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Introduction: The pathophysiology of preeclampsia is represented by placental ischemia and the release of angiogenic factors. Recent research suggests that using the value of the sFtl-1/PIGF ratio is more accurate for monitoring angiogenic activity. The aim of this study consists in assessing the clinical utility of the sFtl-1/PIGF ratio in determining the diagnosis and severity of preeclampsia. Material and Methods: In our study a descriptive and prospective plan was used for analyzing the specific value of the sFtl-1/PIGF ratio in women with preeclampsia and in women with gestational hypertension, depending on the gestational age and severity. Results: The study included 59 women with preeclampsia and 25 women with gestational hypertension. The mean value of the sFtl-1/PIGF ratio of pregnant women with preeclampsia was 209.2 pg/mL, while in the gestational hypertension group, the mean value of the sFtl-1/PIGF ratio was 46.08 pg/mL. The difference between the value of the sFtl-1/PIGF ratio of the group with preeclampsia and the gestational hypertension group was > 67 (pg/mL), with a sensitivity of 86.44% and a specificity of 92.00%. Significant differences were found between the median values of the sFtl-1/PIGF ratio in pregnant women with severe preeclampsia in the early-onset subgroup compared to those in the late-onset subgroup (307 pg/mL, and 98 pg/mL, respectively, p = 0.009 < α = 0.05). Conclusions: The sFtl-1/PIGF ratio may be an alternative method for diagnosing preeclampsia and it can provide data about this condition’s severity.

Chronic kidney disease (CKD) is a worldwide public health problem. The constantly increasing prevalence of CKD requires further research into new additional strategies in its management. The preferred treatment of end-stage renal disease (ESRD) is renal transplantation. Kidney transplant patients benefit from substantial improvement in their quality and duration of life. For these to be feasible, the long-term graft and host survival optimization of the renal transplant recipient must be ensured and chronic allograft dysfunction (CAN) must be prevented. Once an equilibrium in the allograft tolerance is established, renal transplanted patients would benefit from the withdrawal or the reduction of immunosuppression therapy. Identification of early predictive biomarkers of CAN is essential. Recent publications have revealed that in long-term immune tolerance and graft survival several populations of immune cells are involved. Starting from the identification of perforin (PRF) in pathological renal glomeruli and following with the analysis of the molecular expression of PRF in renal biopsy samples, it appears that serum PRF is one of the potential biomarkers of graft dysfunction. Over the years, this protein has captured the attention of the medical world, conducting research that could potentially lead to the discovery of an innovative biomarker. Discovering and understanding the involvement of PRF in developing CAN may open up new therapeutic pathways that would ensure the survival of the kidney transplant. In this review the authors examined the structure, the role and the present understanding of the mechanisms by which serum PRF may be involved in chronic graft dysfunction as well as its role as an immune tolerance biomarker for chronic dysfunction of the renal graft. Contents1. Kidney transplantation in chronic kidney disease 2. Brief immunology of renal transplantation 3. PRF-granzyme pathway 4. Chronic allograft dysfunction 5. Predictive markers of chronic allograft dysfunction 6. PRF 'roots' 7. PRF: Structure and genetics 8. Perforinopathies 9. Conclusions

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