No vested interests allowed. M. -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of David James Sent: 04 August 2010 17:04 To: [log in to unmask] Subject: Re: the Jaffe reaction Who's paying? Cost is coming down and within a relatively short period I suspect that all creats on paeds and low eGFR will be enzymatic. In meantime, why not take a big step and make sure all labs conform to proposed MAPS criteria - see previous thread. And for the record, there is nothing wrong with well run quality core labs.....why are we so afraid of that? dj >>> Kremmyda Angela <[log in to unmask]> 04/08/2010 16:47 >>> Ha! I just had a very bright idea- let's make it a requirement for core regional labs to use enzymatic creatinine. Because, after all, quality comes first. Any volunteers? (this would probably be motivation enough to abandon the idea of core regional labs...) Angela :D This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in eliance on its contents: to do so is strictly prohibited and may be unlawful. -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Roy Fisher Sent: 04 August 2010 16:29 To: [log in to unmask] Subject: Re: the Jaffe reaction Martin Given that the enzymatic creatinine is about eight times the cost, now would not be a good time to change. We only use it for paediatrics, jaundiced patients and where interference is suspected. If the core regional lab takes over your cold work, I suspect that they will only use Jaffe. Roy >>> "Myers Martin (LTHTR)" <[log in to unmask]> 04/08/2010 15:46 >>> The Jaffe reaction is a non-specific colorimetric assay published in 1886 to give a rough estimation of creatinine (Jaffe, M Z. Physiol Chem, 10, 391 (1886). Whilst this was a significant advance in the 19th Century, I think that as 21st Century Clinical Biochemists we should perhaps move our subject on a bit use the enzymatic method for all patients. I have been using it for some time and would recommend it to my learned colleagues! Martin ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of COLLINS MICHAEL (RM1) Norfolk and Norwich University Hospital Sent: 03 August 2010 18:20 To: [log in to unmask] Subject: Re: Calculate GFR My comparisons of enzymatic creatinine, compensated Jaffe and uncompensated Jaffe found that compensated Jaffe was worse than uncompensated Jaffe at low levels. We only run enzymatic creatinine on young children. Mike Collins BMS3 Biochemistry Automation Norfolk & Norwich University Hospital England [log in to unmask] http://www.nnuh.nhs.uk/ ________________________________ From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of McKillop, Derek Sent: 03 August 2010 17:01 To: [log in to unmask] Subject: Re: Calculate GFR Craig We are also wrestling with the issue of which formula we should be recommending. If we follow the recommendation "not to estimate GFR for children when using an alkaline picrate ("Jaffe") method that has calibration traceable to IDMS " (see link below) we should therefore only be analysing creatinine in children using the enzymatic assays and calculating eGFR by the new Schwartz formula. http://nkdep.nih.gov/labprofessionals/labgfr_children.htm http://nkdep.nih.gov/professionals/gfr_calculators/idms_schwartz.htm The problem is that our paediatricians currently use the old formula which has different k values for different developmental stages. The new formula has only one k value and in his paper ( http://jasn.asnjournals.org/cgi/rapidpdf/ASN.2008030287v1.pdf ) Schwartz cautions that the formula may not be valid in children with normal body habitus. The risk therefore is that by introducing a single k formula we inadvertently increase the inaccuracy in specific developmental stages than would be the case if we were to use the old formula but with the new ID-MS values. Prof Schwartz has indicated to me that studies are ongoing to address this matter and should be published soon. Sorry to have generated more questions than answers. Derek McKillop PhD FRCPath Principal Clinical Scientist Dept Clinical Biochemistry Craigavon Area Hospital Southern Health and Social Care Trust Internal Extension: 3709 Direct Line: 028 38613709 -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Webster Craig Sent: 03 August 2010 15:42 To: [log in to unmask] Subject: Calculate GFR Hi, Our users would like to start calculating GFR based on creatinine results for children based on the Counahan-Barrett equation, basically the idea is we use a lookup table giving the median height for a child of the patient's age, and use that to calculate GFR. We would use a modified Counahan-Barrett equation, which in SI units is GFR=(40*HT)/Cr. We have relied on the literature overview and guidelines from the US Renal organisation KDOQI. From what I can see this equation is based on a study done by Morris et al, Arch Dis Child which was done in 1982 using a Jaffe / Alkaline picrate reaction with LKB autoanalyser. We currently use a Roche Modular creatinine method calibrated using an ID-MS traceable calibrator. Does anyone know of or implemented a similar system but have related the calculation to more recent methods? Cheers Craig Craig Webster Consultant Clinical Scientist Birmingham Heartlands Hospital Birmingham B95SS This e-mail and any attachments may contain confidential and privileged information. If you are not the intended recipient, please notify the sender immediately by return e-mail, delete this e-mail and destroy any copies. 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