kreatininu (sKM/sKr), který prokázal korelaci s výskytem KV-příhod. Hladinu KM doporučuje PO za účelem KV-prevence vyšetřovat u pacientů se zvýšeným KV-rizikem (s hypertenzí, diabetem, dyslipidemií, chronickým onemocněním ledvin, akumulací KV-rizikových faktorů či KV-onemocněním) a při hodnotě indexu sKM/sKr > 3,6 zahájit intervenci k cílovým hodnotám KM v séru < 360 μmol/l u mužů a < 300 μmol/l u žen. Intervence spočívá v edukaci pacienta a úpravě životního stylu, optimalizaci léčby dalších KV-rizikových faktorů a podávání inhibitoru XO, v 1. linii alopurinolu. Dávku alopurinolu je třeba postupně titrovat v rozmezí obvykle 100–300 mg/den podle dosažení cílové hladiny KM při pravidelných kontrolách 1krát za 4–6 týdnů. Po stabilizaci stavu je doporučena pokračující léčba za pravidelného monitorování 1krát za 6 měsíců.

A panel of experts from the Czech and Slovak Republics, with the contribution of Professor C. Borghi from the University of Bologna, discussed the clinical approach for the investigation and treatment of hyperuricemia (HU) in patients with increased cardiovascular (CV) risk. Since elevated uric acid (UA) modifies CV risk, it should be considered as an important modifier of CV risk and patients in whom its therapeutic reduction may improve CV parameters should be identified. The lack of selection of suitable patients is probably the reason for the inconsistent results of studies evaluating the clinical outcomes of antihyperuricemic therapy to date. The expert panel suggests treating HU due to an increase in xanthine oxidase (XO) activity, which is associated with an increase in CV risk, rather than HU due to decreased renal excretion of UA, which is not as risky from a CV perspective. To differentiate, he proposes to use a new index of the ratio of serum UA to creatinine (sUA/sCr), which has been shown to correlate with the incidence of CV events. For the purpose of CV prevention, it is recommended to investigate UA levels in patients with increased CV risk (hypertension, diabetes, dyslipidemia, chronic kidney disease, accumulation of CV risk factors or CVD) and to initiate intervention to target serum UA levels < 360 μmol/l in men and < 300 μmol/l in women with sUA/sCr index > 3.6. Intervention consists of patient education and lifestyle modification, optimization of treatment of other CV risk factors and administration of an XO inhibitor, allopurinol in the first line. The dose of allopurinol should be gradually titrated, usually in the range of 100–300 mg/day, according to the achievement of the target level of UA, with regular checks every 4–6 weeks. After stabilization of the condition, continued treatment with regular monitoring every 6 months is recommended.

• MeSH
• Allopurinol administration & dosage   MeSH
• Phenotype MeSH
• Hyperuricemia * diagnosis   complications   physiopathology   therapy   MeSH
• Cardiovascular Diseases * complications   prevention & control   MeSH
• Creatinine blood   MeSH
• Uric Acid blood   metabolism   MeSH
• Humans MeSH
• Heart Disease Risk Factors MeSH
• Practice Guidelines as Topic MeSH
• Xanthine Oxidase antagonists & inhibitors   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Review MeSH

• MeSH
• Cystatin C analysis   blood   MeSH
• Diabetes Mellitus MeSH
• Diabetic Retinopathy diagnosis   MeSH
• Diabetic Nephropathies diagnosis   MeSH
• Adult MeSH
• Glomerular Filtration Rate * MeSH
• Cohort Studies MeSH
• Diabetes Complications * diagnosis   MeSH
• Creatinine analysis   blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Prospective Studies MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Publication type
• Comment MeSH
• Overall MeSH

INTRODUCTION: Pulsed electric field (PEF) has emerged as a promising energy source for catheter ablation of atrial fibrillation (AF). However, data regarding the in-vivo effect of PEF energy on erythrocytes during AF ablation procedures are scarce. This study aimed to quantify the impact of PEF energy on erythrocyte damage during AF ablation by assessing specific hemolytic biomarkers. METHODS: A total of 60 patients (age: 68 years, males: 72%, serum creatinine: 91 μmol/L) with AF underwent catheter ablation of AF using PEF energy delivered by a multipolar pentaspline Farawave catheter (Farapulse, Boston Scientific, Inc.). Ablation beyond pulmonary vein isolation was performed at the operator's discretion. Peripheral venous blood was sampled for assessing the plasma levels of free hemoglobin (fHb), direct (conjugated) bilirubin, lactate dehydrogenase (LDH), and creatinine before, immediately after the ablation, and on the next day. RESULTS: Following the PEF ablation with duration of [median (interquartile range)] 75 (58, 95) min, with 74 (52, 92) applications and PVI only in 27% of patients, fHb, LDH, and direct bilirubin significantly increased, from 40 (18, 65) to 493 (327, 848) mg/L, from 3.1 (2.6, 3.6) to 6.8 (5.0, 7.9) μkat/L, and from 12 (9, 17) to 28 (16, 44) μmol/L, respectively (all p < .0001). A strong linear correlation was found between the peak fHb and the number of PEF applications (R = 0.81, p < .001). The major hemolysis (defined as fHb >500 mg/L) was predicted by the number of PEF applications with the corresponding area under the receiver operating characteristic curve of 0.934. The optimum cut-off value of >74 PEF applications predicted the major hemolysis with 89% sensitivity and 87% specificity. CONCLUSION: Catheter ablation of AF using PEF energy delivered from a pentaspline catheter is associated with significant intravascular hemolysis. More than 74 PEF applications frequently resulted in major hemolysis. However, the critical amount of PEF energy that may cause kidney injury in susceptible patients remains to be investigated.

• MeSH
• Bilirubin blood   MeSH
• Biomarkers * blood   MeSH
• Time Factors MeSH
• Equipment Design MeSH
• Erythrocytes MeSH
• Atrial Fibrillation * surgery   diagnosis   physiopathology   blood   MeSH
• Hemoglobins metabolism   MeSH
• Hemolysis * MeSH
• Catheter Ablation * adverse effects   instrumentation   MeSH
• Creatinine blood   MeSH
• L-Lactate Dehydrogenase blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Predictive Value of Tests MeSH
• Risk Factors MeSH
• Aged MeSH
• Cardiac Catheters MeSH
• Treatment Outcome MeSH
• Check Tag
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Patients undergoing kidney transplant are at risk of severe COVID-19. Our single-center retrospective analysis evaluated the outcomes of kidney transplant outpatients with COVID-19 who were managed with reduced immunosuppression and treatment with molnupiravir. Between January 2022 and May 2023, we included 93 patients (62 men, average age 56 years), serum creatinine 127 (101-153) μmol/L. Molnupiravir was administered, and immunosuppressive therapy was reduced immediately following the confirmation of SARS-CoV-2 infection by PCR, which was 2 (1-3) days after the onset of symptoms. Only three (3.2%) patients required hospitalization, and one patient died. Acute kidney injury was observed in two patients. During the follow-up period of 19 (15-22) months, there was no significant increase in proteinuria, no acute or new chronic graft rejection, and kidney graft function remained stable; serum creatinine was 124 (106-159) μmol/L post-COVID-19 infection and 128 (101-161) μmol/L at the end of the follow-up period. Our results demonstrate that early initiation of molnupiravir treatment combined with a temporary reduction in immunosuppressive therapy results in favorable clinical outcomes in patients with COVID-19, with preservation of good graft function and no episodes of graft rejection.

• MeSH
• Antiviral Agents therapeutic use   MeSH
• COVID-19 * complications   MeSH
• Adult MeSH
• Immunosuppressive Agents * therapeutic use   MeSH
• Creatinine blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Outpatients MeSH
• Graft Rejection MeSH
• Retrospective Studies MeSH
• SARS-CoV-2 MeSH
• Aged MeSH
• Kidney Transplantation * adverse effects   MeSH
• Treatment Outcome MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Stainless steel welders are exposed to heavy filler metals. We evaluated the concentration of these metals in whole blood and urine, and the relevant biochemical parameters in relation to the total chromosomal aberrations (CAs), chromatid-type (CTA-type, CTAs) and chromosome-type (CSA-type, CSAs), in 117 welders and control individuals. Statistically higher concentrations of the total Cr, Ni and Mn were observed in whole blood and urine of welders, and the concentrations were higher in welders who smoked. On the contrary, concentrations of urinary heavy metals Cr and Mn adjusted for creatinine were significantly higher in the control groups. A statistically higher frequency of total CAs was observed in the whole group of welders, and also in the non-smoking welders, as compared to controls. The frequency of total CAs significantly correlated with the concentration of Cr, Ni and Mn in whole blood (R=0.61, P˂0.0001, R=0.33, P˂0.0001 and R=0.66, P˂0.0001, respectively), with urinary concentrations of Ni and Mn (R=0.27, P=0.003 and R=0.28, P=0.003, respectively) and with urinary concentrations of Cr, Ni and Mn adjusted for creatinine (R=0.22, P=0.029, R=0.26, P=0.005 and R=0.20, P=0.030, respectively). Likewise, the frequency of CTA-types significantly correlated with the concentration of Cr and Mn in whole blood (R=0.31, P=0.0007 and R=0.34, P=0.0002). The frequency of CSA-types significantly correlated with concentrations of Cr, Ni and Mn in whole blood (R=0.43, P˂0.0001, R=0.38, P˂0.0001 and R=0.46, P˂0.0001, respectively). The statistically higher values of serum creatinine and total bilirubin were detected in all welders, as well as in smokers when compared to the corresponding controls. The exposure to heavy metals in welders increased the frequencies of CAs and altered the balance between urinary excretion of heavy metals and their possible accumulation.

• MeSH
• Chromium urine   blood   MeSH
• Chromosome Aberrations * chemically induced   MeSH
• Adult MeSH
• Smoking adverse effects   urine   blood   MeSH
• Creatinine urine   blood   MeSH
• Middle Aged MeSH
• Humans MeSH
• Manganese urine   blood   MeSH
• Stainless Steel MeSH
• Nickel urine   blood   MeSH
• Occupational Exposure * adverse effects   analysis   MeSH
• Case-Control Studies MeSH
• Welding * MeSH
• Metals, Heavy * urine   blood   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH

Cíl: V této studii jsme se zaměřili na zhodnocení diagnostické hodnoty skóre HALP, hodnoty kyseliny močové v séru a poměru kyselina močová-kreatinin, což jsou zánětlivé markery v diagnostice preeklampsie (PE). Materiál a metody: Do studie bylo zařazeno 166 těhotných žen, které splnily kritéria pro zařazení a vyloučení. Byly rozděleny do dvou skupin: 81 těhotných žen s diagnózou PE (skupina PE) a 85 těhotných žen se zdravým těhotenstvím (kontrolní skupina). Demografická a porodnická historie skupin: týdny těhotenství při diagnóze; hematologické a biochemické parametry; skóre hemoglobinu, albuminu, lymfocytů a destiček (HALP) a poměr kyselina močová-kreatinin v séru (sUA/sCr); a výsledky novorozenců byly zaznamenány a porovnány mezi skupinami. Výsledky: Mezi skupinami nebyl signifikantní rozdíl z hlediska věku, gravidity, parity a indexu tělesné hmotnosti (p = 0,533; 0,188; 0,085; 0,915). Průměrný gestační věk, průměrná porodní hmotnost, 1. a 5. min Apgar skóre a průměrné hodnoty pH pupečníku byly nižší ve skupině PE ve srovnání s kontrolní skupinou (p = 0,0001 pro všechny). Procento přijetí na NICU bylo vyšší ve skupině PE (p = 0,0001). Skóre HALP u skupiny PE bylo významně nižší než u kontrolní skupiny (2,2 vs. 3,2; p = 0,0001). Poměry kyseliny močové a sUA/sCr byly významně vyšší ve skupině PE ve srovnání s kontrolní skupinou (pro kyselinu močovou 6,2 ± 1,7 vs. 4,5 ± 1,2; p = 0,0001; pro sUA/sCr 12,0 ± 4,0 vs. 9,1 ± 3,0; p = 0,0001). V diagnostice PE měla sérová kyselina močová senzitivitu 82,7 % při hodnotách 4,7 a vyšších; 58% senzitivitu při hodnotách poměru sUA/sCr 10,9 a vyšších a 3,7% senzitivitu při hodnotách HALP skóre 6,6 a vyšších (p = 0,0001; 0,001; 0,001; v tomto pořadí). Závěr: V naší studii jsme zjistili, že skóre HALP u PE bylo významně nižší než u zdravých kontrol a hodnota kyseliny močové a poměry sUA/sCr byly významně vyšší. Diagnostická hodnota sérové hodnoty kyseliny močové a poté poměr sUA/sCr byly vyšší u PE. Zjistili jsme však, že skóre HALP bylo pro diagnózu PE nedostatečné.

Objective: In this study, we aimed to evaluate the diagnostic value of the HALP score, serum uric acid value, and uric acid-creatinine ratio, which are inflammatory markers, in the diagnosis of preeclampsia (PE). Materials and methods: One hundred sixty-six pregnant women who met the inclusion and exclusion criteria were included in the study. They were divided into two groups: 81 pregnant women diagnosed with PE (PE group) and 85 pregnant women with healthy pregnancies (control group). Demographic and obstetric stories of the groups; weeks of pregnancy at diagnosis; hematological and biochemical parameters; hemoglobin, albumin, lymphocyte, and platelet (HALP) score and serum uric acid-creatinine ratio (sUA/sCr); and the results of the newborns were recorded and compared between groups. Results: There was no significant difference between the groups in terms of age, gravidity, parity, and body mass index (P values = 0.533, 0.188, 0.085, 0.915, resp.). Mean gestational age, mean birth weight, 1st and 5th minute Apgar scores, and mean umbilical cord pH values were lower in the PE group compared to the control group (P values = 0.0001 for all). Percentage of NICU admissions was higher in the PE group (P = 0.0001). HALP score of the PE group was significantly lower than the control group (2.2 vs. 3.2; P = 0.0001). Uric acid and sUA/sCr ratios were significantly higher in the PE group compared to the control group (for uric acid, 6.2 ± 1.7 vs. 4.5 ± 1.2; P = 0.0001; for sUA/sCr, 12.0 ± 4.0 vs. 9.9 ± 3.1; P = 0.0001). In diagnosing PE, serum uric acid had a sensitivity of 82.7% at values of 4.7 and above, 58% sensitivity at values of sUA/sCr ratio of 10.9 and above, and 3.7% sensitivity at HALP score values of 6.6 and above (P values = 0.0001, 0.001, 0.001, resp.). Conclusion: In our study, we found that the HALP score in PE was significantly lower than in healthy controls, and the uric acid value and sUA/sCr ratios were significantly higher. Diagnostic value of the serum uric acid value and then the sUA/sCr ratio were higher in PE. However, we found that the HALP score was insufficient for diagnosing PE.

• Keywords
• skóre HALP,
• MeSH
• Biomarkers * blood   MeSH
• Adult MeSH
• Creatinine blood   MeSH
• Uric Acid blood   MeSH
• Humans MeSH
• Young Adult MeSH
• Pre-Eclampsia * blood   MeSH
• ROC Curve MeSH
• Statistics as Topic MeSH
• Pregnancy MeSH
• Check Tag
• Adult MeSH
• Humans MeSH
• Young Adult MeSH
• Pregnancy MeSH
• Female MeSH
• Publication type
• Clinical Study MeSH

Neoadjuvant chemotherapy (NAC) is the preferred treatment option in locally advanced breast cancer (BC). The administration of NAC is associated with a wide range of adverse effects. This pilot observational prospective study examined the effect of NAC using anthracycline + cyclophosphamide (AC) followed by paclitaxel (PTx) on a portfolio of 22 plasma and urinary amino acids, plasma proteins (albumin, prealbumin, transferrin), and products of nitrogen metabolism (urea, creatinine, uric acid) in plasma and urine. Plasma and 24-h urine samples were obtained from ten patients with early breast cancer (N1-3 N0-2 M0), at the following time points: before the start of NAC and during the AC/PTx treatment period (a total of 8 measurements at three-weekly intervals). Amino acids were analyzed using ion exchange chromatography. There were no significant differences in the measured parameters in plasma and urine between pre-NAC and during AC- and PTx-treatment. No trend was detected. A significant difference in the portfolio of plasma and urinary amino acids was found only in the pre-treatment period compared to the control group. Levels of eight plasma amino acids (8/22) were significantly reduced and those of nine urine amino acids were increased (9/22). Nitrogenous catabolites in plasma and urine were not indicative of increased protein catabolism during the anthracycline and taxane treatment periods. A slightly positive nitrogen balance was accompanied by an average weight gain of 3.3 kg (range 0-6 kg). The AC/PTx treatment regimen did not cause significant changes in the monitored laboratory parameters.

• MeSH
• Amino Acids * urine   blood   MeSH
• Anthracyclines therapeutic use   administration & dosage   MeSH
• Cyclophosphamide * therapeutic use   MeSH
• Adult MeSH
• Nitrogen * urine   MeSH
• Creatinine urine   blood   MeSH
• Blood Proteins * metabolism   analysis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Breast Neoplasms * drug therapy   blood   urine   MeSH
• Neoadjuvant Therapy * MeSH
• Paclitaxel * therapeutic use   administration & dosage   MeSH
• Pilot Projects MeSH
• Prospective Studies MeSH
• Antineoplastic Combined Chemotherapy Protocols therapeutic use   MeSH
• Aged MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Aged MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH

• MeSH
• Biomarkers * blood   MeSH
• Child MeSH
• Creatinine blood   MeSH
• Humans MeSH
• Serum Albumin, Human analysis   classification   MeSH
• Malnutrition * diagnosis   classification   blood   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Publication type
• Review MeSH

PURPOSE: The primary goal was to estimate reference values of parathyroid hormone (PTH) in very low birth weight infants without severe neonatal morbidity. A secondary objective was to assess the relationship between PTH serum levels and selected laboratory markers of bone metabolism. METHODS: Ninety two infants with birth weight less than 1500 g met the inclusion criteria of the study. Serum levels of PTH, 25-hydroxyvitamin-D [25(OH)D], C3-epi-25(OH)D, total calcium, phosphorus, and alkaline phosphatase, and urinary levels of calcium, phosphorus, and creatinine were examined on day 14 and subsequently every 2 weeks until discharge. RESULTS: Of the total 167 serum samples examined for PTH levels in infants without 25(OH)D deficiency the estimated range was 0.9-11.9 pmol/l (8.5-112.3 pg/mL). During the first month, no statistically significant correlation was observed between PTH level and that of 25(OH)D, C3-epimers of 25(OH)D, S-Ca, S-P, or ALP, nor with urinary excretion of calcium and phosphorus. From the second month of life, there was a moderately significant correlation between PTH and 25(OH)D (Rho = -0.40, P =< .001), between PTH and calcium/creatinine ratio (Rho = -0.56, P = < .001), and between PTH and phosphorus/creatinine ratio (Rho = 0.51, P = < .001). CONCLUSIONS: The physiological range for PTH levels for preterm neonates without 25(OH)D deficiency was estimated as 0.9-11.9 pmol/l (8.5-112.3 pg/mL). It seems that elevation of serum PTH above this range can be considered as hyperparathyroidism in very low birth weight infants.

• MeSH
• Alkaline Phosphatase blood   MeSH
• Phosphorus blood   urine   MeSH
• Creatinine blood   urine   MeSH
• Humans MeSH
• Infant, Very Low Birth Weight * blood   urine   MeSH
• Infant, Newborn MeSH
• Parathyroid Hormone * blood   MeSH
• Reference Values MeSH
• Calcium * blood   urine   MeSH
• Vitamin D blood   analogs & derivatives   MeSH
• Check Tag
• Humans MeSH
• Male MeSH
• Infant, Newborn MeSH
• Female MeSH
• Publication type
• Journal Article MeSH