Scandinavian journal of clinical and laboratory investigation. Supplementum
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 2008
ReviewKidney Injury Molecule-1 (KIM-1): a specific and sensitive biomarker of kidney injury.
There is an urgent need for the detection and monitoring of kidney injury in both the acute and chronic disease setting. Urinary kidney injury molecule-1 (Kim-1), a type-1 transmembrane protein, is not normally present, but is expressed on the proximal tubule apical membrane with injury. Kim-1 has proved to be an outstanding indicator of kidney injury in the rat, outperforming blood urea nitrogen and serum creatinine as predictors of histopathological changes in the proximal tubule in response to many pathophysiological states or toxicants. Studies in man indicate that tissue expression and urinary excretion of the ectodomain of KIM-1 are sensitive and specific markers of injury as well as predictors of outcome.
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 2008
Fatty acid-binding protein as marker for renal injury.
The assessment of biomarkers to detect renal injury has been studied before, but the sensitivity and specificity of urinary and serum profiles of these markers still need to be improved. One of the promising new markers for detection of renal injury is the family of 15 kDa cytoplasmic fatty acid-binding proteins (FABPs). Remarkably, however, the application of FABP as marker for renal injury due to ischaemia, toxic heavy metals or in end-stage renal failure has only recently been investigated. ⋯ Urinary L-FABP has been evaluated recently more explicitly and shows significant elevations in progressive end-stage renal failure as well as after ischaemic injury due to renal transplantation or cardiac bypass surgery. H- and L-FABP have been shown to be useful markers for rapid detection and monitoring of renal injury. Further study of the diagnostic and prognostic use of these FABP types will require further commercialization of automated and rapid assays for proper clinical application.
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 1999
Randomized Controlled Trial Clinical TrialThe need for a point of care testing: an evidence-based appraisal.
The need for point of care testing (POCT) must be seen within the context of the need for biochemical diagnosis of patients suspected of acute coronary syndromes (ACS). The electrocardiogram is the initial test to select patients for thrombolysis and risk stratification. The majority of patients presenting with chest pain do not have AMI and diagnostic sensitivity of the ECG is only 55-75%. ⋯ POCT for cardiac markers has a definite place in management when very short TAT is required such as the ED. If the laboratory TAT exceeds 25% of the decision time, then POCT will be required. If therapeutic decisions are to be made, only POCT will be able to fulfil the TAT requirement.
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 1999
ReviewNeurochemical monitoring of the acutely injured human brain.
The main goal of modern neurointensive care (NIC) of patients with acute brain injury (traumatic brain injury, neurovascular disease) is to prevent additional loss of viable brain tissue due to secondary injury processes. It is generally held that secondary injury, mediated by, for example, cerebral hypoxia/ischemia and destructive molecular cascades on the cellular level, contributes significantly to the extent of brain damage after head injury and stroke. ⋯ This paper describes intracerebral microdialysis as a novel approach to neurochemical monitoring of the human brain. The main objectives are (i) to monitor cortical energy metabolism in order to detect secondary ischemia and (ii) to monitor secondary injury processes, such as glutamate receptor overactivation and increased free radical production, in NIC patients.
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Scand. J. Clin. Lab. Invest. Suppl. · Jan 1999
ReviewBiochemical markers of cardiac damage: from traditional enzymes to cardiac-specific proteins. IFCC Subcommittee on Standardization of Cardiac Markers (S-SCM).
Measurement of cardiac markers in blood has been the mainstay for diagnosis of acute myocardial infarction for nearly 50 years. The field has evolved from measurement of enzyme activity to mass concentrations of proteins using automated non-isotopic immunoassays. With changing clinical practices, cardiac markers are now needed to detect the presence of minor myocardial infarction in patients with unstable angina. ⋯ In the case of cardiac troponin, clinical observations and animal studies suggest that cytosolic free troponin may be released in reversible ischemia in addition to irreversible cell damage. The IFCC S-SCM has recommended use of two cut-off concentrations for cardiac troponin to differentiate normal from minor myocardial injury and AMI. A low cut-off may detect reversible ischemic events in some cases.