Background Fragments of parathyroid hormone (PTH) have been identi ed (amino acids 7--84) which may interfere with commercially available 'intact molecule' PTH assays. Novel assays which employ an antibody directed to the rst seven amino acids of the N-terminus of PTH are thought to be free from cross-reactivity with the 7--84 fragments, and therefore measure true 'whole molecule' PTH. Transplant recipients (as well as those in end-stage renal failure) have been reported to have elevated levels of 'intact' in comparison with 'whole molecule' PTH.
A 29-year old female presented with a one-week history of vomiting, diarrhoea, abdominal pain, and headache. On admission, she had acute renal failure requiring dialysis. Tests revealed a hemolytic anemia with thrombocytopenia. An initial diagnosis of thrombotic thrombocytopenic microangiopathy was made and plasma exchange was instigated. However, renal biopsy did not show thrombotic microangiopathy but instead revealed acute kidney injury with mild tubulointerstitial nephritis and numerous oxalate crystals, predominantly in the distal tubules. The patient had been taking large doses (>1100 mg daily) of vitamin C for many months. She also gave a history of sclerotherapy using injections of an ethylene glycol derivative for superficial leg veins. The patient completed five sessions of plasma exchange and was able to discontinue dialysis. She eventually achieved full renal recovery. She has now discontinued sclerotherapy and vitamin supplementation.
Background: Immunoassays for urinary albumin are often subject to the problem of antigen excess (the 'hook' effect) at high albumin concentrations. We developed an automated protocol to identify such samples based on urinary albumin to creatinine ratio (uACR) and urinary total protein (uTP) results. Methods: An automated flagging system was designed and written into the laboratory computer system to alert technical staff to samples potentially affected by the 'hook effect'. This flag was activated when there was a combination of an uTP of 2400 mg/L and an uACR of ,30 mg/mmol. Results: The potential rate of false-negative uACR results was approximately 0.17% in samples from primary care and diabetic clinic sources. Conclusions: Samples with falsely low uACR results were identified, allowing the vast majority of results to be authorized without intervention. The protocol prevented the reporting of false-negative uACR results which might impact on the management of patients.
Higher pump flows during hypothermic CPB increase hepatic blood flow. There was a trend towards attenuation of post-operative inflammatory response; however, larger studies will be needed to confirm these findings.
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