High sensitive troponin I (hsTnI) is one of the markers of cardiac damage. Its values increase two to three hours after a heart attack and remain elevated for days. Recent studies have shown that kidneys are the main organ of elimination of troponin from blood. Our previous studies have shown that troponin I is removed and concentrated in the first morning urine. Increased blood pressure is one of the most common comorbidities today. By measuring blood pressure, we can see the current value of the pressure, but we do not know what the values are during the rest of the day. The aim of our research was to determine if there is a difference in the concentration of troponin I in urine among patients suffering from hypertension and among healthy individuals. The study involved 20 participants divided into two groups. In the first group were healthy individuals, while in the second group were individuals with hypertension. The first morning urine was sampled and the hsTnI was measured using a highsensitivity test on the Immuno-enzymatic analyser Abbott Architect i1000SR. Within the normotensive group, the mean value of hsTnI in the first morning urine was 14.95 pg/mL, while in the group of participants with elevated blood pressure, the mean value of hsTnI in the first morning urine was 26.59 pg/mL. The difference between these two groups was statistically significant with p=0.0451 (p<0.05). By measuring hsTnI in urine and determining the difference between healthy and those with hypertension, a new diagnostic test for hypertension monitoring and detection would be obtained.

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The most common causes of therapeutic failure in hypertensive control are undiscovered secondary causes of hypertension and lack of patient/doctor compliance. In about 10% of cases, it can be attributed to resistant hypertension caused by a hyperactivity of the sympathetic nervous system, condition with a high cardiovascular risk to the patient. Resistant hypertension is failure to diminish blood pressure values to <140/90 mmHg (<140/85 mmHg for diabetic patients) with a lifestyle method and prescription of least three antihypertensive drugs in optimal doses, including a diuretic, or when patients use four or more antihypertensive drugs regardless of blood pressure control. Patients with resistant hypertension are typically presented with a long-standing history of poorly controlled hypertension. Early diagnosis and adequate treatment are needed to avoid end organ damage and to prevent cardiorenovascular remodeling. Cardiorenovascular morbidity and mortality are significantly higher in resistant hypertensive population. The need for the individualization of therapy and the use of the management strategies are also given weight in the treatment of resistant hypertension patients, including optional, innovative therapies, like a renal denervation or baroreflex activation. New innovative device therapies create an additional novel pathway of blood pressure-lowering procedures and should be prescribed by a specialist hypertension clinic.

Our aim was to evaluate biochemical markers in plasma (NGAL, CysC) and urine (NGAL, KIM-1) in children's early onset of acute kidney injury after congenital heart defect surgery using cardiopulmonary bypass. This study prospectively included 100 children with congenital heart defects who developed AKI. Patients with acute kidney injury had significantly higher CysC levels 6 and 12 h after cardiac surgery and plasma NGAL levels 2 and 6 h after cardiac surgery. The best predictive properties for the development of acute kidney injury are the combination (+CysCpl or +NGALu) after 12 h and a combination (+CysCpl and +NGALu) 6 and 24 h after cardiac surgery. We showed that plasma CysC and urinary NGAL could reliably predict the development of acute kidney injury. Measurement of early biochemical markers in plasma and urine, individually and combination, may predict the development of cardiac surgery-associated acute kidney injury in children.

Aim To investigate the risk factors and the outcomes of extracorporeal membrane oxygenation (ECMO) in pediatric patients treated at the University Hospital Center Zagreb, the largest center in Croatia providing pediatric ECMO.Methods This retrospective study enrolled all the pediatric patients who required E-CPR from 2011 to 2019. Demographic data, cardiac anatomy, ECMO indications, ECMO complications, and neurodevelopmental status at hospital discharge were analyzed. ResultsIn the investigated period, E-CPR was used in 16 children, and the overall survival rate was 37.5%. Six patients were in the neonatal age group, 5 in the infant group, and 5 in the "older" group. There was no significant difference between the sexes. Four patients had an outof-hospital arrest and 12 had an in-hospital arrest. Twelve out of 16 patients experienced renal failure and needed hemodialysis, with 4 out of 6 patients in the survivor group and 8 out of 10 in the non-survivor group. Survivors and non-survivors did not differ in E-CPR duration time, lactate levels before ECMO, time for lactate normalization, and pH levels before and after the start of ECMO. ConclusionThe similarity of our results to those obtained by other studies indicates that the ECMO program in our hospital should be maintained and improved.