尿嗜酸性粒细胞在急性间质性肾炎诊断中的应用
英文原标题： Utility of Urine Eosinophils in the Diagnosis of Acute Interstitial Nephritis.
作者：Angela K Muriithi ,Samih H Nasr ,Nelson Leung
期刊名称：Clin J Am Soc Nephrol
发表时间：2013-09-19
索引：Clin J Am Soc Nephrol.2013 Sep 19;
中文摘要来源：于晓晨翻译 董润审核
中文摘要
背景和目的：研究表明尿嗜酸性粒细胞（Urine eosinophils，UEs）与急性间质性肾炎（acute interstitial nephritis，AIN）有关联，但最大的4项系列研究并未将肾活检作为诊断的金标准。
设计、设置、对象和测量方法：我们对1994年至2011年通过肾活检确诊AIN并进行UE试验的患者进行了一项回顾性研究。UEs通过汉斯染色检测。我们将UE临界值设为1%和5%，且均进入了比较分析。
结果：本研究纳入了566例患者，其均在1周内接受UE试验和肾活检。其中，322例为男性，平均年龄59岁。467例患者出现脓尿，即每高倍视野至少有1个白细胞。91例患者诊断AIN（80%为药物诱导的AIN）。多种肾脏病均出现UEs。如果以1% UE作为临界值，试验区分AIN和其他疾病的敏感度为30.8%，特异度为68.2%，阳性似然比和阴性似然比分别为0.97和1.01。因为本试验的AIN患病率为16%，所以阳性预测值和阴性预测值分别为15.6%和83.7%。如果以5% UE作为临界值，敏感度下降，但特异度上升。脓尿提高了敏感度，降低了特异度。UEs鉴别AIN和急性肾小管坏死的能力并不优于其鉴别AIN和其他肾脏病的能力。
结论：尿嗜酸性粒细胞可见于AIN等多种肾脏病。如果以常用的1% UE作为临界值，那么该试验不改变AIN的验前概率。即使以5% UE作为临界值，UEs也不能鉴别AIN和急性肾小管坏死等肾脏病。
英文摘要
BACKGROUND AND OBJECTIVES
Urine eosinophils (UEs) have been shown to correlate with acute interstitial nephritis (AIN) but the four largest series that investigated the test characteristics did not use kidney biopsy as the gold standard.
Urine eosinophils (UEs) have been shown to correlate with acute interstitial nephritis (AIN) but the four largest series that investigated the test characteristics did not use kidney biopsy as the gold standard.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS
This is a retrospective study of adult patients with biopsy-proven diagnoses and UE tests performed from 1994 to 2011. UEs were tested using Hansel's stain. Both 1% and 5% UE cutoffs were compared.
This is a retrospective study of adult patients with biopsy-proven diagnoses and UE tests performed from 1994 to 2011. UEs were tested using Hansel's stain. Both 1% and 5% UE cutoffs were compared.
RESULTS
This study identified 566 patients with both a UE test and a native kidney biopsy performed within a week of each other. Of these patients, 322 were men and the mean age was 59 years. There were 467 patients with pyuria, defined as at least one white cell per high-power field. There were 91 patients with AIN (80% was drug induced). A variety of kidney diseases had UEs. Using a 1% UE cutoff, the comparison of all patients with AIN to those with all other diagnoses showed 30.8% sensitivity and 68.2% specificity, giving positive and negative likelihood ratios of 0.97 and 1.01, respectively. Given this study's 16% prevalence of AIN, the positive and negative predictive values were 15.6% and 83.7%, respectively. At the 5% UE cutoff, sensitivity declined, but specificity improved. The presence of pyuria improved the sensitivity somewhat, with a decrease in specificity. UEs were no better at distinguishing AIN from acute tubular necrosis compared with other kidney diseases.
This study identified 566 patients with both a UE test and a native kidney biopsy performed within a week of each other. Of these patients, 322 were men and the mean age was 59 years. There were 467 patients with pyuria, defined as at least one white cell per high-power field. There were 91 patients with AIN (80% was drug induced). A variety of kidney diseases had UEs. Using a 1% UE cutoff, the comparison of all patients with AIN to those with all other diagnoses showed 30.8% sensitivity and 68.2% specificity, giving positive and negative likelihood ratios of 0.97 and 1.01, respectively. Given this study's 16% prevalence of AIN, the positive and negative predictive values were 15.6% and 83.7%, respectively. At the 5% UE cutoff, sensitivity declined, but specificity improved. The presence of pyuria improved the sensitivity somewhat, with a decrease in specificity. UEs were no better at distinguishing AIN from acute tubular necrosis compared with other kidney diseases.
CONCLUSIONS
UEs were found in a variety of kidney diseases besides AIN. At the commonly used 1% UE cutoff, the test does not shift pretest probability of AIN in any direction. Even at a 5% cutoff, UEs performed poorly in distinguishing AIN from acute tubular necrosis or other kidney diseases.
UEs were found in a variety of kidney diseases besides AIN. At the commonly used 1% UE cutoff, the test does not shift pretest probability of AIN in any direction. Even at a 5% cutoff, UEs performed poorly in distinguishing AIN from acute tubular necrosis or other kidney diseases.
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