Evaluation of Celiac Disease by Minimally Invasive Biomarkers in a Spanish Pediatric Population.

BACKGROUND: The diagnosis of celiac disease (CD) has been substantially improved with the availability of highly sensitive CD-specific IgA-TG2, Ig-GDP, and IgA-EMA. The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) published (2012) and updated (2020) diagnostic criteria for CD in order to simplify CD diagnosis and to avoid biopsies in selected patients. METHODS: A prospective study including 5641 pediatric patients (0-16 years old) from January 2012 to January 2019 was performed. CD diagnosis was made according to the ESPGHAN algorithm. The objective of this study was to evaluate the utility of biomarkers and the relationship between TGA-IgA and EMA titers. RESULTS: CD diagnoses were confirmed in 113 patients, 110 were IgA-TG2-positive and 3 (2.7%) had IgA deficiency. The diagnosis was made by serologic tests in 95 (84.1%) patients. Only 18 (15.9%) patients underwent intestinal biopsy. We obtained 100% concordance between IgA-EMA and positive results for IgA-TG2 ≥ 10 ULN with IgA-EMA antibody titer ≥ 1:80. CONCLUSIONS: This study provides evidence of a positive correlation between IgA-TG2 antibody serum levels and IgA-EMA. The diagnosis could be guaranteed with strict application of IgA-TG2 values ≥ 10 ULN (confirmed by subsequent testing) plus the serological response to the gluten-free diet (GFD).

About the correct definition of acanthocytes for their use as markers of glomerular haematuria / Sobre la correcta definición de los acantocitos para su uso como marcadores de hematuria glomerular

Acanthocytes, when≥5% of urinary erythrocytes examined, are considered as the most reliable marker of glomerular haematuria. However, some uncertainties still exist in the literature about their morphological definition. The aim of this paper is to discuss this topic and to suggest a univocal definition of acanthocytes as erythrocytes with the shape of a ring with one or more protrusions

Los acantocitos, cuando son≥5% de los eritrocitos urinarios examinados, se consideran el marcador más fiable de la hematuria glomerular. Sin embargo, todavía existen algunas incertidumbres en la literatura acerca de su definición morfológica. El objetivo de este artículo es discutir este tema y proponer una definición unívoca de los acantocitos como eritrocitos con la forma de un anillo con una o más protuberancias

Evaluación de un nuevo reactivo monoclonal, N-Látex Free Light Chains, para la cuantificación nefelométrica de las cadenas ligeras Kappa y Lambda libres en suero / Evaluation of a new monoclonal reagent, N-Látex Free Light Chains, for nefelometric quantification of free light chain kappa and lambda in serum

Introducción. Con la evaluación del ensayo de cadenas ligeras libres en suero Kappa y Lambda (FLC), pretendemos colaborar en la imprescindible estandarización internacional de esta técnica. Su utilidad en el diagnóstico y seguimiento de mielomas, gammapatías de significado incierto (MGUS), amiloidosis, plasmocitomas solitarios etc. está ampliamente demostrada en la bibliografía, las guías clínicas internacionales las incluyen para el específico diagnóstico de las discrasias de células plasmáticas. Material y métodos. Se evaluó un nuevo reactivo N-Látex CLL para nefelometría, basado en anticuerpos monoclonales, que lleva adjunto un reactivo suplementario específico, que fue desarrollado con inmunoglobulinas de ratón. Resultados. La exactitud y precisión del método evaluadas con controles de 3 niveles de concentración fueron aceptables. Se ha comparado este reactivo con el Freelite(R), procesando 30 muestras de pacientes, por el nefelómetro BNII (Siemens), se solventaron los falsos positivos del 2.°. Así mismo, se comparó el método por nefelometría (BN II) frente a turbidimetría (SPA PLUS) los resultados fueron favorables a la nefelometría. En cuanto a sensibilidad y especificidad del método evaluado, se realizaron las curvas ROC, con 60 pacientes y se obtuvieron resultados con una moderada correlación. Discusión. Consideramos que la falta de reproductibilidad en la cuantificación de las FLC existente, se debía a los factores: alta variabilidad entre los lotes de reactivos de la misma casa comercial; diferencias en los resultados de las muestras con elevadas concentraciones de FLC por no incluir el chequeo de exceso de antígeno, y diferencias en los principios de medida de los autoanalizadores utilizados (AU)

Introduction. Evaluation of testing of serum free light chains Kappa and Lambda (FLC), to collaborate on the essential international standardization of this technique. Its usefulness in diagnosis and follow-up of myeloma, Gammapatías of undeterminated significance (MGUS), amyloidosis, solitary plasmocitomas etc. is amply demonstrated in the literature, the international clinical guidelines include them for the specific diagnosis of the discrasias of plasma cells. Material and methods. We evaluated a new reagent N-Látex CLL for Nephelometry, based on monoclonal antibodies, which leads attached a supplementary reagent specific, which was developed with mouse immunoglobulins. Results. The accuracy and precision of the method evaluated with 3 levels of concentration controls were acceptable. It has been compared this reagent with the existing 30 samples from patients with the nephelometer BNII (Siemens), false positives of the 2nd were overcome. Likewise compared the method by nephelometry (BN II) against turbidimetry (SPA PLUS) the results were favourable to the nephelometry reference technique. In terms of sensitivity and specificity of the evaluated method, ROC curves, with 60 patients were conducted and results with a moderate correlation. Discussion. We believe that the lack of reproducibility in the quantification of the FLC due to factors: high variability between batches of reagents in the same commercial House; differences in the results of the samples with high concentrations of FLC, for not including the checking of antigen excess, and differences in the principles of the used clinical measurement (AU)