Raised serum fructosamine concentration caused by IgA paraproteinaemia

Diabetes mellitus in chronic kidney disease: Biomarkers beyond HbA1c to estimate glycemic control and diabetes-dependent morbidity and mortality

Diabetes mellitus (DM) is the leading cause of chronic kidney disease (CKD). Optimal glycemic control contributes to improved outcomes in patients with DM, particularly for microvascular damage, but blood glucose levels are too variable to provide an accurate assessment and instead markers averaging long-term glycemic load are used. The most established glycemic biomarker of long-term glycemic control is HbA1c. Nevertheless, HbA1c has pitfalls that limit its accuracy to estimate glycemic control, including the presence of altered red blood cell survival, hemoglobin glycation and suboptimal performance of HbA1c assays. Alternative methods to evaluate glycemic control in patients with DM include glycated albumin, fructosamine, 1-5 anhydroglucitol, continuous glucose measurement, self-monitoring of blood glucose and random blood glucose concentration measurements. Accordingly, our aim was to review the advantages and pitfalls of these methods in the context of CKD.

Serum fructosamine concentrations in hyperthyroid cats

Serum fructosamine concentrations were measured in 35 healthy cats and in 30 hyperthyroid cats before and 30 days after curative radioiodine ((131)I) treatment. Hyperthyroid cats were divided into those with 30 day post-treatment total thyroxine (T4) concentrations within (EuT4) or below (HypoT4) the reference range. The median (semi-interquartile range, SIR) fructosamine concentration was significantly lower in hyperthyroid compared with healthy cats (295. 0 (18.5) micromol l(-1)) both before (254.0 (27.6) micromol l(-1)) and after (268.5 (28.0) micromol l(-1)) treatment (P < 0.001 in each case). (131)I therapy was associated with increases in serum fructosamine (mean increase 20.4 micromol l(-1), P = 0.039) and total protein (6.3 g l(-1), P < 0.002) in the HypoT4 group and in globulin concentration in both EuT4 (5.9 g l(-), P < 0.002) and HypoT4 (5.2 g l(-1), P = 0.023) groups. There were no direct relationships between the observed elevations in fructosamine concentration and those in total protein or globulin concentrations suggesting that the effect may be due to reduced rates of protein turnover. Reduced values may need to be considered when interpreting serum fructosamine concentrations for monitoring the degree of glycaemic control in diabetic cats with concurrent hyperthyroidism.

Fructosamine measurement in ponies: validation and response following experimental cyathostome infection

Validation of an assay for measurement of fructosamine in equine serum and plasma utilised blood samples collected from 24 British native breed ponies. The results indicated that fructosamine can be measured easily using an assay which is precise and accurate. Paired plasma and serum fructosamine measurements were highly correlated, however, greater variations were observed within serum compared with those in plasma. A reference range for fructosamine in plasma was calculated to be 256.9 +/- 60.6 mumol litre-1 (mean +/- 2 SD). In order to assess the fructosamine response following experimental cyathostome infection, nine British native breed ponies were allocated to one of three groups: Group 1 (3.9 million third-stage cyathostome larvae (L3) over a nine-week-period), Group 2 (3.15 million L3 over seven weeks) and Group 3 (uninfected controls). From four weeks prior to infection, blood was obtained, once weekly, from all animals for measurement of plasma fructosamine, plasma albumin and serum globulin concentrations. Plasma fructosamine concentrations decreased in all infected ponies post-infection due to enteric protein loss and/or altered protein composition and/or increased protein turnover.