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英文原標(biāo)題： Utility of Urine Eosinophils in the Diagnosis of Acute Interstitial Nephritis.

作者：Angela K Muriithi ,Samih H Nasr ,Nelson Leung

期刊名稱：Clin J Am Soc Nephrol

發(fā)表時(shí)間：2013-09-19

索引：Clin J Am Soc Nephrol.2013 Sep 19;

中文摘要來(lái)源：于曉晨翻譯 董潤(rùn)審核

 

背景和目的：研究表明尿嗜酸性粒細(xì)胞（Urine eosinophils，UEs）與急性間質(zhì)性腎炎（acute interstitial nephritis，AIN）有關(guān)聯(lián)，但最大的4項(xiàng)系列研究并未將腎活檢作為診斷的金標(biāo)準(zhǔn)。

 

設(shè)計(jì)、設(shè)置、對(duì)象和測(cè)量方法：我們對(duì)1994年至2011年通過(guò)腎活檢確診AIN并進(jìn)行UE試驗(yàn)的患者進(jìn)行了一項(xiàng)回顧性研究。UEs通過(guò)漢斯染色檢測(cè)。我們將UE臨界值設(shè)為1%和5%，且均進(jìn)入了比較分析。

 

結(jié)果：本研究納入了566例患者，其均在1周內(nèi)接受UE試驗(yàn)和腎活檢。其中，322例為男性，平均年齡59歲。467例患者出現(xiàn)膿尿，即每高倍視野至少有1個(gè)白細(xì)胞。91例患者診斷AIN（80%為藥物誘導(dǎo)的AIN）。多種腎臟病均出現(xiàn)UEs。如果以1% UE作為臨界值，試驗(yàn)區(qū)分AIN和其他疾病的敏感度為30.8%，特異度為68.2%，陽(yáng)性似然比和陰性似然比分別為0.97和1.01。因?yàn)楸驹囼?yàn)的AIN患病率為16%，所以陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值分別為15.6%和83.7%。如果以5% UE作為臨界值，敏感度下降，但特異度上升。膿尿提高了敏感度，降低了特異度。UEs鑒別AIN和急性腎小管壞死的能力并不優(yōu)于其鑒別AIN和其他腎臟病的能力。

 

結(jié)論：尿嗜酸性粒細(xì)胞可見(jiàn)于AIN等多種腎臟病。如果以常用的1% UE作為臨界值，那么該試驗(yàn)不改變AIN的驗(yàn)前概率。即使以5% UE作為臨界值，UEs也不能鑒別AIN和急性腎小管壞死等腎臟病。

 

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.

 

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.

 

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.

 

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.