[Heparin-induced hyperkalaemia - a case report]. / Hiperkaliemia zalezna od heparyny ­ opis przypadku.

Heparins are drugs commonly used in the prevention and treatment of thromboembolic complications. It is also common to be aware of the complications of their use, such as increased risk of bleeding or induction of throbocytopenia. However, it should not be forgotten that in about 7% of patients the use of heparins may lead to the significant hyperkalaemia. AIM: The aim of this study was to draw attention to the rare, but potentially fatal complication of heparin treatment. CASE REPORT: Here we present the case of the 85-year-old man with the several co-morbid conditions, who developed hyperkalaemia during hospitalization. Hyperkalaemia was resistant to typical conventional treatment. It occured that the reason for this complication was hypoaldosteronism caused by the use of low molecular weight heparin in the prophylactic dose. Kaliaemia normalization was achieved not until the fludrocortisone was used. Heparin induced hyperkalaemia occurs in about 7-8% treated patients. Therefore, it is not a rare complication, but given the prevalence of heparin use and the potential number of patients with this complication, it is rarely diagnosed. Potentially because hyperkalaemia is usually asymptomatic and because heparin treatment is usually temporal. The reported case of a patient with asymptomatic heparin induced hyperkalaemia proves that in everyday practice we may face this complication, and its diagnosis and proper treatment is possible only if we remember about this risk.

The Uremic Toxin Indoxyl Sulfate Accelerates Thrombotic Response after Vascular Injury in Animal Models.

Chronic kidney disease (CKD) patients are at high risk for thrombotic events. Indoxyl sulfate (IS) is one of the most potent uremic toxins that accumulates during CKD. Even though IS is associated with an increased risk for cardiovascular disease, its impact on thrombotic events still remains not fully understood. The purpose of the study was to evaluate the direct effect of IS on thrombotic process. We examined the impact of acute exposure to IS on thrombus development induced by electric current in Wistar rats, intravital thrombus formation after laser-induced injury in the mice endothelium, coagulation profile, clot formation dynamics, platelet aggregations, and erythrocyte osmotic resistance. IS doses: 10, 30 and 100 mg/kg body weight (b.w.) increased weight of thrombus induced by electric current in dose-dependent manner (p < 0.001). Furthermore, two highest IS doses increased laser-induced thrombus formation observed via confocal system (increase in fluorescence intensity and total thrombus area (p < 0.01)). Only the highest IS dose decreased clotting time (p < 0.01) and increased maximum clot firmness (p < 0.05). IS did not affect blood morphology parameters and erythrocyte osmotic resistance, but augmented collagen-induced aggregation. Obtained data indicate that IS creates prothrombotic state and contributes to more stable thrombus formation. Thus, we concluded that IS may be one of crucial uremic factors promoting thrombotic events in CKD patients.

OxyVita®C, a next-generation haemoglobin-based oxygen carrier, with coagulation capacity (OVCCC). Modified lyophilization/spray-drying process: proteins protection.

Uncontrolled haemorrhage is one of the leading causes of death. This issue is present in controlled environments, such as hospitals, as well as pre-hospital and remote locations. Treatment is more challenging in remote locations where there is a lack of effective products to deliver oxygen and control coagulation. Poorly treated haemorrhage can lead to rapidly deteriorating bodily conditions that can result in organ failure and tissue death. Thus, the availability of products to support oxygen delivery to tissues and coagulation processes within the body is essential for the effective treatment of severe haemorrhage, particularly in out-of-the-hospital settings. The presence of such products would fill the gap that is currently present in emergency treatment. Promising results of an ex-vivo study on a novel haemoglobin-based oxygen carrier OxyVita®C with coagulation capacity (OVCCC) are presented in this article. The proprietary protein protection technology allows for the powderization of protein components without changes in their characteristics and physiological activity. This technology was applied to the oxygen carrier OxyVita®C, to plasma and to platelets. The functionality of all tested components, as well as a mixture of OxyVita®C and platelets, was studied. The results suggest future clinical trials investigating the powderization of OVCCC, plasma and platelets are warranted. The development of this powderization method offers a huge advancement into a field in which no viable products exist.

[Was it necessary to modify the classification of chronic kidney disease stages designed by NKF KDOQI? - "Nefrotest" study results]. / Czy istniala koniecznosc modyfikacji klasyfikacji przewleklej choroby nerek wg NKF KDOQI? - wyniki badania "Nefrotest".

INTRODUCTION: The introduction of the classification of chronic kidney disease (CKD) by NKF KDOQI guidelines in 2002, including the staging and risk assessment of this disease, was a landmark event. The division of CKD into stages 1-5 turned out to be very useful and sensitive tool in the hands of both scientists and clinical practitioners; it established common nomenclature pertaining to CKD all over the world. This stratification profoundly changed the approach to CKD, transforming it from a somewhat neglected clinical problem to the phenomenon named "the epidemic of CKD". However, after a short period if clinical experience a heated debate was initiated in the literature, indicating the shortcomings of the adopted classification. The most questionable areas included methodological issues as well as dissimilar prognoses for patients depending on the cause of kidney dysfunction, the presence of proteinuria and comorbidities. AIM: The aim of this study was to evaluate the prevalence of CKD and the risk factors based on NKF KDOQI classification of 2002 in the population of Ostróda administrative district. MATERIAL AND METHOD: In total 437 individuals (F 277, M 160) aged 52.7±18.0 were examined. The study was conducted in Ostróda among randomly selected inhabitants of Ostróda adminstrative district. Serum creatinine was determined by a modified Jaffe method and eGFR was calculated (MDRD formula) for each individual. The correlations between serum creatinine and eGFR, gender and age were studied. Additionally, 326 of the examined participants were interviewed to establish CKD risk factors: kidney disease in the family, being overweight and/or obese, arterial hypertension, diabetes, smoking, heart attack, stroke. RESULTS: 58.6% of the examined individuals demonstrated abnormal eGFR values (<90 ml/min/l.73 m2), whereas serum creatinine above the laboratory norm was found in 1.3% of patients. Significant CKD risk factors included an increased prevalence of obesity (78.3%), arterial hypertension (38.6%), and smoking (26.8%); 23.9% reported kidney disease in the family. CONCLUSIONS: Based on our study, it can be concluded that CKD prevalence evaluated according to the classification of 2002 seems to be overestimated, and the main factor contributing to a false CKD diagnosis is a physiological decline in eGFR values with aging. The modification of CKD classification carried out by NKF in 2012 requires further observation and evaluation of its usefulness in daily clinical practice.