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Background: Assessment of kidney function in emergency settings is essential across all medical subspecialties. Daily assessment of patient creatinine result from emergency medical services showed that some creatinine results apparently deviated from expected creatinine values implying occurrence of drug-related interferences. Methods: Real-time head-to-head clinical evaluation of an enzyme method (Roche CREP2) in comparison to Jaffé gen. 2 method (Roche CREJ2) was performed. During the period of December 2022 and January 2023 we analyzed 8498 patient specimens where 5524 were heavily medicated STAT patient specimens, 500 were pediatric specimens and 2474 specimens were from a distant general population in a different region using the same methods. Results: About 5 percent of hospital specimens having patient history showed apparent drops of creatinine concentrations by the enzyme method against the compensated Jaffé method. Suspect medication was found in 43 out of 46 reviewed patients where medication data were allowed for review. A general patient cohort showed no drops of concentrations measured by the enzyme method. Pediatric hospital cohort showed 6 drops out of 500 total measurements. Conclusions: Pharmacotherapy-induced inaccuracies with enzyme creatinine methods imply the need for proper method validations in the relevant patient population such as emergency hospital setting and may facilitate introduction of cystatin C to emergency medicine clinical practice as suitable creatinine alternate biomarker.

Background: Assessment of kidney function in emergency settings is essential across all medical subspecialties. Daily assessment of patient creatinine result from emergency medical services showed that some creatinine results apparently deviated from expected creatinine values implying occurrence of drug-related interferences. Methods: Real-time clinical evaluation of an enzyme method (Roche CREP2) in comparison to Jaffé gen. 2 method (Roche CREJ2) was performed. During the period of December 2022 and January 2023 we analyzed 8498 paired patient specimens, 5524 were heavily medicated STAT patient specimens, 500 were pediatric specimens and 2474 were analyzed in a distant general population in a different region using the same methods. Results: About 2 percent of hospital specimens with patient history showed apparent drops of creatinine concentrations with the enzyme method against the compensated Jaffé method. Suspect medication was found in 43 out of 46 reviewed patients where medication data were allowed for review. A general patient cohort showed no drops of concentrations measured by the enzyme method. Pediatric hospital cohort showed 6 drops out of 500 total measurements. Conclusions: We implemented immediate corrective measures that were replacement of enzyme creatinine with Jaffé gen.2 method, the “full Schwartz” composite formula for pediatric medicine and CKD-EPI with cystatin C for STAT adult medical services. We conclude that pharmacotherapy-induced inaccuracies with enzyme creatinine methods imply the need for proper method validations in the relevant patient population and may facilitate introduction of cystatin C to emergency medicine clinical practice.

Spindle cell hemangioma is a benign vascular tumor typically occurring in the dermis or subcutis of distal extremities as red–brown lesions that can grow in both size and number over time. They can be very painful and potentially disabling. A family history of cancer or previous history may be relevant and must be taken into consideration. Juxtaglomerular cell tumor (reninoma) is an extremely rare cause of secondary hypertension diagnosed mostly among adolescents and young adults. Excessive renin secretion results in secondary hyperaldosteronism. Subsequent hypokalemia and metabolic alkalosis, together with high blood pressure, are clues for clinical diagnosis. Histological examination of the excised tumor leads to a definitive diagnosis. Reninoma is found in subcapsular localization, in most cases as a solitary mass, in imaging studies of kidneys. Exceptionally, it can be located in another part of a kidney. Both spindle cell hemangioma and reninoma are extremely rare tumors in children and adolescents. Herein, the authors present a case report of a patient with hereditary BRCA1 interacting protein C-terminal helicase 1 (BRIP1) mutation, spindle cell hemangioma, and secondary hypertension caused by atypically localized reninoma.

Paroxysmal nocturnal hemoglobinuria (PNH) is a rare disorder of unknown frequency. In its classic form, PNH is characterized by hemolysis accompanied by nocturnal hemoglobinuria. The clinical course is unpredictable and may vary from severe hemolysis and recurrent venous thrombosis to latent periods with milder symptoms. We report a 15-year-old girl with hemolytic episodes, abdominal pain, and passage of dark urine. Hemoglobinuria was demonstrated by a "blood"-positive dipstick test in the absence of red blood cells in the urinary sediment. The diagnosis of PNH was confirmed by flow cytometry.