Clinical Application of Thromboelastography in Patients With Severe Fever With Thrombocytopenia Syndrome.

AIM: To investigate the clinical application of thromboelastography (TEG) in severe fever with thrombocytopenia syndrome (SFTS). METHODS: One hundred and fifty-seven patients with SFTS were included in the study. The participants were distributed into 3 groups; A, B, and C. And 103 patients in group A met the clinical criteria as they exhibited slight liver and kidney dysfunction. Group B consisted of 54 patients with SFTS who were critically ill while group C was a healthy control group with 58 participants. RESULTS: Patients with SFTS exhibited lower coagulation than the healthy participants. Group B patients exhibited significantly lower coagulation compared to group A. There was no significant difference in platelet count and fibrinogen content between patients in group A and group B, but platelet aggregation function and fibrinogen activity were significantly lower in group B patients. CONCLUSION: Our results suggest that it is risky to solely rely on platelet count and the fibrinogen in SFTS. Monitoring of TEG and other coagulation indexes should be emphasized.

Establishment of Normal Range for Thromboelastography in Healthy Middle-Aged and Elderly People of Weihai in China.

TEG can monitor the dynamic changes of blood clot formation and lysis by activating the coagulation system of a small sample of whole blood in vitro. The parameters can reflect the level of coagulation factors, the function of fibrinogen and platelet, and the presence or absence of hyperfibrinolysis. At present, the normal reference range of the parameters of TEG is mainly based on the reference values established by the Western population. Due to the differences in the distribution of ethnic groups, many countries have established their reference ranges for healthy populations. In China, some scholars have tried to establish the corresponding TEG reference range according to the characteristics of the population in different regions. This study tried to establish the reference range for thromboelastography in healthy middle-aged and elderly people of Weihai in China and compare it with the reference range provided by the manufacturer. The fasting venous blood of 454 healthy middle-aged and elderly people was collected, including 239 males and 215 females. The thromboelastography TEG-5000 was used to measure the reaction time (R), coagulation formation time (K), coagulation angle (Angle), and maximum amplitude (MA). The reference range of TEG parameters of middle-aged and elderly healthy males was R: 4.38-8.27 min, K: 1.44-2.82 min, Angle: 48.53-72.17 deg, and MA: 51.95-72.02 mm; respectively, in the females, the normal value was R: 3.43-7.40 min, K: 1.07-2.53 min, Angle: 48.22-77.22 deg, and MA: 53.10-74.58 mm; The difference of R, K, Angle, and MA between the male group and the female group was statistically significant (P < 0.05); In this study, if we use the reference range established by the manufacturer, the R specificity for males was 91.6%, K specificity was 98.7%, Angle specificity was 85.8%, and MA specificity was 93.7%; the range for females was 68.4%, 99.5%, 75.8%, and 87.4%, respectively. There are statistically significant differences between R, K, Angle, and MA in middle-aged and elderly healthy women and men. It is necessary to establish a TEG reference range for healthy females and males.

Urine markers of renal tubular injury in idiopathic membranous nephropathy: A cross sectional study.

INTRODUCTION: Idiopathic membranous nephropathy (IMN) is a primary glomerular disease and a major cause of adult nephrotic syndrome. Presently, little is known about the capabilities of the urine markers to reflect the severity of IMN. We aimed at establishing whether urinary N-acetyl-ß-glucosaminidase (NAG), Retinol binding protein (RBP), Kidney injury molecule-1 (KIM-1) and Neutrophil gelatianse-associated lipocalin (NGAL) are related with renal parameters and the histological grades tubular injury. METHODS: The levels of urinary NAG, RBP, KIM-1 and NGAL were determined in 165 biopsy-proven patients and 64 healthy controls. Their levels were then compared between patients and healthy subjects, and between patients with and without nephrotic syndrome. Their linearity with renal parameters and associations with histological grades of renal tubular injury were also assessed. RESULTS: All biomarkers were significantly increased in patients (p < .001). However, no significant increase was observed between patients exhibiting moderate and severe grades tubular injury and those exhibiting mild histological grade. With exception of RBP, all biomarkers were higher in patients with nephrotic syndrome (p < .001) and significantly correlated with majority of renal parameters including proteinuria. CONCLUSION: Our findings suggest that although urine markers of tubular injury are increased in IMN, they may not offer a reflection of histological grades.

Serum phospholipase A2 receptor antibodies and immunoglobulin G subtypes in adult idiopathic membranous nephropathy: Clinical value assessment.

BACKGROUND: Idiopathic membranous nephropathy (IMN) is widely considered as an organ-specific autoimmune disorder. Implicated in its pathogenesis are the phospholipase A2 receptors (PLA2R) expressed on glomerular podocytes against which serum antibodies are formed. In this study we quantified and assessed the clinical value of total serum PLA2R antibodies and the subtype antibodies in IMN. METHODS: We measured serum levels of total PLA2R antibodies and IgG subtype antibodies by Enzyme Linked Immunosorbent Assay (ELISA) in 146 biopsy-proven IMN patients, 51 non-IMN patients and 62 healthy controls. We went ahead and determined the diagnostic potential of total serum PLA2R antibodies and assessed if a relationship exists between the dominat subtype antibody and the clinical parameters. RESULTS: The diagnostic sensitivity and specificity of total serum PLA2R antibody for IMN were found at 69.9% and 100% respectively. Significant differences in systolic blood pressure, serum Cystatin C, serum albumin and estimated glomerular filtration rate (eGFR) were found between the antibody-positive and antibody-negative groups of IMN patients. Subtype antibody 4 and 1 exhibited the highest positive rates of 94.4% and 91.6% respectively. The mean serum proportion of subtype antibodies was 65.4, 12.7, 7.6 and 4.6% for subtype 4, 1, 3 and 2 respectively. Serum levels of total protein and albumin were significantly decreased among patients with high serum titres of antibody subtype 4. CONCLUSION: Our findings underscore the diagnostic potential of total serum PLA2R antibodies and highlight the importance of antibody subtype 4 over other subtype antibodies in IMN.

A review of urinary angiotensin converting enzyme 2 in diabetes and diabetic nephropathy.

Urinary angiotensin converting enzyme 2 (ACE2) is significantly increased in diabetes and diabetic nephropathy. While studies on its clinical significance are still underway, its urinary expression, association with metabolic and renal parameters has been in the recent past considerably studied. The recent studies have demystified urine ACE2 in many ways and suggested the roles it could play in the management of diabetic nephropathy. In all studies the expression of urinary ACE2 was determined by enzyme activity assay and/with the quantification of ACE2 protein and mRNA by methods whose reliability are yet to be evaluated. This review summarizes recent findings on expression of urinary ACE2, examines its relationship with clinical parameters and highlights possible applications in management of diabetic nephropathy.