Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease.

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dc.contributor.authorKumar, Sravan
dc.contributor.authorAgarwal, Ritesh
dc.contributor.authorBal, Amanjit
dc.contributor.authorSharma, Kusum
dc.contributor.authorSingh, Navneet
dc.contributor.authorAggarwal, Ashutosh N
dc.contributor.authorVerma, Indu
dc.contributor.authorRana, Satyawati V
dc.contributor.authorJha, Vivekanand
dc.date.accessioned2015-06-26T10:18:18Z
dc.date.available2015-06-26T10:18:18Z
dc.date.issued2015-03
dc.description.abstractBackground & objectives: Pleural effusion is a common occurrence in patients with late-stage chronic kidney disease (CKD). In developing countries, many effusions remain undiagnosed after pleural fluid analysis (PFA) and patients are empirically treated with antitubercular therapy. The aim of this study was to evaluate the role of adenosine deaminase (ADA), nucleic acid amplification tests (NAAT) and medical thoracoscopy in distinguishing tubercular and non-tubercular aetiologies in exudative pleural effusions complicating CKD. Methods: Consecutive stage 4 and 5 CKD patients with pleural effusions underwent PFA including ADA and PCR [65 kDa gene; multiplex (IS6110, protein antigen b, MPB64)]. Patients with exudative pleural effusion undiagnosed after PFA underwent medical thoracoscopy. Results: All 107 patients underwent thoracocentesis with 45 and 62 patients diagnosed as transudative and exudative pleural effusions, respectively. Twenty six of the 62 patients underwent medical thoracoscopy. Tuberculous pleurisy was diagnosed in six while uraemic pleuritis was diagnosed in 20 subjects. The sensitivity and specificity of pleural fluid ADA, 65 kDa gene PCR, and multiplex PCR were 66.7 and 90 per cent, 100 and 50 per cent, and 100 and 100 per cent, respectively. Thoracoscopy was associated with five complications in three patients. Interpretation & conclusions: Uraemia remains the most common cause of pleural effusion in CKD even in high TB prevalence country. Multiplex PCR and thoracoscopy are useful investigations in the diagnostic work-up of pleural effusions complicating CKD while the sensitivity and/or specificity of ADA and 65 kDa gene PCR is poor.en_US
dc.identifier.citationKumar Sravan, Agarwal Ritesh, Bal Amanjit, Sharma Kusum, Singh Navneet, Aggarwal Ashutosh N, Verma Indu, Rana Satyawati V, Jha Vivekanand. Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease. Indian Journal of Medical Research. 2015 Mar; 141 (3): 308-314.en_US
dc.identifier.urihttps://imsear.searo.who.int/handle/123456789/158469
dc.language.isoenen_US
dc.source.urihttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4442328/?report=classicen_US
dc.subjectADAen_US
dc.subjectchronic renal failureen_US
dc.subjectCKDen_US
dc.subjectPCRen_US
dc.subjectpleurisyen_US
dc.subjectthoracoscopyen_US
dc.subjecttuberculosisen_US
dc.subject.meshAdenosine Deaminase --metabolism
dc.subject.meshHumans
dc.subject.meshKidney Diseases
dc.subject.meshPleural Effusion
dc.subject.meshPleurisy --complications
dc.subject.meshPolymerase Chain Reaction --methods
dc.subject.meshPolymerase Chain Reaction --utilization
dc.subject.meshTuberculosis, Pleural --complications
dc.subject.meshThoracoscopy --methods
dc.subject.meshThoracoscopy --utiization
dc.titleUtility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease.en_US
dc.typeArticleen_US
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