[Alkaline phosphatase isoenzymes in the serum of patients with renal insufficiency]. / Isoenzimas de fosfatasa alcalina en el suero de pacientes con insuficiencia renal.

OBJECTIVE: The aim of this study was to test the utility of serum alkaline phosphatase isoenzymes determination from patients with renal insufficiency. MATERIAL AND METHODS: Serum levels of alkaline phosphatase isoenzymes were determined in a group of 58 patients: 22 of them suffering acute renal insufficiency (ARI) and 36 with chronic renal failure (CRF) undergoing regular hemodialysis, results obtained were compared from a population of 30 healthy adults. Intestinal, bone, liver, macromolecular and intestinal variant isoenzymes, were separated by electrophoresis on agarose gel and quantified using a densitometer. RESULTS: Were found a significant increase the total alkaline phosphatase activity in both pathologic groups (p < 0.05 in ARI and p < 0.01 in CRF). Isoenzymatic profiles showed: increase of the bone fraction (p < 0.05 in ARI and p < 0.001 in CRF), decrease of the liver isoenzyme (p < 0.001) in both groups, macromolecular fraction elevated in acute patients (p < 0.05) and a significant increase of the intestinal and intestinal variant isoenzyme in the chronic patients (p < 0.001). CONCLUSION: The renal insufficiency modified the normal distribution of alkaline phosphatase isoenzymes and the study of their serum levels could be an effective non-invasive marker, for the evaluation of bone disease and intestinal disorders associated with renal failure.

Isoenzimas de fosfatasa alcalina en el suero de pacientes con insuficiencia renal / Alkaline phosphatase isoenzymes in the serum of patients with renal insufficiency

Objetivo: estudiar la utilidad clínica de la determinación sérica de las isoenzimas de fosfatasa alcalina en pacientes con insuficiencia renal.Material y métodos: se midieron las isoenzimas de fosfatasa alcalina en un grupo de 58 pacientes: 22 con insuficiencia renal aguda (IRA) y 36 con fallo renal crónico (IRC) y sometidos a hemodiálisis, comparándose los resultados con los de una población de 30 adultos sanos. Las isoenzimas intestinal, ósea, hepática, macromolecular e intestinal variante se separaron por electroforesis sobre gel de agarosa, cuantificándose por densitometría. Resultados: la actividad total de fosfatasa alcalina se mostró significativamente aumentada en ambos grupos patológicos (p<0,05 en IRA y p<0,01 en IRC). Los perfiles isoenzimáticos mostraron: un incremento de la fracción ósea (p<0,05 en IRA y p<0,001 en IRC), descenso de la fracción hepática (p<0,001) en ambos grupos, fracción macromolecular aumentada en pacientes con IRA (p<0,05) y un aumento significativo de la fracción intestinal e intestinal variante en pacientes con IRC (p<0,001).Conclusión: la insuficiencia renal modifica la distribución sérica de isoenzimas de fosfatasa alcalina, su cuantificación podría servir de marcador, no invasivo, para valorar las complicaciones óseas e intestinales asociadas al fallo renal. (AU)

[Isoamylases and isolipases values in the serum from patients wtih renal insufficiency]. / Valoración de isoamilasas e isolipasas en el suero de pacientes con insuficiencia renal.

OBJECTIVE: The aim of this study is to test the utility os serum isoamylases and isolipases as determined from patients with renal insufficiency. MATERIAL AND METHODS: Serum levels of isoamylases and isolipases were determined in a group of sixty-eight patients with renal disease, 32 of them suffering acute insufficiency and 36 with chronic renal failure undergoing regular hemodialysis, results obtained were compared from a population of 44 healthy adults. We used a new method for isolipases determination in serum based on its separation on agarose gel. Two forms of lipase, L1 and L2, were identified by this method and quantitated by densitometry. RESULTS: Were found a significant increase of pancreatic isoamylase P2 and P/S isoenzymatic ratio in acute patients (p < 0.001) as chronic (p < 0.05). In both groups, the isolipase L1 activity and L1/L2 isoform ratio were showed significantly elevated (p < 0.01). We studied the relationship between isoamylases and isolipases establishing the P2/L2 ratio (normal range < 0.6) showing, in the two pathologic groups, significantly elevated values compared with the control group (p < 0.001) and a positive and significant correlation between the P2/L2 and P/S isoform ratios (r = 0.76, p < 0.05 in acute patients; r = 0.58, p < 0.05 in chronic patients). CONCLUSION: The combined study of serum levels of isoamylases and isolipases could be an effective marker for diagnosis and evolution of associated pancreatitis with acute or chronic renal failure.

Valoración de isoamilasas e isolipasas en el suero de pacientes con insuficiencia renal / Isoamylases and isolipases valoration in the serum from patients with renal insufficiency

Objetivo: Estudiar la utilidad clínica de la determinación de isoamilasas e isolipasas en el suero de pacientes con insuficiencia renal.Material y métodos: Determinamos los niveles séricos de isoamilasas e isolipasas en un grupo de 68 pacientes con enfermedad renal, 32 con insuficiencia aguda y 36 con fallo renal crónico y sometidos a hemo diálisis, comparándose los resultados con los de una población de 44 adultos sanos. Utilizamos un nuevo método para la determinación sérica de isolipasas basado en su separación electroforética sobre gel de agarosa. Dos formas de lipasa, L1 y L2, fueron identificadas por este método y cuantificadas por densitometría.Resultados: Encontramos un aumento significativo de la isoamilasa pancreática P2 y del cociente isoenzimatico P/S tanto en los pacientes agudos (p<0,001) como en los crónicos (p<0,05). En ambos grupos la actividad de la isolipasa L1 y el cociente L1/L2 se mostraron significativamente elevados (p<0,01). Estudiamos la relación entre isoamilasas e isolipasas estableciendo el cociente P2/L2 (rango normal <0,6) encontrando, en los dos grupos patológicos, valores significativamente elevados respecto al grupo control (p<0,001) y una correlación positiva y estadísticamente significativa entre los cocientes P2/L2 y P/S (r=0,76, p<0,05 en pacientes agudos; r = 0,58, p<0,05 en crónicos).Conclusión: El estudio combinado de isoamilasas e isolipasas séricas podría ser un marcador efectivo para el diagnóstico y evolución de la pancreatitis asociada al fallo renal agudo o crónico (AU)

[Alkaline phosphatase isoenzymes in serum and bronchoalveolar lavage from patients with bronchopulmonary disease]. / Isoenzimas de fosfatasa alcalina en el suero y lavado broncoalveolar de pacientes con patología broncopulmonar.

OBJECTIVE: In this study, we are looking at the principal isoenzymes of alkaline phosphatase (ALP), as injury markers of cellular membranes from bronchial epithelium, in 80 patients diagnosed with bronchopulmonary pathology from different ethology, using serum samples and bronchoalveolar lavage fluid (BAL). METHOD: Patients were grouped according to age as following: 26 preterm neonates suffering respiratory distress syndrome requiring mechanical ventilation; 32 children ranging from 2 to 12 years old, and 22 adults (30-65 years old) examined by bronchoscopy for the purpose of diagnosis. Results obtained from all pathological groups were compared with a control group showing similar characteristics. Isoenzymes were separated by electrophoresis on agarose gel and were quantified by desitometry. Total protein was measured in BAL; ALP activity was expressed in UI/mg x 10-3 of protein. RESULTS: We found that macromolecular ALP fraction was significantly increased in the serum of neonates with distress (p < 0.01), in the patients 2-12 years and adults affected by pulmonary pathology (p < 0.001). The electrophoresis of ALP isoenzymes showed a unique isoenzymatic band corresponding with its macromolecular fraction in the BAL fluid. CONCLUSIONS: We conclude that increased macromolecular fraction of alkaline phosphatase found in the serum of patients diagnosed with respiratory problems could have its origin in damaged pulmonary tissue.

Isoenzimas de fosfatasa alcalina en el suero y lavado broncoalveolar de pacientes con patología broncopulmonar / Alkaline phosphatase isoenzymes in serum and bronchoalveolar lavage from patients with bronchopulmonary disease

Objetivo: Se estudiaron las principales isoenzimas de la fosfatasa alcalina (ALP) como marcadores de lesión de las membranas celulares del epitelio bronquial, utilizando suero y líquido procedente del lavado broncoalveolar (LBA), en 80 enfermos con patología broncopulmonar de etiología diversa. Método: Los enfermos se clasificaron, atendiendo a su edad, en tres grupos, comparándose los resultados de cada grupo patológico con un grupo control de características similares: 26 recién nacidos prematuros, con distress respiratorio grave, que precisaron ventilación mecánica; 32 niños entre 2-12 años con broncopatía obstructiva y 22 adultos (30-65 años) sometidos a broncoscopia y LBA con fines diagnósticos. Las isoenzimas se separaron por electroforesis sobre gel de agarosa y se cuantificaron por densitometría. En el LBA se midieron proteínas totales, expresándose la actividad de ALP en UI/mg de proteína ¥ 10-3. Resultado: Encontramos la fracción macromolecular de ALP significativamente aumentada en el suero de los neonatos con distress (p<0,01), en los enfermos de 2-12 años y en los adultos patológicos estudiados (p<0,001). La electroforesis de isoenzimas de ALP en el LBA mostró una única banda isoenzimática, correspondiente a su fracción macromolecular. Conclusiones: El aumento de la fracción macromolecular de la ALP en el suero de los enfermos con problemas respiratorios podría tener su origen en el tejido pulmonar dañado. Fosfatasa Alcalina. Isoenzimas. Enfermedad Broncopulmonar. Lavado Broncoalveolar (AU)

[Creatine kinase BB activity in the serum and bronchial aspirate of preterm newborns with respiratory distress syndrome]. / Actividad de la isoenzima CKBB en suero y broncoaspirado de recién nacidos pretérmino con síndrome de distrés respiratorio.

OBJECTIVE: The aim of this study was to test the utility of serum creatine kinase (CK) isoenzyme determinations as a marker of tissue injury in preterm newborns with respiratory distress syndrome (RDS). PATIENTS AND METHODS: Two groups of neonates were studied, 26 suffering from RDS who required mechanical ventilation and 20 healthy newborns with gestational ages, hours of life and birth weights similar to the first group. The activity of CK and its isoenzymes was determined in the bronchial aspirate and serum samples that were obtained before and 24 hours after exogenous surfactant therapy. The isoenzymes were separated by electrophoresis on agarose gel and their activity expressed as a percentage of the total CK. Total proteins were quantified in the bronchial aspirate and CK enzymatic activity expressed in U/mg of protein x 10-3. RESULTS: The CK-BB isoenzyme was significantly increased (p < 0.001) in the serum of infants with RDS compared with the control group. In the bronchial aspirate, the isoenzymatic study showed that the CK-BB isoenzyme represented 98-100% of the total enzymatic CK activity. CONCLUSIONS: The study shows significant differences in the CK isoenzyme patterns of neonates with RDS compared to controls. An increase in serum levels of the CK-BB isoenzyme could be an effective marker of tissue injury in lung disease in the newborn.

[Serum creatine kinase MM isoforms and lactate dehydrogenase isoenzymes in patients with non-traumatic acute rhabdomyolysis]. / Isoformas de creatin quinasa-MM e isoenzimas de lactico deshidrogenasa en el suero de pacientes con rabdomiolisis aguda no traumática.

We studied lactate-dehydrogenase (LD) isoenzymes and creatinekinase MM (CKMM) isoforms MM1, MM2 and MM3, in the serum of 18 patients with nontraumatic acute rhabdomyolysis, to test the utility of these markers in the diagnosis and disease evolution. The isoenzymes were separated by electrophoresis on agarose gel and were quantified with a densitometer. We studied the correlation between CKMM isoforms calculating the MM3/MM1 ratio, establishing the reference values from control group of 36 healthy adults. MM3 and MM3/MM1 ratio values were significantly increased in patients with rhabdomyolysis (p < 0.001) and progressively decreased coinciding with signs of getting better, showing 10 days after similar values of control group. LD4 and LD5 isoenzymes were significantly increased (p < 0.001) keeping elevated until 8-10 days when they showed a significant decrease compared with admission values (p < 0.05) but keeping elevated respect to control (p < 0.01).

[Lactate dehydrogenase isoenzymes in the serum and bronchial aspirate of newborn infants with respiratory difficulty of different etiologies]. / Isoenzimas de lactato deshidrogenasa en el suero y aspirado bronquial de recién nacidos con dificultad respiratoria de etiología diversa.

OBJECTIVE: To study the usefulness of lactate dehydrogenase isoenzymes serum determination as tissue injury markers in newborns with respiratory distress. DESIGN AND METHODS: Ninety four neonates were studied and classified in two groups: 64 suffering various types of respiratory problems, and 30 healthy newborns of a similar birth weight and gestational age. LDH activity and its isoenzymes was determined in the serum of all the infants and in 23 samples of the bronchial aspirate of infants who required ventilation support. The isoenzymes were separated by electrophoresis on agarose gel and their activity was expressed as percentage of the total LDH. RESULTS: LDH1 and LDH2 isoenzymes were decreased, and LDH4 and LDH5 isoenzymes were significantly increased (p > 0.001) in infants serum with respiratory distress, compared with controls. We compared LDH isoenzymes values found in bronchial aspirate with their values found in serum of ventilate infants, and we found a significant levels of LDH2 and LDH3 were lower, and those of LDH5 were higher (p < 0.001) in bronchial aspirate than in serum and a positive correlation (r = 0.47, p < 0.01) between LDH5 values in both samples. CONCLUSIONS: The study shows significantly differences in the LDH isoenzyme profiles of neonates with respiratory distress compared with controls. The increase in serum of LDH4 and particularly of LDH5 isoenzymes could be an effective marker of tissue damage in lung disease in the newborn.

[Serum CK-BB. A biochemical marker in neonatal necrotizing enterocolitis]. / CK-BB sérica. Marcador bioquímico en la enterocolitis necrotizante neonatal.

OBJECTIVE: We performed a prospective study of 72 preterm neonates with high-risk predisposing them to necrotizing enterocolitis (NEC) in which isoenzyme CK-BB activity in serum was measured at birth and after establishment of feeding with the purpose being to investigate whether CK-BB isoenzyme measurement may be useful in the diagnosis of NEC and an efficient marker in the evolution of the disease. DESIGN AND METHODS: In 12 neonates with NEC, CK-BB was measured in serum, at the beginning of symptoms and every 48 hours until remission of the acute episode. Control data were obtained from 26 healthy preterm and 20 preterm neonates with diarrhoea of several etiologies. Fourteen infants were excluded from the study due to complications. Electrophoresis on an agarose gel was used determine CK isoenzymes and these are expressed as the percentage of total CK activity. RESULTS: There were no differences in CK-BB values between the control groups. At the beginning of symptoms, the CK-BB in serum was significantly greater in neonates with NEC (p < 0.001) than in the control groups and were continuously elevated until complete recovery from NEC. CONCLUSION: The CK-BB was shown as a useful marker in the diagnosis and evolution of NEC.