Novel Biomarkers for Early Detection of Acute Kidney Injury and Prediction of Long-Term Kidney Function Decline after Partial Nephrectomy.

BACKGROUND: Identifying acute kidney injury (AKI) within few hours of onset is certainly helpful. However, early prediction of a long-term eGFR decline may be an even more important goal. Our aim was to identify and compare serum [creatinine, kineticGFR, cystatin C, neutrophil gelatinase-associated lipocalin (NGAL)] and urinary (NephroCheck, NGAL, proteinuria, albuminuria, acantocytes at urinary sediment) predictors of AKI that might efficiently predict long-term GFR decline after robotic Nephron-Spearing Surgery (rNSS). METHODS: Monocentric prospective observational study. Patients scheduled for rNSS for suspected localized Renal Cell Carcinoma from May 2017 to October 2017 were enrolled. Samples were collected preoperatively and postoperatively (timepoints: 4 h, 10 h, 24 h, 48 h), while kidney function was re-assessed up to 24 months. RESULTS: 38 patients were included; 16 (42%) developed clinical AKI. The eGFR decline at 24 months was more pronounced after postoperative AKI (-20.75 vs. -7.20, p < 0.0001). KineticGFR at 4 h (p = 0.008) and NephroCheck at 10 h (p = 0.001) were, at multivariable linear regression analysis, efficient predictors of post-operative AKI and long-term eGFR decline if compared to creatinine (R2 0.33 vs. 0.04). CONCLUSIONS: NephroCheck and kineticGFR have emerged as promising noninvasive, accurate, and early biomarkers of postoperative AKI and long-term GFR decline after rNSS. Combining NephroCheck and kineticGFR in clinical practice would allow to identify high risk of postoperative AKI and long-term GFR decline as early as 10 h after surgery.

Isolated case of platelet satellitism around white blood cells and phagocytosis by neutrophils and monocytes.

INTRODUCTION: Rarely, platelets can interact with other blood elements, forming platelet aggregates. This paper presents an isolated case of platelet satellitism around neutrophils, lymphocytes and monocytes with platelet phagocytosis by both neutrophils and monocytes. CASE PRESENTATION: The subject was an 89-year-old woman with breast cancer on anti-estrogenic hormone cancer therapy. Whole blood sample collected in a tube with EDTA (Ethylenediaminetetra-acetic acid) anticoagulant was analysed within 4 hours, using an XN haematology analyser (Sysmex). The CBC (complete blood count) presented the following results: WBC (White blood cell) 4.0 x 109/L, RBC (Red blood cell) 3.58 x 1012/L, haemoglobin 116 g/L, haematocrit 34.9%, MCV (Mean corpuscular volume) 97.5 fL, MCH (Mean corpuscular haemoglobin) 32.5 pg, MCHC (Mean corpuscular haemoglobin concentration) 33.2 g /dL, RDW (Red blood cell distribution width) 14.6% and PLT (Platelet) 136. CONCLUSION: This manuscript describes the platelet satellitism around neutrophils, lymphocytes and monocytes and the interesting, very rare and singular phenomenon of platelet phagocytosis by not only neutrophils but also monocytes.