Current biomarkers for evaluating disease activity or severity in lupus nephritis (LN) are considered to be unsatisfactory. Pathological changes in glomerular basement membrane and selectivity of electrical discharge are causing specific patterns of urine proteins excretion. Together with alpha-1 antitrypsin (AAT), they are expected to become new biomarkers to assess LN activity.Seventy-one urine samples were collected from healthy controls and LN patients. Patterns of urine specific proteins were determined using column chromatography and SDS-PAGE tests, LN activity was calculated using SLEDAI-renal domain score, and AAT concentrations was measured by ELISA.The majority of proteins in the control group have molecular weights of >66 kDa (88%) and 21-to 25-kDa proteins were observed only in the case group. The p values for differences in urine AAT concentration between active LN and healthy controls, inactive LN and healthy controls, and active LN and inactive LN were 0.004, 0.046, and 0.054, respectively, whereas those for urine AAT/creatinine ratio were 0.489, 0.019, and 0.915, respectively. There were differences in the patterns of the molecular weight of proteins and urine AAT concentrations between case group and control group. However, no such differences were identified between active and inactive LN.
<p>Langerhans Cell Histiocytosis or LCH and Myelodysplastic syndrome or MDS in children are rare diseases. It is estimated to be 1 to 4 cases per 1 million population and less than 5% of hematologic cases. MDS in LCH can occur due to genetic predisposition, impaired cytokine production, or secondary to chemotherapy. The article reported a patient case of a 13-month-old female who came to hospital with paleness since two weeks before admission. The patient also experienced skin redness, abdominal distention, and weight loss. From the physical examination, anemia, maculopapular rash, and hepatosplenomegaly were obtained. From the laboratory test, anemia of hypochromic anisopoikilocytosis, monocytosis, thrombocytopenia, and hypoalbuminemia were obtained. On examination of bone marrow aspiration, MDS with Refractory Cytopenia of Childhood type or RCC was obtained. Positive results confirmed the diagnosis of Langerhans Cell Histiocytosis on CD68 and S100 in histopathological examinations.</p>
Pseudohyperkalemia dan pseudohypokalemia mengacu pada peningkatan ataupun penurunan kadar kalium serum yang tidak sesuai dengan kondisi sistemik pasien yang sebenarnya. Ketika klinisi dihadapkan pada kasus-kasus hiperkalemia atau hipokalemia, pertanyaan pertama yang seharusnya muncul adalah apakah hasil tersebut sesuai dengan kondisi klinis pasien. Beberapa faktor dapat menyebabkan timbulnya pseudohyperkalemia ataupun pseudohypokalemia, di antaranya adalah hiperleukositosis yang sering muncul pada kasus-kasus keganasan hematologi. Hiperleukositosis sangat berpengaruh pada hasil pemeriksaan laboratorium seperti kalium, fosfat, dan tekanan oksigen arterial. Kami menyajikan dua kasus dengan hasil kalium serum yang palsu pada pasien leukemia myeloid dengan jumlah leukosit yang sangat tinggi. Satu sampel pemeriksaan darah awal dari satu pasien menunjukkan hipokalemia dan pasien lainnya menunjukkan hiperkalemia tanpa keluhan yang sesuai. Sampel darah berikutnya yang diambil dari pasien pertama segera diperiksa setelah dilakukan sentrifugasi, yang memperlihatkan hasil elektrolit yang normal. Ketidaksesuaian dari hasil laboratorium ini kemungkinan disebabkan oleh aktivitas metabolisme leukosit secara in vitro pada kasus-kasus hiperleukositosis. Hasil laboratorium yang tidak sesuai ini dapat menyebabkan pengambilan keputusan yang salah baik dalam hal penegakan diagnosis dan pemberian terapi. Penemuan mengenai ketidaksesuaian hasil elektrolit dengan kondisi klinis pasien pada keganasan hematologi yang disertai dengan hiperleukositosis dapat mencegah intervensi terapeutik yang tidak tepat. Kesimpulannya, hiperleukositosis dapat menyebabkan pseudohyperkalemia dan pseudohypokalemia yang dapat dicegah dengan pengambilan sampel yang benar dan analisis serum atau plasma dengan segera setelah proses sentrifugasi. Kata kunci: hiperleukositosis, leukemia, pseudohyperkalemia, pseudohypokalemia.
Background: Many serological examination methods have been developed to assist in diagnosing autoimmune diseases, one of which is the Chemiluminescent Immunoassay (CLIA) method. The CLIA method is an alternative method that is faster and estimated to have the same accuracy with IFA as the gold standard examination. It can help diagnose autoimmune diseases more quickly and easily. This study aims to determine the diagnostic value and conformity of the Anti-Nuclear Antibody (ANA) examination using the IFA method with the CLIA method in patients with autoimmune diseases.Methods: The research design is a cross sectional study with consecutive sampling methods in autoimmune disease patients at Dr. Saiful Anwar Hospital Malang. ANA examination using the IFA method and the CLIA method. The data obtained by examining the IFA method is categorical, and the CLIA method is numerical. The diagnostic test uses the ROC curve and generates the AUC to determine the cut-off point. Furthermore, the suitability test was carried out using the Cohen's Kappa analysis technique. Data were analyzed using SPSS version 25 for Windows.Results: The research sample collected was 110. Patients with positive ANA IFA results showed the same results with the CLIA method (58,18%). The diagnostic test using the cut-off value of serum ANA levels of 41.79 AU/mL showed a sensitivity value of 98.4%, specificity 95.5%, a positive predictive value of 95.63% and a negative predictive value of 98.35% with an AUC of 0.990. The suitability value of the ANA examination with the IFA and CLIA methods with the Cohen's Kappa test showed very good results, which was 0.908 (p=0.000).Conclusion: There is a very good suitability value in examining the ANA parameters of the IFA method and the CLIA method. ANA CLIA examination has good diagnostic value. Latar Belakang: Banyak metode pemeriksaan serologi yang berkembang untuk membantu penegakan diagnosis penyakit autoimun, salah satunya metode Chemiluminescent Immunoassay (CLIA). Metode CLIA merupakan alternatif metode yang lebih cepat dan diperkirakan memiliki keakuratan yang sama dengan pemeriksaan baku emas Immunofluorescence Assay (IFA), sehingga dapat membantu menegakkan diagnosa penyakit autoimun dengan lebih cepat dan mudah. Penelitian ini bertujuan untuk mengetahui nilai diagnostik dan kesesuaian hasil pemeriksaan Anti-Nuclear Antibody (ANA) metode IFA dengan metode CLIA pada pasien dengan penyakit autoimun.Metode: Desain penelitian adalah studi potong lintang dengan metode consecutive sampling pada pasien penyakit autoimun di RSUD Dr. Saiful Anwar Malang. Pemeriksaan ANA menggunakan metode IFA dan metode CLIA. Data yang diperoleh dengan pemeriksaan metode IFA bersifat kategorikal, dan metode CLIA bersifat numerik. Uji diagnostik menggunakan kurva ROC dan menghasilkan AUC untuk menentukan cut-off-point. Selanjutnya dilakukan uji kesesuaian dengan teknik analisis Cohen’s Kappa. Data dianalisis dengan SPSS versi 25 untuk Windows.Hasil: Sampel penelitian terkumpul 110. Pasien dengan hasil ANA IFA positif yang menunjukkan hasil yang sama dengan metode CLIA adalah (58,18%). Uji diagnostik menggunakan nilai cut-off kadar ANA serum 41,79 AU/mL menunjukkan nilai sensitivitas 98,4%, spesifisitas 95,5%, nilai ramal positif 95,63% dan nilai ramal negatif 98,35% dengan AUC 0,990. Nilai kesesuaian pemeriksaan ANA dengan metode IFA dan CLIA dengan uji Cohen’s Kappa menunjukkan hasil yang sangat baik secara bermakna yaitu sebesar 0,908 (p=0.000)Kesimpulan: Terdapat nilai kesesuaian yang sangat baik pada pemeriksaan parameter ANA metode IFA dan metode CLIA. Pemeriksaan ANA CLIA memiliki nilai diagnostik yang bagus
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