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Mirjana Đerić and Velibor Čabarkapa

Cardiovascular Biomarkers in Chronic Kidney Disease

Cardiovascular morbidity and mortality are markedly increased in chronic renal failure patients. Although it cannot be regarded as a cardiovascular disease risk equivalent, kidney dysfunction is considered an independent predictor of increased cardiovascular risk that increases with deteriorating kidney function. The association is a very complex one, and the term cardiorenal syndrome is now widely used. Cardiovascular disease in chronic kidney disease patients usually manifests as ischemic heart disease (in the form of angina, acute coronary syndrome or sudden cardiac death), cerebrovascular disease, peripheral vascular disease, and congestive heart failure. Vascular disease includes atherosclerosis and vascular calcifications, and cardiomyopathy comprises left ventricular hypertrophy, cardiac fibrosis and left ventricular systolic and diastolic dysfunction. In addition to the well-established traditional risk factors such as hypertension, hyperlipidemia, insulin resistance and diabetes mellitus, the association is supported by synergistic action of non-traditional risk factors such as excessive calcium-phosphorus load, hyperparathyroidism, anemia, hemodynamic overload, malnutrition, inflammation, hyperhomocysteinemia, altered nitric oxide synthase and increased oxidative stress. This paper summarizes the current understanding of the significance of specific uremic retention solutes, natriuretic peptides, biochemical markers of disorders in calcium-phosphorus homeostasis, systemic inflammation, oxidative stress, and dyslipidemia.

Open access

Nevena Eremić and Mirjana Đerić

Evaluation of Coronary Risk Score Applications in 10-Year Coronary Heart Risk Estimation

Atherosclerosis is a multifactorial disease with risk factors that have multiple effects. In the identification and treatment of asymptomatic individuals at high risk for developing coronary heart disease (CHD) different risk scoring schemes are used in everyday routine. The aim of this study was to compare SCORE recommended for our country with two other most frequently used risk schemes for 10-year CHD risk evaluation: Framingham and PROCAM as well as their modifications. From 220 examined subjects of both sexes, who were treated mainly for lipid metabolism disorder at the Dispensary for Atherosclerosis Prevention, Centre for Laboratory Medicine, Clinical Centre of Vojvodina, 110 subjects were included in our study and agreed to a one-year follow-up. At first check-up, 15% had low risk according to Framingham Weibull and 78% according to PROCAM, intermediate 12% according to PROCAM NS up to 45% according to Framingham Weibull, and high 8% according to PROCAM up to 40% according to Framingham Weibull. After a one-year treatment 30% were in the low risk category according to Framingham Weibull and 88% according to PROCAM. Intermediate from 10% according to PROCAM to 36% according to Framingham Weibull, and high from 2% according to PROCAM to 25% according to Framingham Weibull. There is a significantly lower percentage of high risk individuals and a higher percentage of low risk individuals after one year of lipid disorder treatment.

Open access

Nevena Eremić, Mirjana Đerić and Ljiljana Hadnađev

Diagnostic Accuracy of IGA Anti-Tissue Transglutaminase Antibody Testing in Celiac Disease

Contemporary guidelines for the first-line diagnosis of celiac disease recommend determination of IgA anti-tissue transglutaminase antibodies or IgA antiendomysial antibodies, as well as total serum IgA antibodies. The aim of our study was to assess the validity and clinical significance of serological testing for IgA anti-tissue transglutaminase antibodies in the diagnosis of celiac disease, and to investigate the presence of malabsorption symptoms in celiac patients. IgA anti-tissue transglutaminase antibody testing was performed in 50 subjects with clinically suspected celiac disease (21 men and 29 women). All subjects underwent endoscopy with small intestine biopsy. Celiac disease was confirmed by histopathological findings in four subjects, whereas the IgA anti-tissue transglutaminase test was positive in three subjects. The IgA anti-tissue transglutaminase test showed sensitivity of 75% and specificity of 100%. There were significant differences between men with biopsy-confirmed and excluded celiac disease in the erythrocyte parameters MCV (96.5±7.7 vs. 78.6 ±11.3; p<0.05), MCH (36.9±4.6 vs. 25.9±4.9; p<0.01), and MCHC (382.5±16.3 vs. 326.9±19.1; p<0.005), as well as in the levels of total protein (47.5 ±16.3 vs. 68.3 ± 7.6; p<0.01) and albumins (24.6±9.5 vs. 42.1 ± 6.9; p<0.01). In addition, HDL-cholesterol levels were significantly lower in men with biopsy-confirmed celiac disease (0.42.±0.12 vs. 0.90±0.30; p<0.05). Our results show a high correlation between IgA anti-tissue transglutaminase testing and endoscopy with biopsy as the gold diagnostic standard.

Open access

Velibor Čabarkapa, Mirjana Đerić and Zoran Stošić

Testing of IQ™ 200 Automated Urine Analyzer Analytical Performances in Comparison with Manual Techniques

Automation is necessary in laboratory systems. It enables reduction of time required for sample analysis, as well as standardization of methods. However, automation of urine control in laboratories is much less common than in hematological analyses. Not long ago, the necessary automated systems for urine analysis have also been developed. The objective of this study is a comparison of the IQ™ 200 automated system for urine analyzing with standardized manual urine analyzing techniques. Comparative analysis of 300 samples was performed by the IQ™ 200 system and by the standardized methods of manual microscopy and chemical urine analysis. The results acquired point to very high compatibility between urine analyses by manual techniques and by the automated system IQ™ 200, and in some analyses IQ™ 200 showed higher sensitivity. It can be concluded, with the aim of standardization and shortening of time required for urine analysis, that utilization of automated urine analyzing systems is recommendable, especially in institutions with a large number of daily analyses. This is also supported by the fact that operation procedure on automated systems is much more simple in comparison to manual techniques.

Open access

Sunčica Kojić-Damjanov, Mirjana Đerić, Nevena Eremić and Velibor Čabarkapa

The Influence of Chronic Helicobacter Pylori Infection on some Serum Lipid Profile Parameters, Apolipoproteins A-I and B and Lp(a) Lipoprotein

Data on proatherogenic lipid profile alterations due to chronic Helicobacter pylori (HP) infection are contradictory. Aim of this study was to examine the differences in some lipid parameters between 55 subjects of both gender with a chronic HP infection (IgG>50 U/mL and IgA <20 U/mL) and 55 gender matched HP seronegative subjects (IgG and IgA <20 U/mL). Total cholesterol (TC) (p<0.001), triglycerides (TG) (p<0.05), LDL-cholesterol (LDL-C) (p<0.02), non-HDL-cholesterol (non-HDL-C), apolipoprotein (apo) B (p<0.001), Lp(a) and HDL-cholesterol (HDL-C) serum levels were higher in HP seropositive than in seronegative subjects, while there were almost no differences in apo A-I. In HP seropositive subjects, the frequency of pathological TC (p<0.001), TG (p<0.05), LDL-C (p<0.01), non-HDL-C (p<0.01), apo B (p<0.02) and Lp(a) serum levels was higher compared to seronegative. Serum HP IgG titers correlated negatively with TC, LDL-C (p<0.05), non-HDL-C, apo B and Lp(a) levels, and positively with TG, HDL-C and apo A-I levels. Results are similar for both genders. Our results confirm the hypothesis that a chronic HP infection could modify the lipid profile in a proatherogenic way.

Open access

Mirjana Đerić, Sunčica Kojić-Damjanov, Velibor Čabarkapa and Nevena Eremić

Biochemical Markers of Atherosclerosis

This paper is a brief review of some lipid parameters and serum markers of inflammation in a view of their predictive relevance for the atherosclerotic disease. A discourse on the importance of measuring different lipids and lipoproteins, concentration of LDL particles and apolipoprotein levels is still underway. Also, the recommendations for apolipoprotein (a), phenotypization and other lipid markers have not yet been established. In recent years the recommendations imply simultaneous measuring of multiple markers and calculating the lipid index values such as lipid tetrad index (LTI), lipid pentad index (LPI) and atherogenic index of plasma (AIP). Several circulating markers of inflammation such as C-reactive protein, serum fibrinogen and elevated leukocyte number, are consistently associated with atherosclerosis. In spite of a lack of evidence on measuring the C-reactive protein in a wide population, the guidelines for its application in diagnostics and therapy of coronary heart disease were developed. Some proinflammatory cytokines, adhesion molecules and markers of leukocyte activation are promising markers, requiring, however, more detailed prospective evaluation. The question to be elucidated is if these inflammatory markers are directly involved in the pathogenic process.

Open access

Biljana Vučković, Mirjana Đerić, Tatjana Ilić, Višnja Čanak and Marija Žarkov

Decrease of Fibrinolytic Potential in the Occurence of Cerebral Ischemia

One of the most present clinical manifestations of long and progressive atherothrombotic occurrences is the ischemic cerebrovascular insult, one of the leading causes of death and illness in the world. Lately, a growing number of scientists believe that disorders in the fibrinolytic mechanism function are the key to the occurrence of cerebral ischemia. The goal of this study is to investigate whether the disorder of the fibrinolytic mechanism has influence on the occurrence of ischemic cerebrovascular insult. Our study includes 90 examinees, 60 of which suffer from ischemic cerebrovascular insult and 30 are clinically healthy examinees forming the control group. The results of our investigation show that statistically a significantly larger number of patients has decreased fibrinolytic potential comparing with controls (p < 0.01). According to this, it has been noted that euglobulin lysis clot time in the patient group is significantly longer (p = 0.005). Statistically, no significant difference has been noted related to the activity of plasminogen (p = 0.085). Further on, the plasminogen activator inhibitor-1 values among the patients have been significantly higher (p = 6.20 x 10-11). Moreover, significantly higher values of tissue-type plasminogen activator antigen have been statistically noted in the patient group (p = 5.20 x 10-5). The results of this investigation impose the conclusions that the decrease in fibrinolytic potential affects the occurrence of ischemic cerebrovascular insult, that it is directly connected to the higher levels of plasminogen activator inhibitor-1 and that the growth of tissue-type plasminogen activator antigen concentration participates in the decrease of fibrinolytic potential among patients suffering from cerebral ischemia.

Open access

Sunčica Kojić-Damjanov, Mirjana đerić, Velibor Čabarkapa and Ljiljana Vučurević-Ristić

Significance of Determining Levels of Apolipoproteins A-I and B in the Diagnostics and Assessment of Lipid-Related Atherogenic Risk in Hyperalpha-Lipoproteinemia, Hypocholesterolemia and Hypo-Hdl-Cholesterolemia

The significance of determining apolipoproteins apoB and apoA-I and their correlation with lipid status parameters were tested in hyperalpha-lipoproteinemia (30 women), hypocholesterolemia (10 men) and hypo-HDL-cholesterolemia (15 women and 21 men). Control groups were 20 normolipidemic men and women, each. ApoA-I showed positive correlation with HDL-cholesterol in hyperalpha-lipoproteinemia, with total and HDL-cholesterol in hypocholesterolemia, and with total and LDL-cholesterol in females with hypo-HDL-cholesterolemia, and negative correlation with cholesterol ratios only in hypocholesterolemia. ApoB showed a positive correlation with total and LDL-cholesterol in all groups, and with cholesterol ratios in hyperalpha-lipoproteinemia and hypo-HDL-cholesterolemia. The apoB/apoA-I ratio, correlating with the majority of lipid parameters, and with the highest percentage of pathological values in all tested groups, was singled out as the most sensitive parameter for the evaluation of lipid-related atherogenic risks.

Open access

Velibor Čabarkapa, Zoran Stošić, Mirjana Đerić, Ljiljana Vučurević-Ristić and Mirjana Drljača

The Importance of Free Light Chains of Immunoglobulins Determination in Serum

For many years, Bence Jones proteinuria has been an important diagnostic marker for multiple myeloma. Relatively new serum tests for free kappa and free lambda light chains of immunoglobulins reflect the production of free light chains more accurately than urine tests. In this study, we examined the value of serum free light chains measurement in the diagnosis of some neoplastic diseases and the discrepance between the findings of serum protein electrophoresis and serum free light chains. Thirty one patients (f=19, m=12) were included in the study, most of them with blood malignant diseases. The results show that in six patients with normal gamma and beta electrophoresis fractions there are abnormal levels of free light chains and/or an abnormal κ/LD ratio. In 20 patients we found an abnormal κ/LD ratio, and in 21 patients we found an abnormal κ or LD level, or both. The obtained results show the important role of serum free light chains determination in identifying patients with monoclonal gammopathies.

Open access

Velibor Čabarkapa, Mirjana Đerić, Zoran Stošić, Vladimir Sakač, Sofija Davidović and Nevena Eremić

Summary

Background: One of the leading causes of terminal renal failure is diabetic nephropathy. The aim of this study was to determine the relationship between homocysteine levels and the biomarkers of renal function, inflammation and oxidative stress, as well as the incidence of macrovascular complications in patients with diabetic nephropathy.

Methods: Sixty-four patients with diabetic nephropathy were included in this study. They were divided according to their homocysteine levels into two groups: hyperhomocysteinemic (HHcy, n=47) and normohomocysteinemic patients (NHCy, n=17). The re sults were compared to a control group (n=20) with normal renal function and without diabetes. Besides homocysteine, cystatine C, creatinine, urea, albuminuria, creatinine clearance, lipid status parameters, apolipoprotein A-I and B, lipo protein (a), CRP, fibrinogen, oxidative LDL were determined using appropriate methods. The incidence of macro vascular diabetic complications was also determined.

Results: The results indicate that the level of renal dysfunction is greater in HHcy than in NHcy patients (p<0.05). In HHcy patients levels of oxLDL were also higher compared to NHcy patients (119.3±140.4 vs. 71.4±50.8 ng/mL, disp< 0.05) as well as fibrinogen levels (4.3±1.3 vs. 3.7±0.8 g/L, p<0.05). The in cidence of macrovascular complications is more frequent in HHcy than in NHcy patients (55.3. vs. 35.3 %, p>0.05), and in patients with macroalbuminuria compared to patients with microalbuminuria (65% vs. 39%, p<0.05).

Conclusions: It can be concluded that HHcy is significantly present in patients with diabetic nephropathy, especially if there is greater reduction of renal function. Besides that, significantly higher concentrations of inflammatory (fibrinogen) and oxidative stress (oxLDL) markers were present in HHcy patients with diabetic nephropathy compared to NHcy patients.Therefore in diabetic nephropathy patients it is useful to regularly monitor the levels of homocysteine, as well as inflammatory and markers of oxidative stress.