Acute Kidney Injury
Acute Kidney Injury
Acute Kidney Injury
–
Rapid Renal Injury Detection
Multiplex Detection of Acute Kidney Injury from a Single Sample
- Simultaneous and quantitative detection of multiple kidney function markers from a single patient sample for complete patient profiling
- Identify early stage renal impairment and ensure earlier intervention. Widely used in drug-related renal clinical trials
- Unique combination of analytes ensures better sensitivity and accuracy compared to traditional serum creatinine measurement
- The Randox AKI array measures four qualified FDA urine markers from one sample
- Multiplex testing better captures reduced renal function, as each biomarker reflects different mechanisms that result in similar injury outputs
- Utilising patented Biochip Technology, the Randox AKI array is currently available on the Evidence Investigator
Acute kidney injury (AKI) is currently diagnosed using serum creatinine as recommended by the KDIGO guidelines. Serum creatinine however, has poor sensitivity and specificity for AKI lagging behind both renal injury and recovery. There is an immediate need for more sensitive biomarkers to enables earlier identification of AKI, monitor drug toxicity and identify patients at an increased risk of CKD, end-stage renal disease or long-term kidney dialysis.
The National Institute for Health and Care Excellence (NICE) has highlighted that is important that patients are assessed for AKI on admission to hospital or transfer, monitored for AKI throughout their stay and AKI is managed appropriately if it develops.
Utilising patented Biochip Technology, the Randox Acute Kidney Injury (AKI) array simultaneously tests for four novel biomarkers delivering early diagnosis and monitoring of treatment efficacy It may also help you conduct safer and faster clinical trials.
Randox Acute Kidney Injury (AKI) Array (4-plex)
This marker is highly upregulated in kidney tubule cells following nephrotoxic injury severe enough to result in acute renal failure, acute tubular necrosis or acute tubulo-interstitial nephropathy.
Due to its small size and basic pH, Cystatin C is freely filtered by the glomerulus. It is then reabsorbed by tubular epithelial cells and subsequently metabolized. Accumulation of Cystatin C in urine is specific for tubular kidney damage and suggests reduced reabsorption at the proximal tubules as a result of toxicant-induced kidney injury.
Expression of Clusterin is upregulated following a variety of renal injuries and is detectable in urine following acute kidney injury induced by administration of nephrotoxic agents. This occurs before the profound renal transformations that give rise to changes in creatinine and BUN.
KIM-1 is a 30kDa type 1 transmembrane glycoprotein found on actvated CD4+ T cells. It is undetectable in healthy kidney tissue but is expressed at very high levels in proximal tubule epithelial cells in the kidney after toxic injury.
The Evidence Investigator
Meet the Evidence Investigator
The Randox AKI array has been developed for the Evidence Investigator, a semi-automated benchtop immunoassay analyser.
The AKI array would improve patient risk stratification whilst monitoring the effectiveness of treatments & drug toxicity by simultaneously and quantitatively detecting multiple urine biomarkers of kidney damage-related analytes from a single sample.
Want to know more?
Contact us or visit our Investigator Webpage
Rare Disease Day: 28th February 2019
28th February 2019
Rare Disease Day: 28th February 2019
Rare Disease Day raises awareness of rare diseases and how patients’ lives are affected. Many rare diseases remain incurable and many go undiagnosed. 1 in 20 people will live with a rare disease at some point in their life and this is why it is so important to raise awareness.1
What is a rare disease?
There is no single definition for a rare disease, as many countries identify them differently. In the United States, the Rare Diseases Act of 2002 defines a rare disease by its prevalence: “any disease or condition that affects fewer than 200,000 people in the United States”. However, the EU defines a rare disease as a condition that affects less than 5 in 10,000 of the population. There are approximately 7000 rare diseases and disorders and 50% of people affected by rare diseases are children.2,3
Hyperlipoproteinemia type III
This rare disease day, Randox will be raising awareness of hyperlipoproteinemia type III. Hyperlipoproteinemia type III, also known as dysbetalipoproteinemia or broad beta disease, is a rare genetic disorder characterised by improper breakdown of lipids, specifically cholesterol and triglycerides. The condition is caused by mutations in the Apo-E gene, however the inheritance of this condition is complicated due to the development of symptoms having to be triggered by a secondary factor to raise lipid levels. These factors include diabetes, obesity or hypothyroidism.
It is unknown exactly what the prevalence of the condition is, but it is estimated to affect approximately 1 in 5,000 – 10,000 of the general population and it has been found that it affects males more often than females, with women rarely being affected until after menopause.4,5
Figure A. Example of cholesterol and lipid build-up [6]
Symptoms
Symptoms for hyperlipoproteinemia type III will vary for each individual and some people may even be asymptomatic. The most common symptom is the development of xanthomas which are deposits of fatty material, the lipids, in the skin and underlying tissue. Xanthomas may appear on the palms of the hands, eyelids, soles of the feet or on the tendons of the knees and elbows.
> Chest pain or other signs of coronary artery disease
> Cramps in the calves when walking
> Sores on toes
> Stroke-like symptoms such as trouble speaking, dropping on one side of the face, weakness in an arm or a leg and a loss of balance6
Complications can arise if the condition is left untreated and these can include: myocardial infarction, ischemic stroke, peripheral vascular disease, intermittent claudication and gangrene of the lower extremities.7
Diagnosis
Although there is no specific diagnostic test for hyperlipoproteinemia type III, diagnosis is based on clinical evaluation and identification of symptoms. Research has indicated that an algorithm comprising a number of dysbetalipoproteinemia indices may be helpful in the diagnosis of the disease. These include:
> Low apolipoprotein B to total cholesterol ratio
> Elevated levels of triglycerides
> Elevated levels of total cholesterol8
Managing the condition
The condition cannot be cured but treatment is to control conditions such as obesity, hypothyroidism and diabetes. Most patients will go through dietary therapy to control their intake of cholesterol and saturated fat. This prevents xanthomas, high levels of lipids in the blood, exercise will also help to lower lipid levels. However, dietary changes may not be effective for some individuals and this is where drugs may be used to lower lipid levels instead.
How Randox can Help
Randox offer a range of routine and niche assays within the lipid testing panel to monitor lipid levels and to identify associated complications. Some of these tests include:
Apolipoprotein B
The Randox Apolipoprotein B tests utilises an immunoturbidimetric method, offers a wide measuring range and is available liquid ready-to-use for convenience and ease of use.
Total Cholesterol
The Randox Total Cholesterol test utilises the CHOD-PAP method and offers an extensive measuring range with a wide range of kits available to suit a wide range of laboratory sizes.
Triglycerides
The Randox Triglycerides test utilises the GPO-PAP method while offering an extensive measuring range with both liquid and lyophilised formats available offering choice and flexibility.
Want to know more?
Contact us or download our Cardiology and Lipid Testing brochure to learn more.
Related Products
Randox Reagents
Resource Hub
Lipid Panel Page
References
[1] Rare Disease Day. What is Rare Disease Day? Rare Disease Day. [Online] 2019. [Cited: February 21, 2019.] https://www.rarediseaseday.org/article/what-is-rare-disease-day
[2] Genetic Alliance UK. What is a Rare Disease? Rare Disease UK. [Online] 2018. [Cited: February 21, 2019.] https://www.raredisease.org.uk/what-is-a-rare-disease/
[3] NZORD. Rare Disease Facts and Figures. NZORD. [Online] 2019. [Cited: February 21, 2019.] https://www.nzord.org.nz/helpful-information/rare-disease-facts-and-figures.
[4] NORD. Hyperlipoproteinemia Type III. NORD. [Online] 2019. [Cited: February 21, 2019.] https://rarediseases.org/rare-diseases/hyperlipoproteinemia-type-iii/
[5] GARD. Hyperlipidemia Type 3. National Centre for Advanciing Translational Sciences. [Online] December 29, 2016. [Cited: February 21, 2019.] https://rarediseases.info.nih.gov/diseases/6703/hyperlipidemia-type-3
[6] Falck, Suzanne. Everything you need to know about hyperlipidemia. Medical News Today. [Online] December 21, 2017. [Cited: February 21, 2019.] https://www.medicalnewstoday.com/articles/295385.php
[7] Medline Plus. Familial Dysbetalipoproteinemia. Medline Plus. [Online] May 16, 2018. [Cited: February 21, 2019.] https://medlineplus.gov/ency/article/000402.htm.
[8] Dysbetalipoproteinemia: Two cases report and a diagnostic algorithm. Kei, Anastazia, et al. 4, s.l. : World Journal of Clinical Cases, 2015, Vol. 3.
Overcoming the burden of Diabetes and Cardiovascular Disease
The Prevalence
Cardiovascular disease (CVD) is the number one cause of death globally with more people dying annually from CVD than any other disease state. In 2018, according to the American Heart Association, CVD accounted for nearly 836,546 deaths in the USA (1) with over 17 million known deaths recorded worldwide. It is also proclaimed that around 1.5 million people globally die each year because of diabetes and diabetes related complications. (2) Is there a common link? Can this issue be controlled?
Studies have suggested that diabetes is one of the leading related conditions associated with increased risk of CVD death. A recent study undertaken in 2018 examined the association of many risk factors associated with CVD, the study was broken down by disease state with over 17,000 participants involved. The findings highlighted that 17.9% of these patients suffered from diabetes mellitus and death from a cardiovascular event. (3) Many other pilot and research studies discovered similar findings considering further risk factors such as high blood pressure, abnormal cholesterol and high triglycerides, obesity, lack of exercise and lifestyle choices such as smoking, alcohol and drug abuse. All of which are common with patients who suffer from diabetes, placing them at an increased risk of CVD.
Findings highlighted that over 68% of people aged over 65 living with diabetes die from some form of heart disease with 16% of individuals dying from an ischemic stroke. (4) The ability to tackle the prevalence of increased death from CVD and diagnosis of diabetes has become a global burden with the international diabetes federation projecting that 592 million people worldwide will have diabetes by 2035. (5)
Worldwide, the increase of diabetes is becoming an economic burden on the patient and healthcare systems mainly due to the direct costs of medical care and the indirect costs of moderated productivity, tied to diabetes and CVD related morbidity and mortality. Many scholars have highlighted economic burden as a primary attribute to both macrovascular and microvascular complications such as coronary artery disease, myocardial infarction, hypertension, peripheral vascular disease, retinopathy, end-stage renal disease and neuropathy. (6)
Overcoming the Burden
As CVD is the most prevalent cause of mortality and morbidity in patients with diabetes, effective treatment and analysis is required to control and decrease the number of CVD deaths across the globe. Tackling this issue head on, the Randox RX series introduce Direct HbA1c which refers to glycated haemoglobin which is a product of haemoglobin (a protein which can be found in red blood cells) and glucose from the blood making it glycated.
Testing for HbA1c provides an indication of what an individual’s average blood sugar level has been over recent weeks/months and is generally considered as an indicator of how well the patient is managing and controlling their diabetes. This is significant for those who suffer from diabetes because the higher the levels of HbA1c, the higher the chance of an individual suffering from further diabetes related issues, therefore testing for HbA1c improves the predictions of a CVD event occurring.
The Randox RX series have Direct HbA1c testing capabilities on the RX Daytona +, RX imola and RX modena. Our latex enhanced immunoturbidimetric method which the RX series utilises makes the test simple and quick to perform. The removal of the pre-dilution step removes the risk of human error compromising your results without the need for a separate HbA1c analyser.
Offering the world’s largest test menu, the RX series has an extensive range of cardiac, diabetes and lipid tests with excellent correlation to gold standard methodologies designed to allow laboratories to expand their testing capabilities onto one single platform, providing cost savings through consolidation.
References:
- American Heart Association. (2018). Heart Disease and Stroke Statistics 2018 At-a-Glance.Available: https://www.heart.org/-/media/data-import/downloadables/heart-disease-and-stroke-statistics-2018—at-a-glance-ucm_498848.pdf. Last accessed 7th Feb 2019.
- World Heart Federation. (2017). Cardiovascular diseases (CVDs) – Global facts and figures.Available: https://www.world-heart-federation.org/resources/cardiovascular-diseases-cvds-global-facts-figures/. Last accessed 7th Feb 2019.
- Gomadam, P et al, (2018). Blood pressure indices and cardiovascular disease mortality in persons with or without diabetes mellitus. Journal of Hypertension. 36 (1), 1-5.
- Heart attack and stroke symptoms. (2018). Cardiovascular Disease and Diabetes.Available: https://www.heart.org/en/health-topics/diabetes/why-diabetes-matters/cardiovascular-disease–diabetes. Last accessed 7th Feb 2019.
- Aguiree F, Brown A, Cho NH, Dahlquist G, Dodd S, Dunning T, Hirst M, Hwang C, Magliano D, Patterson C. (2013) IDF Diabetes Atlas.
- Bahia LR, Araujo DV, Schaan BD, Dib SA, Negrato CA, Leão MP, Ramos AJ, Forti AC, Gomes MB, Foss MC, Monteiro RA, Sartorelli D, Franco LJ, Value Health. (2011), 137-40.
Obesity and Kidney Disease: What is the Connection?
30th January 2019
Obesity and Kidney Disease: What is the Connection?
The month of January has forever been the month of resolutions with many choosing to ditch the sweets and join the gym. However, for many these efforts are limited to January and bad habits are quick to remerge. Obesity has been a burden on the health service for many years with the problem, like many people’s waist lines, only continuing to expand.
Recent findings have shown that this problem is no longer just increasing in developed countries but also in developing countries. In fact, worldwide obesity has tripled since 1975. In 2016, more than 1.9 million adults were classed as overweight, of which over 650 million were obese.1 These are shocking statistics for a condition that is preventable. As a global concern, it is important to assess all the potential risks of this problem.
The most common diseases associated with obesity are cardiovascular disease (CVD) and diabetes. However, the associated risks are much greater than this. Being overweight may also increase the risk of certain types of cancer, sleep apnea, osteoarthritis, fatty liver disease and kidney disease.2
Obesity is now recognised as a potent risk factor for the development of renal disease.3 Excess weight has a direct impact on the development and progression of chronic kidney disease (CKD). Globally, the prevalence of diabetic kidney disease rose by 39.5% between 2005 and 2015, coinciding with the increased CKD prevalence.4 In obese individuals, the kidneys have to work harder, filtering more blood than normal to meet the metabolic demands of increased body weight, increasing the risk of kidney disease.
The traditional diagnostic test for renal impairment is creatinine. This test is carried out through the measurement of creatinine levels in the blood to assess the kidneys ability to clear creatinine from the body. This is called the creatinine clearance rate which helps to estimate the glomerular filtration rate (GFR), which is the rate of blood flow through the kidneys.5
Problems arise when using creatinine for CKD testing as a number of factors need to be taken into consideration including age, gender, ethnicity and muscle mass. For this reason, black men and women exhibit higher creatinine levels than white men and women, raising concern over the accuracy of this test for certain patient groups.6 In addition, serum creatinine is not an adequate screening test for renal impairment in the elderly due to their decreased muscle mass.7
The main disadvantage of using creatinine to screen for renal impairment is that up to 50% of renal function can be lost before significant creatinine levels become detectable as creatinine is insensitive to small changes in GFR. Consequently, treatment is not provided at the appropriate time which can be fatal, therefore, an earlier and more sensitive marker for renal function is vital.8
These disadvantages have not only been highlighted in research but also by the national institute for health and care excellence (NICE). NICE updated the classification of CKD in 2004 to include the albumin: creatinine ratio (ACR). They split chronic kidney disease patients into categories based on GFR and ACR. Figure 1 highlights the different categories and risk of adverse outcomes. NICE recommend using eGFR Cystatin C for people in the CKD G3aA1 and higher.9
Figure 1 Classification of Chronic Kidney Disease using GFR and ACR categories.9
Despite these suggestions, Creatinine is still being used for G3a1 and increasing risk levels.
The utility of cystatin C as a diagnostic biomarker for kidney disease has been documented to show superiority of traditional CKD tests. There is no ‘blind area’ making it very sensitive to small changes in GFR and capable of detecting early reductions. Furthermore, this marker is less influenced by diet or muscle mass and has proven to be a beneficial test in patients who are overweight.8
A number of studies support the statement: ‘Cystatin C levels are higher in overweight and obese patients’. This is important because when cystatin c levels are too high, it may suggest that the kidneys are not functioning properly. One study conducted, using a nationally representative sample of participants, found that overweight and obesity maintained a strong association with elevated serum cystatin C. This suggests that weight can affect the levels of cystatin C and therefore the likelihood of developing kidney disease.10
How Randox can Help
The Randox automated Latex Enhanced Immunoturbidimetric Cystatin C tests offers an improved method for assessing CKD risk, combined with a convenient format for routine clinical use, for the early assessment of at risk patients. Randox is currently one of the only diagnostic manufacturers who offer an automated biochemistry test for Cystatin C measurement, worldwide.
Want to know more?
Contact us or visit our featured reagent page to learn more.
Related Products
Randox Reagents
Resource Hub
References
- World Health Organization. Obesity and Overweight . int. [Online] WHO. [Cited: January 22, 2019.] https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight.
- Health Risks of Being Overweight. NIDDK. [Online] National Institute of Diabetes and Digestive and Kidney Diseases. [Cited: March 24, 2019.] https://www.niddk.nih.gov/health-information/weight-management/health-risks-overweight.
- Kidney Health Australia . Obesity and Chronic Kidney Disease: The Hidden Impact. Kidney Health Week/ World Kidney Day 2017. [Online] Kidney Health Australia. [Cited: January 22, 2019.] https://kidney.org.au/cms_uploads/docs/kidney-health-australia-report-obesity-and-chronic-kidney-disease–the-hidden-impact_06.03.17.pdf.
- Neuen, Brendon Lange, et al. Chronic kidney disease and the global NCDs agenda. s.l. : BMJ Global Health, 2017
- Creatinine and Creatinine Clearance Blood Tests. WebMD. [Online] WebMD. [Cited: January 22, 2019.] https://www.webmd.com/a-to-z-guides/creatinine-and-creatinine-clearance-blood-tests#1.
- Lascano, Martin E and Poggio, Emilio D. Kidney Function Assessment by Creatinine-Based Estimation Equations. Cleveland Clinic. [Online] August 2010. [Cited: 16 May 2018.] http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/nephrology/kidneyfunction/.
- Swedko, Peter J, et al. Serum Creatinine Is an Inadequate Screening Test for Renal Failure in Elderly Patients. Research Gate. [Online] February 2003. [Cited: 6 May 2018.] https://www.researchgate.net/publication/8243393_Serum_Creatinine_Is_an_Inadequate_ Screening_Test_for_Renal_Failure_in_Elderly_Patients.
- Mishra, Umashankar. New technique developed to detect chronic kidney disease. Business Line. [Online] 07 May 2018. [Cited: 17 May 2018.] https://www.thehindubusinessline.com/news/science/new-technique-to-detect-chronic-kidney-disease/article23803316.ece.
- National Institute for Health and Care Excellence. Chronic kidney disease in adults: assessment and management: 1 Recommendations. National Institute for Health and Care Excellence. [Online] January 2015. https://www.nice.org.uk/guidance/cg182/chapter/1- recommendations#classification-of-chronic-kidney-disease-2.
- Overweight and Obesity and Elevated Serum Cystatin C Levels in US Adults . Muntner, Paul, et al. 4, s.l. : NCBI, 2008, Vol. 121.
The move from Nephelometry to Immunoturbidimetric Testing
Background
In clinical diagnostics, proteins are part of a wide range of biochemical markers used to identify health and disease in patient samples. Proteins play a key role in the human body, as they are involved in almost every process and can be associated to functions and regulatory pathways that are either signature for disease onset or a target for therapeutic intervention.
There are two main methods used to detect proteins in patient samples; nephelometry and immunoturbidimetry. Nephelometry although traditionally thought to be more sensitive can be expensive due to higher consumable costs. In addition to this nephelometers can be inefficient and are limited by their test menu. Immunoturbidimetric tests are an increasingly accepted alternative to nephelometry for specific protein assays, and studies have shown a close correlation between Randox immunoturbidimetric tests and nephelometry. This particularly lies with the latex enhanced immunoturbidimetry methodology utilised by Randox.
Why the RX series?
Renowned for quality and reliability, the RX series excels in clinical testing combining robust hardware, intuitive software and a world leading test menu featuring routine and novel high performing reagents.
Running specific protein tests on the RX series provides laboratories with a wide range of advantages. The move from nephelometric testing to immunoturbidimetric lowers laboratory costs as nephelometry requires the use of dedicated instruments which are much slower, have higher consumable costs and require highly trained personnel, with the disadvantage of not being able to perform any other type of assay on a single platform.
The RX series improves laboratory efficiencies not just saving costs but also time. Our range of routine clinical chemistry analysers provide users with flexibility and versatility through consolidation of testing onto one single platform.
High Performing and Unique Testing Menu
The RX series of specific protein assays assist in the diagnosis and evaluation of various conditions each with excellent sensitivity and limited inference levels. Randox manufacture immunoturbidimetric kits for the study of a wide range of specific proteins including unique products such as Apolipoprotein C-II, Apolipoprotein C-III, Apolipoprotein E, Cystatin C and Microalbumin.
Most recently the RX series welcomed the addition of Direct HbA1c to our testing panel, available to be run on the RX Daytona +, RX imola and RX modena. If you are interested in running your protein assays on a routine biochemistry analyser, Randox offers a large range of high quality routine and niche protein assays that can be run on most automated analysers.
Click to discover more about our world leading RX series Testing menu or contact us today @theRXseries to find out how we can improve your laboratories testing capabilities.
World Diabetes Day: The Biggest Burden on the NHS
Diabetes
Approximately 400,000 people in the UK are living with type 1 diabetes, with over 29,000 being children and young people [1]. Type 1 diabetes affects 96% of all children with diabetes in England and Wales, with incidences increasing by approximately 4% each year.
Globally, the UK has the fifth highest rate of type 1 diabetes diagnosis in children (aged up to 14) with 85% of these children having no family history of the condition. Whilst the condition isn’t fatal and can be managed, it cannot be cured. Type 1 diabetes increases the risk of developing other health problems such as heart disease, stroke, foot and circulation problems, sight problems including blindness, nerve damage and kidney problems. However, many of these related conditions are preventable and it is recommended to stabilise blood sugar levels, attend diabetes appointments regularly and complete a diabetes course to educate patients and family members and prevent the risk of further help complications[2].
Diabetes in children
Children under five are at the highest risk of developing diabetic ketoacidosis due to a late diagnosis and it is also thought to be due to of lack of public knowledge of the signs and symptoms attributed to type 1 diabetes. Such symptoms include:
- Frequent urination as the kidneys are trying to expel excess sugar in the blood, resulting in dehydration which leads to extreme thirst.
- Increased hunger or unexpected weight loss because the body is unable to attain enough energy from food
- Slow healing cuts as high blood sugar levels can affect blood flow which can cause nerve damage.
- Fatigue as the body is unable to convert sugar into energy
- Irritable behaviour combined with other symptoms can be a means of concern
Diabetes and the NHS
Diabetes costs the NHS approximately £9.8 billion per year, an estimate of 10% of total expenditures. Hospital admissions of children and young people with diabetes presents a considerable burden on themselves, their families and the NHS. It is estimated that approximately 80% of these cases are potentially avoidable.
A report produced by the National Paediatric Diabetes Audit found that although the numbers of admissions didn’t significantly differ year to year, it highlighted differences in terms of socio-economic risk factors:
- Living in a deprived area increases the risk of hospital admissions which can be attributed to lack of education in the community about diabetic symptoms and the management of diabetes.
- Children below 5 years of age have a 35% increased risk of hospitalisation compared to those aged 5-9
- Females have a 33% increased risk of developing type 1 diabetes compared to males.
- Children with poor diabetes control have a twelve-fold increased risk of hospital admission
- Insulin pump users have a 27% increased risk of hospital admission compared to those who use insulin injections.
Figure A. Number of preventable paediatric diabetes admissions [3]
Prevention
There are campaigns in place to aid in the early diagnosis of type 1 diabetes which mainly focus on raising awareness of the signs and symptoms of diabetes. On this World Diabetes Day, it is important to know that it is not just simply the responsibility of the diabetic patient to prevent admission but the main responsibility lies with the diabetic teams that inform the families with children who are diagnosed with type 1 diabetes.
Paediatric diabetes teams should ensure that the families and the children receive structured education for self-management when diagnosed and throughout the illness. In doing so, the diabetic teams should implement blood ketone testing from diagnosis and utilise the nationally agreed hypoglycaemia management guidelines. It is also important that diabetic teams are fully aware of the patient characteristics associated with a greater risk of admission and that they use this knowledge to develop anti-admission strategies specifically tailored to the needs of each individual group.
Primary care practitioners should seek access to a specialist diabetic team who they can refer to when deciding if a patient requires admission to hospital. Furthermore, they should access blood glucose and ketone testing to identify patients at risk of diabetic ketoacidosis that require hospital admission.
How Randox can Help
Randox offer a range of assays to diagnosis and monitor diabetes and to monitor associated complications. Some of these tests are unique to Randox, including:
Fructosamine
The Randox fructosamine assay employs the enzymatic method which offers improved specificity and reliability compared to conventional NBT-based methods. The Randox enzymatic method does not suffer from non-specific interferences unlike other commercially available fructosamine assays.
D-3-Hydroxybutyrate (Ranbut)
The Randox D-3-Hydroxybutyrate (Ranbut) assay detects the most abundant and sensitive ketone in the body, D-3-Hydroxybutyrate. The Randox Ranbut assay is used for the diagnosis of ketosis, more specifically diabetic ketoacidosis. Other commercially available tests, such as the nitroprusside method, are less sensitive as they only detect acetone and acetoacetate, not D-3-Hydroxybutyrate.
Adiponectin
The Randox adiponectin assay is a biomarker in diabetes testing as adiponectin is a protein hormone responsible for regulating the metabolism of lipids and glucose and influences the body’s response to insulin. Adiponectin levels inversely correlates with abdominal visceral fat levels.
Want to know more?
Contact us or visit our Diabetes panel page to learn more.
Related Products
Randox Reagents
Resource Hub
References
[1] National Paediatric Diabetes Audit and Royal College of Paediatrics and Child Health, National Paediatric Diabetes Audit Report 2012-15: Part 2, 2017
[2] NHS, “Avoiding Complications” – Type 1 Diabetes, Available at: https://www.nhs.uk/conditions/type-1-diabetes/avoiding-complications/ [Accessed on 24th October 2018].
[3] “Potentially Preventable Pediatric Hospital Inpatient Stays for Asthma and Diabetes, 2003-2012”, www.hcup-us.ahrq.gov, 2015. [Online] Available: https://www.hcup-us.ahrq.gov/reports/statbriefs/sb192-Pediatric-Preventable-Hospitalizations-Asthma-Diabetes.jsp [Accessed 08-Nov-18]
Automation vs. ELISA
Background
The technological developments and scientific innovations in the field of clinical chemistry from the early 1950’s to date have been vast, enhancing laboratory capabilities and providing the necessary support to clinicians and laboratories to improve patient diagnosis and treatment. (1) Laboratory automation today is a complex integration of robotics, computers, liquid handling and numerous other technologies with a fundamental purpose of saving time and improving performance through the elimination of human error.
Complementing this, in the early 1950’s ready-to-use assay reagent kits, with instructions for use introduced a very significant innovation to the field of automation eliminating the process of manually preparing reagent. (2)
Despite the many advancements in automation many clinical laboratories continue to use manual methods such as ELISA for some specialised tests. (3)
Inefficiencies with ELISA based methods
Manual ELISA based techniques are notoriously inefficient and are particularly draining on time and personnel due to the manual intervention required. The manual nature of the method also means there is greater potential for human error ultimately resulting in lack of sensitivity and potential for cross-reactivity. (4,5)
For many laboratories, the transition from traditional ELISA techniques to an automated method for the detection of the same analyte will significantly improve both costs and time.
Renowned for quality and reliability the RX series range of clinical chemistry analysers ensures confidence in patient testing.
Expanding Capabilities and Performance
With patient care holding a primary focus on clinical chemistry testing, the RX series range of semi-automated and automated analysers offer versatility to suit all laboratory requirements. Expanding your laboratory’s capabilities with our world leading extensive dedicated test menu offers cost savings through consolidation of both routine and specialised tests. By transitioning analytes historically only available as an ELISA based test, laboratories can expand their offering with ease to both patients and clinicians.
Our open system approach to clinical testing offers unique opportunities for consolidation, most of our unique and high-performance assays may be run on any clinical chemistry instrument without the need for specialised equipment.
Outperforming ELISA methodology, the RX series delivers a testing platform that requires limited or no manual preparation. With ELISA, the test is run on a 96 well plate using only a single assay with recommendations to duplicate or triplicate samples to evacuate the extent of errors, therefore increasing time and costs. The RX series of analysers each have different levels of throughput to adapt to the requirements of all laboratories. Utilising robust hardware and intuitive software the RX series guarantees accurate and precise patient testing.
References:
- Olsen K. The first 110 years of laboratory automation: technologies, applications, and the creative scientist. J Lab Autom. 2012; 17:469-80.
- Rosenfeld L. A golden age of clinical chemistry: 1948-1960. Clin Chem. 2000; 46:1705.14.
- Kricja LJ, Savory J. International year of chemistry 2011. A guide to the history of clinical chemistry. Clin Chem. 2011; 57:1118-26.
- Wild D, Sheehan C, Binder S. Introduction to immunoassay product technology in clinical diagnostic testing. In: Wild D, editor. Immunoassay Handbook: Theory and Applications of Ligand Binding, ELISA and Related Techniques. 4th Oxford, UK: Elsevier; 2013.
- Hawker CDED. Laboratory automation: total and subtotal. Clin Lab Med. 2007; 27:749-70.
Flu Season – Molecular Infectious Disease Testing
28 September 2018
Flu Season
Influenza (Flu)
Flu is a contagious respiratory illness cause by influenza viruses that infect the throat, nose, and sometimes lungs. It can cause illness and sometimes death. Getting vaccinated is the best way to prevent catching flu [1].
There are four types of seasonal flu, A, B, C, and D. Types A and B cause seasonal epidemics of disease. Illnesses range from severe to mild and can even result in death in high risk groups. High risk groups include, pregnant women, children under 5 years of age, the elderly, and people with chronic or immunosuppressive medical conditions [2].
Symptoms of Flu [3]
• Sudden fever (temperature above 38C)
• Feeling tired
• Headache
• Sore throat
• Loss of appetite
• Aching
• Chesty cough
Diagnosing Flu
A test to detect Influenza viruses can be used to determine whether a patient has the flu. A swab is taken from either the nose or back of the throat and sent for testing. Molecular assays can be used to detect genetic material of the virus [4]. Molecular methods play an important role in the diagnosis and surveillance of influenza viruses. Molecular diagnostics allow timely and accurate detection of influenza and are already implemented in many laboratories. The combination of automated purification of nucleic acids with real-time PCR should enable even more rapid identification of viral pathogens such as influenza viruses in clinical material [5].
The spread of Flu
Flu season begins as early as October, reaches its peak in February, and ends in March. In the southern hemisphere, flu season falls between June and September. Wherever it’s cold, it’s flu season. This can be seen in Figure A below, which shows google searches for the term ‘flu’ for the last five years for USA (northern hemisphere) and Australia (southern hemisphere). It is obvious that flu is prevalent at different times in the northern and southern hemisphere.
However, it’s a common misconception that flu is caused by the cold. There are many theories as to why the flu season comes in winter [7]:
1. People spend more time indoors, with windows closed, not getting fresh air.
2. A lack of Vitamin D and melatonin from reduced sunlight, weakening the immune system.
3. Influenza virus thrives in the cold, dry air of winter
Of course, there have been attempts to test these theories, but animals do not contract the virus like humans, so testing is difficult. A researcher named Peter Palese decided to test theory 3 after finding an old medical journal article that reported guinea pigs are infected and spread the flu like humans.
Figure A. Google Searches for ‘Flu’ in USA and Australia for the last 5 years [6]
Having set up cages with varying temperatures and relative humidity, he observed how they affected the spread of the flu virus. He found Influenza spread more effectively in cold, dry air [8].
A theory about why this is the case is associated with how the virus moves through the air. When someone breaths out, they release little virus-containing droplets in to the air. The droplet then begins to evaporate. A lower relative humidity means there is less water in the air, meaning there is more room in the air for additional moisture, allowing the droplets to evaporate. A higher humidity means the droplet can’t evaporate because there isn’t as much room for more moisture, and the virus is not suspended into the air [9].
Whatever the case, the fact remains: when winter comes around, the flu will follow.
Prevention
You can avoid catching the flu by getting the flu shot, investing in a humidifier, keeping your hands clean, and limiting contact with those who are already ill. Immunity gained from vaccination decreases over time, so annual vaccination is recommended. Vaccines are most effective when they closely match viruses in circulation. The constantly evolving nature of Influenza viruses requires the WHO Global Surveillance and Response System to monitor influenza viruses around the world and update vaccinations accordingly.
Personal protective measures can be taken in addition to vaccination [2]:
• Properly washing and drying the hands
• Covering the mouth and nose when coughing and sneezing
• Self-isolation when showing symptoms of influenza
• Avoiding contact with sick people
• Avoiding touching the eyes, nose, and mouth
How Randox can Help
Randox offers molecular controls, calibrators, and EQA programmes for respiratory infection testing, which includes Influenza A and B, Adenovirus, Rhinovirus, and others.
Want to know more?
Contact us or visit our Qnostics page to learn more.
Related Products
Molecular EQA
Acusera Controls
RIQAS EQA
Resource Hub
References
[1] “Key Facts About Influenza (Flu) | Seasonal Influenza (Flu) | CDC”, Cdc.gov, 2018. [Online]. Available: https://www.cdc.gov/flu/keyfacts.htm. [Accessed: 25- Sep- 2018].
[2] “Influenza (Seasonal)”, World Health Organization, 2018. [Online]. Available: http://www.who.int/en/news-room/fact-sheets/detail/influenza-(seasonal). [Accessed: 27- Sep- 2018].
[3] “Flu”, nhs.uk, 2018. [Online]. Available: https://www.nhs.uk/conditions/flu/. [Accessed: 25- Sep- 2018].
[4] “Diagnosing Flu | Seasonal Influenza (Flu) | CDC”, Cdc.gov, 2018. [Online]. Available: https://www.cdc.gov/flu/about/qa/testing.htm. [Accessed: 25- Sep- 2018].
[5] J. Ellis and M. Zambon, “Molecular diagnosis of influenza”, Reviews in Medical Virology, vol. 12, no. 6, pp. 375-389, 2002.
[6] “Google Trends”, Google.com, 2018. [Online]. Available: https://trends.google.com/trends/. [Accessed: 26- Sep- 2018].
[7] “The Reason for the Season: why flu strikes in winter – Science in the News”, Science in the News, 2014. [Online]. Available: http://sitn.hms.harvard.edu/flash/2014/the-reason-for-the-season-why-flu-strikes-in-winter/. [Accessed: 26- Sep- 2018].
[8] A. Lowen, S. Mubareka, J. Steel and P. Palese, “Influenza Virus Transmission Is Dependent on Relative Humidity and Temperature”, PLoS Pathogens, vol. 3, no. 10, p. e151, 2007.
[9] “Why Is There a Winter Flu Season?”, Popsci.com, 2013. [Online]. Available: https://www.popsci.com/science/article/2013-01/fyi-why-winter-flu-season#page-5. [Accessed: 26- Sep- 2018].
The RX series celebrate Biomedical Science Day
Biomedical Science Day is taking place this year on the 19th of July. This is an annual celebration with the aim of raising public awareness of the importance of biomedical science and the vital role it plays in the world.
To celebrate biomedical science day the RX series interviewed Aidan Murphy, one of our laboratory analysts at Randox to find out more about what his job in the lab entails day-to-day. Aidan works with the RX series of clinical chemistry analysers and Randox QC on a daily basis.
We asked Aidan a few questions about his life as a scientist. See what he gets up to in Randox on a daily basis …
1. What attracted you to a career in laboratory science?
Science has always interested me in both my academic and personal life, I always aspired to get a science based degree and after achieving this I now hope to improve my laboratory skills to increase my employability.
2. What were your stronger subjects at school?
My strongest subjects in school were biology, chemistry, music and politics. Some of which are more applicable to my current role than others.
3. What does your job in Randox entail?
My job entails a variety of roles ranging from testing Randox diagnostic kits before they’re released to customers as well as maintenance and precision checks of the machines in our lab.
4. What aspects of your job do you enjoy the most?
The independence in my job is great. Knowing what I have to do at the start of each week and the deadlines to do these jobs requires me to organise and prioritise my work accordingly.
5. What are some common preconceived ideas the public have about what laboratory staff do?
From my friends’ ideas of what I do in the lab I have found that a stereotypical image of a lab is one of a dark quiet lab full of strange equipment and even stranger people. However fortunately my lab is a lively one and thankfully with normal people.
6. In your opinion, what are the most important aspects of laboratory work?
Following correct protocols and procedures are imperative in an efficient laboratory. As well as this, good lab practice and good hygiene can have a massive effect on the accuracy of our results.
7. What’s in your lab coat pocket?
My lab coat pockets are quite boring. I have a pair of safety goggles, some post-its and some pens and markers.
8. In what ways does your work make a difference to people’s lives?
Randox is dedicated to improving the quality of diagnostics globally, so knowing that the kits that I have tested are then sent to customers to be used in patient diagnosis gives me a level of job satisfaction that I haven’t got from previous jobs.
Aidan is a fundamental member of the Randox team and plays an essential role in the diagnosis and prevention of disease through his work. Without our valuable laboratory team working extremely hard behind the scenes the lifesaving work we do here at Randox would not be possible.
To find out more about Randox products contact us at theRXseries@randox.com.
Check out our social media sites for more on Biomedical Science Day.
Biochip vs ELISA: Which testing platform is right for me?
Biochip Vs ELISA
Randox Toxicology’s latest video series, ‘Biochip Vs ELISA’, highlights our routine and novel ELISA products and how they differ from Biochip Array Technology.
Showcasing the journey and ongoing brand evolution of Randox Toxicology, these videos will help you to discover which method is right for you!
Episode 1: Meet ELISA
Episode 1 “Meet ELISA” uses speed reading to showcase Randox Toxicology’s extensive and ever-expanding ELISA test menu, including our range of New Psychoactive Substances, drugs of abuse, stimulants, analgesics and sedatives. Manufactured in the United Kingdom, our continuous reinvestment in research and development has enabled us to develop a range of exclusive ELISA kits such as, Mitragynine, MT-45, and U-47700 which was involved in the death of the famous singer Prince.
Our cost effective ELISA kits are the highest quality on the market and results provide excellent correlation with confirmatory methods, typically <10% CV.
Episode 2: Meet Biochip
Based on ELISA principles, Episode 2 “Meet Biochip” illustrates Biochip Array Technology as a solid-state device with discrete test sites onto which antibodies specific to different drug compounds are immobilised and stabilised. Moving away from traditional single analyte assays, Biochip Array Technology boasts cutting-edge multiplex testing capabilities for rapid and accurate drug detection from a single sample.
As the primary manufacturers of Biochip Array Technology, Randox Toxicology offer the most advanced screening technology on the market. With the world’s largest test menu capable of detecting over 500 drugs, Randox Toxicology are changing the landscape of drugs of abuse testing.
Episode 3: Biochip Vs ELISA
Episode 3 “Biochip Vs ELISA” gives you the opportunity to hear from a professional! Laura Keery our Senior Research and Development Team Leader gives you a behind the scenes look at our Biochip Array Technology and ELISA products in action at our new Science Park, answering some of those must know questions.
Episode 4: Biochip Vs ELISA 360-Degrees
If you missed it at SOFT-TIAFT 2017, our Biochip Vs ELISA 360-degree video allows you to experience Biochip and ELISA in action.
Discover which method is right for you! #biochipvselisa
For more information about our revolutionary Biochip Array Technology and ELISA kits, email info@randoxtoxicology.com or visit www.randoxtoxicology.com
