Background and Objective: Information about the type of kidney stones is important for informed therapeutic decisions and the prevention of urolithiasis. Urinary stones are heterogeneous, and their elemental composition and crystal structure vary between patients. The formation of urinary stone deposits depends, among other things, on physiological conditions, the concentration of promoters and inhibitors of crystallization, and proteins found in the urine. The aim of this study was to determine differences in urine osteopontin (OPN) levels between groups of different stone-formers. Methods: Urinary stone specimens (n = 44) were acquired during elective endoscopic procedures. Specimens were divided into subgroups by k-means cluster analysis depending on calcium and phosphorus concentrations. The concentration of urine OPN was determined and compared for each subgroup and the control group. Results: Cluster analysis divided the deposits into three clusters. Cluster 1 contained mainly calcium oxalate deposits; Cluster 2 contained uric acid deposits; Cluster 3 contained deposits with a high content of calcium phosphate. Urine OPN concentration in CaP stone-formers (5.77 ng/mL) differed significantly from those of controls (17.05 ng/mL, p = 0.013) and CaOx stone-formers (15.31 ng/mL, p = 0.048). Conclusions: The concentration of urine OPN varies depending on the elemental composition of renal calculi. The lowest concentration of OPN was determined in the group of patients with a high content of calcium phosphate in the deposits.

BACKGROUND/OBJECTIVES:Urolithiasis is a common disease in Western societies, affecting approximately 10% of the population, and more often men than women. The formation of renal calculi is a complex process, including various compounds and proteins. The aim of this study is to compare differences between the trace element concentrations in male and female renal calculi as well as differences between the trace element concentrations in different stone types. MATERIAL AND METHODS:Renal calculi specimens were obtained during elective nephrolithotripsy procedures. Crystallography of renal calculi was performed using X-ray diffraction; an elemental analysis was performed using Inductively Coupled Plasma-Optical Emission Spectrometry. Statistical analysis was performed to assess the differences in the metal element concentration between men and women. The second part of the analysis measured the differences in the metal element concentration between stones containing calcium phosphate (CaP) and pure calcium oxalate (CaOx) stones. RESULTS:The renal calculi (n = 20) obtained from the male patients had a lower potassium concentration than the calculi (n = 24) from the female patients: 393.4 vs. 792.3 mg/kg, p = 0.007. A comparison of the CaP calculi and CaOx calculi showed a higher zinc concentration (p < 0.001) and potassium concentration (p < 0.001) in the stones containing calcium phosphate. CONCLUSIONS:The renal calculi from females had a significantly higher potassium content than those from males. This difference was not correlated with hyperkalemia or the blood potassium levels, suggesting a sex-dependent role of uromodulin in stone formation. The stones containing calcium phosphate exhibited higher zinc and potassium concentrations compared to the pure calcium oxalate stones. The increased presence of zinc and potassium in urine may accelerate the formation of calcium phosphate calculi.

Purpose:Epidemiological analysis of medical data of patients with type 1 diabetes (T1DM) and disease complications treated in hospital. Methods:A retrospective, cross-sectional study was conducted on records from 306 patients with type 1 diabetes (180 men and 126 women). The study analyzed demographic, clinical, and biological data, focusing on associations between Hashimoto's disease, neuropathy, and retinopathy using k-means clustering. Results:Hypertension was present in 28.8%, Hashimoto's disease in 17.6%, retinopathy in 17.6%, neuropathy in 8.2%. Multivariate logistic regression showed that the chance of retinopathy more than doubles with the coexistence of hypertension (OR 2.096, 95% Cl: 1.035-4.248) and this chance increases by 4.5% with each year of age compared to the previous year (OR 1.045, 95% Cl: 1.011-1.080). The risk of neuropathy increases by 10.8% with each year since diabetes diagnosis compared to the previous year (OR = 1.108, 95% Cl: 1.062-1.156) and the chance of this disease rises by 17.6% with each year of diabetes duration compared to the previous year (OR 1.176, 95% Cl: 1.092-1.267). Clustering was strongest in patients without comorbidities (66.3%). Only 2.3% had Hashimoto's disease and retinopathy, 3.59% had retinopathy and neuropathy, and just 1.3% had all three conditions. Conclusion:Patient age, duration of diabetes, and the presence of hypertension are key risk factors for diabetes-related complication.

Key Clinical Message Lupus anticoagulant caused aPTT prolongation in rare case can cause bleeding tendency especially when combined with other hemostasis abnormalities. In such cases, aPTT value can be corrected by immunosuppressants within several days of treatment. When anticoagulation therapy is needed vitamin K antagonist are a good option for the initial treatment. Abstract Lupus anticoagulant antibodies despite causing aPTT prolongation are commonly associated with increased risk of thrombosis. We present a rare case of patient when these autoantibodies resulted in dramatic aPTT prolongation and combined with associated thrombocytopenia resulted in minor bleeding events. In presented case treatment with oral steroids resulted in aPTT values correction followed by resolution of bleeding tendency within several days. Later, the patient developed chronic atrial fibrillation and was started on anticoagulation treatment initially with vitamin K antagonist without bleeding complications during follow‐up period. Corresponding changes in patient's aPTT time in a course of whole treatment is presented.

2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Rules for diagnosing carbohydrate metabolism disordersKey recommendations• Blood sugar tests for early detection of prediabetes/type 2 diabetes should be performed for people over 45, as well as for younger overweight or obese people if there is at least one additional risk factor of diabetes.[B]• Women not previously diagnosed with diabetes should undergo an oral glucose tolerance test between 24 th and 28 th week of pregnancy to diagnose gestational diabetes.[A]• Diagnosing diabetes in children during the first 9 weeks after birth requires genetic tests for neonatal diabetes.[a]• Patients with cystic fibrosis aged 10 and above should undergo an oral glucose tolerance test each year to diagnose diabetes.[a]Diabetes is a group of metabolic diseases characterised by hyperglycaemia resulting from a defect in insulin secretion and/or activity.Chronic hyperglycaemia is associated with damage, dysfunction and failure of various organs, especially the eyes, kidneys, nerves, heart and blood vessels. I. Symptoms indicative of potentialdiabetes with significant hyperglycaemia:• increased diuresis (polyuria);• increased thirst;• loss of weight not explained by intentional dieting;• other, less typical symptoms: weakness and increased sleepiness, purulent skin lesions and inflammation of genitourinary organs. II. Rules for diagnosing carbohydrate metabolism disorders:• if symptoms of diabetes occur, a random blood sugar test should be performed, with result ≥ 200 mg/dl (≥ 11.1 mmol/l) constituting grounds for diagnosing diabetes;2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Prevention and delay of diabetes Key recommendations• Patients with pre-diabetes should be given recommendations on a healthy lifestyle (physical activity at least 150 min/week; in case of overweight and obese patients, weight reduction of at least 7% and weight maintenance) and information on the effectiveness of such measures in preventing the development of diabetes.[a]• Apart from the modification of lifestyle, pharmacological prevention of diabetes in the form of metformin should be considered in pre-diabetic patients, especially patients with concomitant IFG and IGT and/or a body mass index (BMI) ≥ 35 kg/m 2 and/or patients under 60 years of age, as well as in women with a history of gestational diabetes mellitus.[a]• Screening should be performed using fasting glucose, oral glucose.[c] Type 1 diabetesCurrently, there is no effective method of preventing type 1 diabetes either in the general population or at-risk people.Type 2 diabetes 1. Screening should be performed using fasting glucose or oral glucose tolerance test.2. Risk factors of type 2 diabetes (see chapter 1). Review of recommendations for preventing or delaying the development of diabetes:2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Monitoring of glucose Key recommendations• Most people on insulin therapy using the method of multiple daily injections should self-monitor blood glucose (SMBG) both before and after meals, at bedtime, before planned physical activity, when low blood glucose is suspected, and before activities where hypoglycaemia is particularly dangerous (e.g.driving).[B] 2022 Guidelines on the management of patients with diabetes A position of Diabetes Poland Setting objectives for diabetes managementKey recommendations• In individuals with diabetes, the overall target for glycaemic control expressed by the HbA 1c level is no more than 7.0% (53 mmol/mol).[a]• LDL fraction cholesterol less than 55 mg/dl (less than 1.4mmol/l) and a reduction of at least 50% from baseline in individuals with very high cardiovascular risk diabetes.[B]• LDL-C concentration less than 70 mg/dl (1.8 mmol/l) and a reduction of at least 50% from baseline in individuals with high cardiovascular risk diabetes.[a]• LDL-C levels less than 100 mg/dl (2.6 mmol/l) in individuals at moderate cardiovascular risk (young people under 35 yrs.with type 1 diabetes without chronic complications and other cardiovascular risk factors or with type 2 diabetes below 50 yrs.with a diabetes duration of less than 10 years, without other risk factors).[a]• Recommended arterial blood pressure: less than 130/80 mm Hg. [a]

INTRODUCTION:Diabetic kidney disease (DKD) pathogenesis is multifactorial and is a combination of metabolic, genetic, and environmental factors. Due to a long period of asymptomatic course, it is often diagnosed late when advanced stages of the disease are present. Among patients with diabetes, the presence of chemotactic cytokine receptor 5 (CCR5) gene polymorphism is suspected to be associated with the risk of DKD occurrence; however, the results of the research conducted so far are inconclusive. The aim of this study was to evaluate the CCR5 gene polymorphism (rs1799987, 59029 A/G) association with DKD among patients with type 2 diabetes mellitus (T2DM), who are residents of the Upper Silesia region of Poland.MATERIAL AND METHODS:CCR5 gene polymorphism (rs1799987, 59029 A/G) was assessed among consecutive patients with type 2 diabetes mellitus (T2DM) treated in a single outpatient diabetology clinic in Upper Silesia, Poland. Its association with DKD was examined. Additionally, selected clinical and demographic data were included in the analysis.RESULTS:Among 467 eligible study patients, there was no association between examined CCR5 gene polymorphism and the presence of DKD in relation both to the American Diabetes Association definition (p = 0.6) and to the National Kidney Foundation definition (p = 0.3) of this complication.CONCLUSION:The presented study did not confirm the association between the examined gene polymorphism and the risk of DKD; further studies in this area are needed in order to establish or explicitly exclude this association.

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TBC1D1 and TBC1D4 proteins play analogous, but not identical role in governing insulin-signalling pathway. Little is known about changes in expression levels of TBC1D1 and TBC1D4 genes in mammals, including humans. Number of factors were studied, but data remain controversial. The aim of this study was to evaluate the effect of selected cytokines, adipokines and myokines with known or putative insulin sensitivity regulation activity (adiponectin, irisin, omentin, interleukin 6, leptin, resistin, and tumour necrosis factor) on TBC1D1 and TBC1D4 expression levels in cultured differentiated human adipocytes. No significant differences were found between the adipocytes treated with different stimuli and this effect was determined not dose dependent. It is reasonable to conclude that relative shortage of data showing no change in TBC1D1 and TBC1D4 from literature results from publication bias; therefore, our finding provides additional insight into the role of both genes.

Positron emission tomography (PET) is a nuclear imaging technique that uses radiotracers to visualize metabolic processes of interest across different organs, to diagnose and manage diseases, and monitor therapeutic response. This systematic review aimed to characterize the value of PET for the assessment of renal metabolism and function in subjects with non-oncological metabolic disorders. This review was conducted and reported in accordance with the PRISMA statement. Research articles reporting “kidney” or “renal” metabolism evaluated with PET imaging between 1980 and 2021 were systematically searched in Medline/PubMed, Science Direct, and the Cochrane Library. Search results were exported and stored in RefWorks, the duplicates were removed, and eligible studies were identified, evaluated, and summarized. Thirty reports met the inclusion criteria. The majority of the studies were prospective (73.33%, n = 22) in nature. The most utilized PET radiotracers were 15O-labeled radio water (H215O, n = 14) and 18F-fluorodeoxyglucose (18F-FDG, n = 8). Other radiotracers used in at least one study were 14(R,S)-(18)F-fluoro-6-thia-heptadecanoic acid (18F-FTHA), 18F-Sodium Fluoride (18F-NaF), 11C-acetate, 68-Gallium (68Ga), 13N-ammonia (13N-NH3), Rubidium-82 (82Rb), radiolabeled cationic ferritin (RadioCF), 11C‐para-aminobenzoic acid (11C-PABA), Gallium-68 pentixafor (68Ga-Pentixafor), 2-deoxy-2-F-fluoro-d-sorbitol (F-FDS) and 55Co-ethylene diamine tetra acetic acid (55Co-EDTA). PET imaging provides an effective modality for evaluating a range of metabolic functions including glucose and fatty acid uptake, oxygen consumption and renal perfusion. Multiple positron emitting radiolabeled racers can be used for renal imaging in clinical settings. PET imaging thus holds the potential to improve the diagnosis of renal disorders, and to monitor disease progression and treatment response.

Background: Vitamins A, C and E are important parts of the antioxidant barrier. Polish data on antioxidant vitamins deficiency in the population are rare, especially among physically active people with metabolic disorders. The aim of this study was to evaluate the serum concentrations of vitamins A, C and E in people with metabolic syndrome (MS) working in agriculture, the prevalence of their deficiency in these workers, and the correlation between antioxidant vitamins concentration and traditional biomarkers of cardiovascular diseases. Material and Methods: The study included 332 residents of the Lodi Voivodeship working in agriculture: 231 people with MS and 101 healthy ones. The serum concentrations of vitamins A, C and E were assessed using the chemilu-minescent immunoassay technology. The antioxidant vitamins intake was assessed by means of a 24-h recall questionnaire using Diet 5.0 software. Results: 'Ihe mean serum concentrations of vitamins A, C and E were significantly lower in the MS workers than in the healthy ones No correlation was found between the antioxidant vitamins concentration and the dietary intake but there was a correlation between the antioxidant vitamins concentration and high-density lipoprotein cholesterol (HDL-C). A correlation was found between the serum concentrations of vitamins A and C, and vitamins A and E, in the MS workers. Conclusions: The serum concentrations of antioxidant vitamins in the MS workers were significantly lower than in the healthy controls, despite the similar physical activity level. The dietary intake had no impact on the serum concentrations of these vitamins. The HDL-C concentration in the MS workers correlated with the concentrations of all antioxidant vitamins.

INTRODUCTION Cardiovascular diseases are the main death cause in Poland. Several clinical studies showed association between metabolic syndrome and higher prevalence of diabetes mellitus, cardiac events and mortality. The aim of the study was to estimate cardiovascular complications and death risk in subjects with metabolic syndrome (MS) working in agriculture. MATERIAL AND METHODS The study included 332 people working in agriculture in Lodz voivodeship, 231 with MS and 101 healthy ones. Increased risk of cardiovascular complications was determined for pulse pressure (pp) >63 mmHg. Based on the SCORE index, 10-year death risk due to cardiovascular complications was estimated taking into account sex, age, smoking, systolic blood pressure and total cholesterol concentration. A value ≥5% was accepted as high risk of death within 10 years. RESULTS Increased risk of cardiovascular complications (pulse pressure >63 mmHg) was found in 31.60% subjects with MS and 6.93% healthy ones. CONCLUSIONS High risk of cardiovascular complications and death occurs statistically more frequently in subjects with MS than in the rest of the population.

cukrzyca z gluchotą dziedziczona w sposob matczyny (MIDD, maternally-inherited diabetes with deafness ) jest rzadką postacią cukrzycy monogenowej, w wiekszości spowodowanej zastąpieniem A przez G w pozycji 3243 mitochondrialnego DNA (m.3243A > G). Obraz kliniczny mutacji m.3243A > G jest zmienny, od fenotypow lagodnych do ciezkich. cukrzycy czesto towarzyszą gluchota czuciowo-nerwowa, kardiomiopatia, zaburzenia nerwowo-mieśniowe, zaburzenia psychiatryczne, dystrofia plamki zoltej i niewydolnośc nerek (zaburzenia nerkowe u doroslych z tą mutacją pozostają slabo zdefiniowane). W pracy przedstawiono przypadek 40-letniej kobiety z obustronną gluchotą czuciowo-nerwową, niewydolnością nerek i cukrzycą w wywiadzie, u ktorej rozpo-znano nasilające sie oslabienie mieśni podczas wysilku. Na podstawie obrazu klinicznego oraz wynikow badan laboratoryjnych, w tym badan genetycznych, rozpoznano zespol MIDD. Wedlug wiedzy autorow nigdy wcześniej nie opisywano glomerulopatii z niekompletną kwasicą cewkową dystalną jako przyczyny niewydolności nerek u pacjentow z zespolem MIDD.

Background and Aims: The environmental risk factors of diabetic kidney disease (DKD) do not allow identification of people at higher risk of it. A lot of expectations are being placed to the genetic predisposition. Among patients with diabetes, the presence of CCR5 gene polymorphism is suspected to be associated with DKD, yet the results are inconclusive. The aim of this study was to evaluate its association with DKD among Polish patients with type 2 (T2DM). Materials and Methods: CCR5 gene polymorphism (rs1799987, 59029 A/G) was assessed among 467 consecutive patients with T2DM visiting one outpatient diabetology clinic in Upper Silesia, Poland. DKD diagnosis was based on urinary albumin creatinine ratio >300 mg/g and the presence of diabetic retinopathy. Information related to time of diabetes duration and HbA1c were collected. Results: Clinical characteristic of studied patients is presented in Table 1. We found that both GG genotype (p=0.035) and allele G (p=0.02) were significantly associated with DKD occurrence and G allele was present in all of the DKD patients. Conclusion: A significant association between rs1799987 polymorphism of CCR5 gene and the presence of DKD in the group of Polish patients with T2DM was found what is in accordance with some previous studies. Further studies are needed in this area to confirm this association. Disclosure K. Nabrdalik: None. P.S. Pokrzywnicka: None. H. Kwiendacz: None. P. Adamczyk: None. D. Moczulski: None. H. Moczulska: None. K. Drozdz: None. W. Grzeszczak: None. J. Gumprecht: Consultant; Self; Astra, Bioton, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Polfa Tarchomin S.A., Sanofi, Servier. Speaker’s Bureau; Self; Astra, Bioton, Boehringer Ingelheim International GmbH, Eli Lilly and Company, Merck & Co., Inc., Merck Sharp & Dohme Corp., Mundipharma International, Novo Nordisk A/S, Polfa Tarchomin S.A., Sanofi, Servier.

Introduction: Multifactorial pathogenesis of diabetic kidney disease (DKD) consists of a combination of metabolic, environmental, and genetic factors. A genome-wide association study has shown that ELMO1 is a candidate gene for DKD occurrence and progression. The aim of this study was to assess the association of a single nucleotide polymorphism (rs741301) of the ELMO1 gene with DKD in Polish patients with type 2 diabetes (T2DM). Material and methods: This was a case/control study of 272 T2DM patients with or without DKD. Patients were divided into groups depending on DKD definition according to the American Diabetes Association (ADA) and the National Kidney Foundation (NKF). The association of the rs741301 polymorphism with DKD was assessed in the whole study group as well as in the subgroups stratified according to the presence of DKD. Results: There was no association between rs741301 polymorphisms and the presence of DKD in relation to the ADA definition (p = 0.6) or the NKF definition (p = 0.5) of DKD and with estimated glomelural filtration rate (eGFR) value reflecting the stage of the chronic kidney disease (p = 0.8). Conclusions: Even though the results of this study are negative, there is still a great need for larger studies assessing the genetic susceptibility to DKD to identify patients who are particularly prone to this complication.

Sir, Recent reports highlight the possible genetic background of chronic spontaneous urticaria (CSU). According to eligible published papers, polymorphisms in genes related to inflammation and autoimmunity may predispose to CSU.[1,2] Tumor necrosis factor (TNF) is secreted mainly by macrophages and mast cells and acts as a multifunctional pro-inflammatory cytokine. Its synthesis is augmented on mast cell activation. A few controlled studies showed that TNF-α is upregulated in patients with CSU.[3] Moreover, a few trials in small series gave promising results with TNF-α inhibitors as an effective tool in controlling recalcitrant CSU. Since the role of TNF-α in CSU is suspected, the role of certain polymorphisms of TNF-α can be hypothesized. In our study, patients’ group was composed of 153 unrelated CSU patients (91 females and 62 males, mean age: 36.4 years, range: 19–61) with positive autologous serum skin test (ASST) result. The control group was composed of 106 unrelated healthy volunteers (70 females and 36 males, mean age: 38.9 years, range: 18–59). All individuals were Caucasian and came from the Polish population. Disease severity was analyzed by a 7-day assessment with the Urticaria Activity Score. The age of disease onset was also analyzed. In all the examined subjects, we studied TNF1α rs1799964, rs1799724, and rs1800629 polymorphisms. In statistical analyses, we used Chi-square, odds ratio, and ANOVA tests. The study was approved by the Bioethics Committee of the Medical University of Silesia in Katowice, Poland.

Recent studies underline a potential role of autoimmune and genetic disturbances in this disorder pathogenesis. Variants in genes related to inflammatory processes may possibly predispose to chronic spontaneous urticaria (CSU) occurrence. The objective of this study was to search for an association of Il1 genes polymorphisms with the pathogenesis of CSU. The examined group consisted of 153 unrelated chronic spontaneous autoreactive urticaria patients. The control group consisted of 104 unrelated healthy volunteers. In all studied subjects, IL1 rs1304037 and rs180058 polymorphisms were examined. The Urticaria Activity Score was used to assess disease intensity. The age of disease onset was also analyzed. Statistically significantly higher prevalence of Il1 rs1304037 TT genotype and T allele among CSU was proved. Similarly, the prevalence of Il1 rs1800587 GG genotype and G allele was statistically significantly higher in the CSU group. Haplotype combination rs1304037C/rs1800587G was statistically significantly more frequent in CSU, whereas rs1304037C/rs1800587A revealed statistically significantly less frequent occurrence in CSU. We did not observe any relationship between Il1 genotypes and the disease severity or age of disease onset. We are the first to suggest a significant role of IL1 gene polymorphisms in the susceptibility to CSU. This observation may lead to a better pathogenesis understanding and more effective treatment. We recommend further studies on other polymorphisms in chronic urticaria to analyze the role of the genetic mechanisms in the pathogenesis of this disorder.

BACKGROUND Polish data on vitamin D deficiency in the population are incomplete. Vitamin D deficiency seems to be common, but there is a lack of studies concerning the concentration of 25(OH)D in people with high UV exposure. The aim of this study was to evaluate the plasma concentration of 25(OH)D in people with and without metabolic syndrome (MS), working in agriculture, the prevalence of its deficiency in these workers, and the correlation between the plasma concentration of 25(OH)D and traditional biomarkers of cardiovascular diseases. MATERIAL AND METHODS The study included 332 people working in agriculture in the Łódź voivodeship, including 231 people with MS and 101 healthy ones. The plasma concentration of 25(OH)D was assessed using the chemiluminescent immunoassay technology. The vitamin D intake was assessed using a 24-h recall questionnaire using Diet 5.0 software. RESULTS The mean plasma concentration of 25(OH)D was 13.64±8.01 ng/ml in MS workers, and it was significantly lower than in the healthy ones (26.61±10.12 ng/ml, p < 0.00001); the highest concentration of 25(OH)D was noted in summer months. Deficient plasma concentrations of 25(OH)D were found significantly more often in MS workers than in the controls (81.82% and 20.79%, respectively, p < 0.00001). No correlation was found between the plasma vitamin D concentration and its dietary intake. The plasma concentration of 25(OH)D correlated with age of the examined workers (r = -0.28, p = 0.023), high density lipoprotein concentration (r = 0.19, p = 0.036) and glucose concentration (Rho = -0.24, p = 0.02). A multivariate analysis of variance demonstrated that the body mass index affected significantly the mean value of the 25(OH)D concentration in MS workers. CONCLUSIONS The concentration of vitamin D in the plasma of workers with MS was significantly lower than in the healthy controls despite the same high UV exposure; these workers also manifested significantly higher 25(OH)D deficiency than the control subjects. This study indicates the need for further research on the concentration of 25(OH)D in people with metabolic disorders regardless of UV exposure and vitamin D intake with a diet. Med Pr. 2021;72(1).