Chronic obstructive pulmonary disease (COPD), an increasing global health problem, may be complicated by acute atherothrombotic events. Although systemic inflammation plays the leading role in atherothrombotic processes, platelet activation and increased coagulation together with oxidative stress can significantly exacerbate atherosclerosis in COPD patients. In this study we determined platelet count, mean platelet volume (MPV) and classical markers of systemic inflammation - serum C-reactive protein (CRP), white blood cell (WBC) count and the relative proportion of segmented neutrophils in COPD patients, and compared them to those from the healthy controls. The most important and novel finding of this study was that patients with COPD had a significantly increased platelet count, along with a reduced MPV when compared to healthy controls (286 vs. 260 × 10(9)/l; 9.6 vs. 8.7 fL, respectively). Cigarette smoking had no influence on these results. The presence of systemic inflammation was clearly proved by the increase in classical inflammatory markers (CRP, WBC and segmented neutrophil count).

Chronic obstructive pulmonary disease (COPD) is characterized by chronic inflammation and oxidant/antioxidant imbalance. Glutathione is the most abundant cellular low-molecular weight thiol and the glutathione redox cycle is the fundamental component of the cellular antioxidant defence system. Concentration of total glutathione and catalytic activities of glutathione peroxidase and glutathione reductase were determined in peripheral blood of patients (n = 109) and healthy subjects (n = 51). Concentration of total glutathione in patients was not changed in comparison to healthy controls. However, we found statistically significant difference between patients with moderate and severe disease stages. Glutathione reductase activity was increased, while glutathione proxidase activity was decreased in the patients with COPD, when compared to healthy controls. We found no significant difference in glutathione peroxidase and glutathione reductase activities between stages. Patients who smoked had lower concentration of total glutathione compared with former smokers and never-smoking patients. Lung function parameters were inversely associated with glutathione level. Evidence is presented for differential modulation of glutathione peroxidase and glutathione reductase activities in peripheral blood of patients with stable COPD. We suppose that in addition to glutathione biosynthesis, glutathione reductase-dependent regulation of the glutathione redox state is vital for protection against oxidative stress.

Chronic kidney disease (CKD) is a common clinical condition with significant adverse consequences for the patient and it is recognized as a significant public health problem. The role of laboratory medicine in diagnosis and management of CKD is of great importance: the diagnosis and staging are based on estimation of glomerular filtration rate (eGFR) and assessment of albuminuria (or proteinuria). Therefore, the joint working group of the Croatian society of medical biochemistry and laboratory medicine and Croatian chamber of medical biochemists for laboratory diagnostics in CKD issued this national recommendation regarding laboratory diagnostics of CKD.
Key factors for laboratories implementing the national guidelines for the diagnosis and management of CKD are:
1. Ensure good communication between laboratory professionals and clinicians, such as nephrologists or specialists in general/family medicine,
2. Ensure all patients are provided with the same availability of laboratory diagnostics,
3. Ensure creatinine assays are traceable to isotope dilution mass spectrometry (IDMS) method and have minimal bias and acceptable imprecision,
4. Select the appropriate GFR estimating formula. Recommended equation is the 2009 Chronic Kidney Disease Epidemiology Collaboration (CKD – EPI) equation,
5. In reporting the key laboratory tests (creatinine, eGFR, urine albumin-to-creatinine ratio, urine protein-to-creatinine ratio) use the appropriate reporting units,
6. Provide adequate information on limitations of creatinine measurement.
The manuscript has been organized to identify critical points in laboratory tests used in basic laboratory diagnostics of CKD and is based on the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease.

No abstract

AIMTo evaluate the influence of creatinine methodology on the performance of chronic kidney disease (CKD)-Epidemiology Collaboration Group-calculated estimated glomerular filtration rate (CKD-EPI-eGFR) for CKD diagnosis/staging in a large cohort of diabetic patients.METHODSFasting blood samples were taken from diabetic patients attending our clinic for their regular annual examination, including laboratory measurement of serum creatinine and eGFR.RESULTSOur results indicated an overall excellent agreement in CKD staging (kappa = 0.918) between the Jaffé serum creatinine- and enzymatic serum creatinine-based CKD-EPI-eGFR, with 9% of discordant cases. As compared to the enzymatic creatinine, the majority of discordances (8%) were positive, i.e., associated with the more advanced CKD stage re-classification, whereas only 1% of cases were negatively discordant if Jaffé creatinine was used for eGFR calculation. A minor proportion of the discordant cases (3.5%) were re-classified into clinically relevant CKD stage indicating mildly to moderately decreased kidney function (< 60 mL/min per 1.73 m2). Significant acute and chronic hyperglycaemia, assessed as plasma glucose and HbA1c levels far above the recommended glycaemic goals, was associated with positively discordant cases. Due to a very low frequency, positive discordance is not likely to present a great burden for the health-care providers, while intensified medical care may actually be beneficial for the small number of discordant patients. On the other hand, a very low proportion of negatively discordant cases (1%) at the 60 mL/min per 1.73 m2 eGFR level indicate a negligible possibility to miss the CKD diagnosis, which could be the most prominent clinical problem affecting patient care, considering high risk of CKD for adverse patient outcomes.CONCLUSIONThis study indicate that compensated Jaffé creatinine procedure, in spite of the glucose-dependent bias, is not inferior to enzymatic creatinine in CKD diagnosis/staging and therefore may provide a reliable and cost-effective tool for the renal function assessment in diabetic patients.

Hema to loš ki bi lje zi ane mi je i kon cen tra ci ja C-reak tiv nog pro tei na kod sta bil ne kro nič ne op struk cij ske pluć ne bo les ti He ma to lo gi cal mar ke rs of ane mia and C-reac ti ve pro tein in pa tien ts wi th stab le chro nic ob struc ti ve pul mo na ry di sea se Do lo res Pan ci rov 1 , Va nja Radišić Bi ljak 2 , Gor da na Stjepanović 3 , Iva na Če pe lak 41 Od jel za bio ke mij sko-he ma to loš ku di jag nos ti ku, Op ća bol ni ca "Dr. Ivo Pedišić", Si sak 1 De par tme nt of Bioc he mis try and He ma to lo gy Diag nosis, Dr. Ivo Pedišić Ge ne ral Hos pi tal, Si sak, Croatia 2 Me di cin sko-bio ke mij ski labo ra to rij, Po lik li ni ka "Sun ce", Zag reb 2 Me di cal Bioc he mis try La bo ra to ry, Sun ce IHC, In ter na tio nal Heal th Cen ter, Zag reb, Croatia 3 Pul mo loš ki od jel, Op ća bol ni ca "Dr. Ivo Pedišić", Si sak 3 De par tme nt of Pul monolo gy, Dr. Ivo Pedišić Ge ne ral Hos pi tal, Si sak, Croatia 4 Za vod za me di cin sku bio ke mi ju i he ma to lo gi ju Far ma ceut sko-bio ke mij skog fa kul te ta Sveu či liš ta u Zag re bu, Zag reb 4 De par tme nt of Me di cal Bioc he mis try and He ma to lo gy, School of Phar ma cy and Bioc he mis try, Uni ver si ty of Zag reb, Zag reb, Croa tia Sa že takUvod: Cilj is tra ži va nja bio je od re di ti vri jed nos ti he ma to loš kih bi lje ga anemi je i kon cen tra ci je C-reak tiv nog pro tei na (CRP) kod bo les ni ka obo lje lih od sta bil ne kro nič ne op struk cij ske pluć ne bo les ti (KOPB), ka ko bi se ut vr di la prisutno st ane mi je, stu panj sis tem ske upa le i ko re la ci ja iz me đu ana li ta. Ma te ri ja li i me to de: U is pi ti va nje je bi lo uk lju če no 150 boles ni ka s KOPB (for si ra ni ek spi racij ski vo lu men u pr voj se kun di (en gl. for ced expi ra to ry volu me in 1 se co nd (FEV 1 ) = 48 ± 21%) i 51 kon trol ni is pi ta nik (FEV 1 = 106 ± 15%). Pre ma smjer ni ca ma Glo bal ne ini ci ja ti ve za kro ničnu op struk cij sku plućnu bo le st (en gl. Glo bal Ini tia ti ve for Chro nic Ob struc ti ve Lu ng Di sea se, GOLD) bo les ni ci su po di je ljeni u če ti ri pod sku pi ne, a pre ma kri te ri ji ma SZO za ane miju u dvi je sku pi ne: is pi ta ni ci s ane mi jom i bez nje. Kon cen tra ci ja CRP u se ru mu od re đe na je imu no tur bi di met rij skom me to dom, a kon cen tra ci ja he ma to loških bi lje ga pro toč nom ci to met ri jom. Re zul ta ti: Ni je na đe na sta tis tič ki zna čaj na raz li ka u bro ju erit ro ci ta, kon centra ci ji he mog lo bi na i vri jed nos ti ma he ma tok ri ta iz me đu sku pi ne svih bo lesni ka s KOPB i kon trol ne sku pi ne, kao ni iz me đu pod sku pi na GOLD i kon trol ne sku pi ne. Ane mi ja je bi la pri sut na kod 24% bo les ni ka. Kon cen tra ci ja CRP bi la je sta tis tič ki zna čaj no vi ša kod sku pi ne svih bo les ni ka s KOPB (P < 0,001), svih pod sku pi na GOLD (I. P < 0,001; IIA., IIB., III. P < 0,001) i pod sku pi na s ane mijom i bez nje (P < 0,001) u us po red bi s kon trol nom sku pi nom. Spe ci fi č no st i os jet lji vo st CRP od re đe na je ROC anali zom i po ka za...

IntroductionEarly identification and management of chronic kidney disease (CKD) is highly cost-effective and can reduce the risk of kidney failure progression and cardiovascular disease. In 2014, the Joint Croatian Working Group (JCWG) for laboratory diagnostic of CKD on the behalf of Croatian society of medical biochemistry and laboratory medicine (CSMBLM) and Croatian chamber of medical biochemists (CCMB) conducted a survey across Croatian medical-biochemistry laboratories to assess the current practice in this area of laboratory medicine. The aim of this study was to present the data collected through the survey and to give insight about laboratory diagnostics of chronic kidney disease in Croatia.Materials and methodsAn invitation to participate in the survey was sent to all Croatian medical-biochemistry laboratories (N = 196). The questionnaire was designed in a form of questions and statements, with possible multiple answers, comprising 24 questions.ResultsThe response rate was 80/196 (40.8%). 39 answers were from primary medical-biochemistry laboratories. 31/78 (0.40) laboratories measure creatinine with non-standardized method (uncompensated Jaffe method). 58/78 (0.74) of laboratories that measure creatinine do not report eGFR values. Similar number of laboratories (58/80, 0.73) do not measure urine albumin or protein.ConclusionsThere is a large heterogeneity among Croatian laboratories regarding measuring methods, reporting units and reference intervals (cut-off values), both for creatinine and urine albumin or protein. The two key prerequisites for CKD screening, automatic reporting of eGFR and albuminuria or proteinuria assessment, are not implemented nationwide. There is a need for harmonization in laboratory diagnostics of CKD in Croatia.

IntroductionThe evaluation of patients with suspected appendicitis strives to identify all patients with presenting symptoms while minimizing negative appendectomy rate. The aim of the study was to identify the optimal combination of clinical and laboratory parameters that should facilitate the emergency department surgeon’s definite decision.Materials and methodsThe study group comprised 120 patients with suspicion of acute appendicitis (AA). In 60 patients the AA diagnosis was confirmed intraoperatively and by histological analysis. Clinical parameters included: appetite, vomiting, diarrhea, dysuria, signs of localized peritonitis and pain migration. Measured laboratory parameters were: C-reactive protein (CRP), complete blood count (CBC) and the urine test strip.ResultsThe control group of patients were more likely to present following symptoms: no changes in appetite (P < 0.001), diarrhea (P = 0.009) and dysuria (P = 0.047). CRP and white blood cell count (WBC) were significantly higher in the group with confirmed AA compared to the control group (44.7 vs. 6.6, and 13.6 ± 3.9 vs. 9.0 ± 3.4, respectively; P < 0.001). The multivariate logistic regression analysis identified lack of appetite (P = 0.013), absence of diarrhea (P = 0.004), and positive finding of signs of localized peritonitis (P = 0.013), as well as WBCs (P < 0.001) and negative urine test strip results (P = 0.009) as statistically significant predictors of AA. The highest percentage of correctly classified cases (82%) was achieved by combination of common clinical exam and basic inexpensive laboratory parameters (WBCs and urine test strip).ConclusionsAcute appendicitis in the emergency setting may be successfully ruled in based on elevated WBCs and negative urine test strip in combination with signs of localized peritonitis, lack of appetite and absence of diarrhea. Since CRP did not contribute to the overall diagnostic accuracy, its use in AA diagnostic protocols is of no value.