[High sensitivity cardiac troponin assays 2009: clinical potential, current practice and benefits, the future].

At present, determination of cardiac troponins (cTn) is the biomarker method of choice for diagnostics and risk stratification in patients with a myocardial injury. Past clinical practice had provided sound evidence that low cTn concentrations, measured with unacceptable imprecision by the currently used methods, hold important clinical, diagnostic and stratification potential. The new generation cTn assays, so called high-sensitivity assays, enable determination of very low cTn concentrations with satisfactory analytical precision and open the way to early identification of small but often prognostically important myocardial damage.

[Light chain deposition disease as a cause of renal failure].

The objective of the paper is to draw attention to a rare cause of rapidly progressing renal failure which developed in the course of four months as a result of light chain deposition disease. The authors submit two case-histories of the disease assessed by renal biopsy after previous clinical and laboratory suspicion of monoclonal gammapathy. In one patient in the sternal punctate plasmacytoma was diagnosed and in the second case it was not possible to detect any type of monoclonal gammapathy or another possible cause of disease.

[Renal hemodynamics and albuminuria in patients with arterial hypertension].

Background: The cause of hyperalbuminuria in hypertonic patients can be functional or irreversible structural changes. The objective of the present investigation was an attempt to differentiate these two possibilities by comparing data of hypertonic patients with normal albuminuria (albumin excretion < 20 micrograms/min) and those with microalbuminuria in patients with renovascular hypertension by comparing findings after successful percutaneous transluminal angioplasty of the renal arteries (n = 8).

Methods And Results: The authors examined 20 patients with normal albuminuria (12 men and 8 women, mean age 46 years) and 20 patients with microalbuminuria (12 men and 8 women, mean age 49 years).

[Albuminuria after acute oral administration of proteins in patients with renovascular hypertension].

In a group of 19 patients with renovascular hypertension the effect of a morning snack comprising meat (1 g protein per 1 kg body weight) on urinary albumin excretion was assessed. Concurrently the plasma creatinine concentration (Pcr) was examined which varied between normal and 260 mumol/l and the creatinine clearance (Ccr). After administration of an acute protein load the mean Ccr value increased by 23%.

Urinary albumin excretion in patients with renovascular hypertension.

Twenty-four hour urinary excretion of albumin (UEalb), IgG and beta-2 microglobulin was investigated at a 3 hour-interval in a control group (C) of healthy subjects, in 30 patients with renovascular hypertension (RVH), and in 16 patients with essential hypertension (EH). Mean UEalb in RVH was significantly higher than in C. A significant direct correlation was demonstrated between diastolic blood pressure and UEalb (p < 0.

[Early diagnosis of late complications in juvenile diabetics].

In a group of 69 insulin dependent diabetics aged 19-59 years (mean 25.5 years) with a duration of diabetes of 2 to 34 years (mean 12.5) the authors assessed the incidence of diabetic retinopathy, nephropathy and neuropathy in relation to the duration of diabetes, to its long-term compensation and HLA antigens.

[Electrolyte disorders in cadaveric kidney donors before explantation and the functional development of the transplant in the early postoperative period].

In a group of cadaveric kidney transplantations the problem of the dependence of the functional development of the graft on the function of donor kidney before explanation and on the total time of ischaemia in the immediate postoperative period was investigated. Based on the plasma concentration of endogenous creatinine (PKr), urea (PUrea) and the total ischaemic time (GI), the early function of the graft cannot be predicted. On the contrary, the values of PKr, GI and the kidney index (NIKI = PKr x GI) allow an accurate prediction that the early function of the graft will not be sufficient.

[Microalbuminuria--a risk indicator for the development of nephropathy in insulin-dependent diabetics].

The authors submit preliminary results of a prospective study in 65 insulin-dependent diabetics with a varying duration of the disease where they followed up the development of microangiopathic organ changes in relation to the compensation of diabetes and the development of clinically manifest proteinuria or albumin excretion (microalbuminuria). From the results ensues that in recent and postrecent patients the increased albumin excretion is as a rule only a manifestation of metabolically conditioned and treatable changes of renal function and is of minor importance for the prediction of the risk of development of diabetic nephropathy. In patients with prolonged duration of diabetes the position is not unequivocal and if the albumin excretion persists or increases despite intensive insulin treatment it is most probably an indicator of a high risk of development of diabetic nephropathy.

[Acute myocardial infarct and the kinetics of creatine kinase].

The authors criticize contemporary views on creatine kinase kinetics in relation to the patency or occlusion of the coronary artery in the area of the infarction focus. In the investigation proper the time needed to achieve the peak plasma creatine kinase activity after the onset of infarction pain in patients with necroses in different areas of the left ventricle is assessed. Although the interpretation of the observed phenomenon is not clear so far, this finding makes the informative value of the hitherto used time parameter of the kinetics of this enzyme doubtful, in particular in thrombolytic treatment of myocardial infarction.

[Electrolyte disorders in brain dead organ donors and early functional development of the transplanted kidney].

In 70 cadaverous donors the authors examined 2 hours before collection of organs the serum and urinary electrolyte levels and the creatinine and urea levels. Serious hypokaliaemia (less than 3.0 mmol/l) was found in 24.

[Infarct size and left ventricular function in patients after thrombolytic therapy of acute myocardial infarct].

The authors give an account of factors which influence left ventricular function after thrombolytic treatment of an occluded coronary artery. They found that improvement of left ventricular function following a three-week interval after recanalization of the artery the occlusion of which led to myocardial infarction, depends on the size of the necrotic focus. Improvement of global left ventricular function and above all of the regional function of the infarction segment can be expected if the size of the focus is such that less than 40 gram-equivalent of total creatine kinase are liberated from it.

[Time peak of creatine kinase activity in various sites of myocardial infarct].

The authors studied the differences in the period of time spanning the onset of anginous pain and the peak of plasma creatine kinase activity in different areas of the left ventricle in patients with acute myocardial infarction. The patients were given either intravenous or intracoronary thrombolytic agents. The involvement of different areas of the cardiac muscle had a major effect on the lenght of time until the peak of creatine kinase activity was reached.

Creatine kinase kinetics and myocardial infarction in different regions of the left ventricle.

The interval from the onset of infarction pain to culmination of plasma creatine kinase activity (t-peak) was measured in 68 patients with their first myocardial infarction. There is a major difference in this parameter in patients with infarction in the area of the right coronary artery and that supplied by the left anterior descending coronary artery (LAD). While, in 29 patients with infarction in the right coronary artery area, t-peak was 17.

Microalbuminuria--a marker of the risk of developing nephropathy in insulin-dependent diabetes.

The authors present partial results of a prospective study conducted in 65 insulin-dependent diabetics with varying duration of disease in whom development of micro-angiopathic organ alterations is followed in relation to diabetes compensation and development of clinically manifest proteinuria or to albumin excretion (microalbuminuria). The results suggest that the increase in albumin excretion in recent-onset and non-recent-onset patients is in most cases only an expression of changes in renal function due to metabolism and therapy and apparently of little value in predicting the risk of developing diabetic nephropathy. The situation is not so unambiguous in patients with long duration of diabetes and, in case increased albumin excretion remains unchanged or further increases despite intensive insulin therapy, it may serve most likely as a marker of high risk of developing diabetic nephropathy.

Simulated proteinuria and haematuria.

In nephrology, like in other branches of medicine, falsification is motivated by a desire for profit or is an expression of some mental disorder. Three cases are described in which artificial proteinuria and haematuria were diagnosed by agarose gel electrophoresis of urinary proteins and a simulation and aggravation of renal disease was disclosed.