Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis
Background: Early diagnosis of thrombotic thrombocytopenic purpura (TTP) versus hemolytic and uremic syndrome (HUS) is critical for the prompt initiation of specific therapies. Objective: To evaluate the diagnostic performance of the proteinuria/creatininuria ratio (PU/CU) for TTP versus HUS. Patien...
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| Format: | Article |
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MDPI AG
2022-01-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/3/648 |
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| author | Laure Burguet Benjamin Taton Mathilde Prezelin-Reydit Sébastien Rubin Walter Picard Didier Gruson Anne Ryman Cécile Contin-Bordes Paul Coppo Christian Combe Yahsou Delmas |
| author_facet | Laure Burguet Benjamin Taton Mathilde Prezelin-Reydit Sébastien Rubin Walter Picard Didier Gruson Anne Ryman Cécile Contin-Bordes Paul Coppo Christian Combe Yahsou Delmas |
| author_sort | Laure Burguet |
| collection | DOAJ |
| description | Background: Early diagnosis of thrombotic thrombocytopenic purpura (TTP) versus hemolytic and uremic syndrome (HUS) is critical for the prompt initiation of specific therapies. Objective: To evaluate the diagnostic performance of the proteinuria/creatininuria ratio (PU/CU) for TTP versus HUS. Patients/Methods: In a retrospective study, in association with the “French Score” (FS) (platelets < 30 G/L and serum creatinine level < 200 µmol/L), we assessed PU/CU for the diagnosis of TTP in patients above the age of 15 with thrombotic microangiopathy (TMA). Patients with a history of kidney disease or with on-going cancer, allograft or pregnancy were excluded from the analysis. Results: Between February 2011 and April 2019, we identified 124 TMA. Fifty-six TMA patients for whom PU/CU were available, including 35 TTP and 21 HUS cases, were considered. Using receiver–operating characteristic curves (ROC), those with a threshold of 1.5 g/g for the PU/CU had a 77% sensitivity (95% CI (63, 94)) and a 90% specificity (95% CI (71, 100)) for TTP diagnosis compared with those having an 80% sensitivity (95% CI (66, 92)) and a 90% specificity (95% CI (76, 100) with a FS of 2. In comparison, a composite score, defined as a FS of 2 or a PU/CU ≤ 1.5 g/g, improved sensitivity to 99.6% (95% CI (93, 100)) for TTP diagnosis and enabled us to reclassify seven false-negative TTP patients. Conclusions: The addition of urinary PU/CU upon admission of patients with TMA is a fast and readily available test that can aid in the differential diagnosis of TTP versus HUS alongside traditional scoring. |
| first_indexed | 2024-03-09T23:41:08Z |
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| id | doaj.art-a4039fea67284e2b9b078557045e9d26 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-09T23:41:08Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-a4039fea67284e2b9b078557045e9d262023-11-23T16:51:49ZengMDPI AGJournal of Clinical Medicine2077-03832022-01-0111364810.3390/jcm11030648Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome DiagnosisLaure Burguet0Benjamin Taton1Mathilde Prezelin-Reydit2Sébastien Rubin3Walter Picard4Didier Gruson5Anne Ryman6Cécile Contin-Bordes7Paul Coppo8Christian Combe9Yahsou Delmas10Service de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceService de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceService de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceService de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceService de Réanimation, Centre Hospitalier de PAU, 64000 Pau, FranceService de Réanimation, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceLaboratoire d’hématologie Biologique, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceDépartement d’hématologie et Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris and Sorbonne Universités, 75651 Paris, FranceDépartement d’hématologie et Centre de Reference des Microangiopathies Thrombotiques, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris and Sorbonne Universités, 75651 Paris, FranceService de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceService de Néphrologie Transplantation Dialyse Aphérèses, Centre de Référence Maladies Rénales Rares du Sud-Ouest, Centre Hospitalier Universitaire de Bordeaux, 33000 Bordeaux, FranceBackground: Early diagnosis of thrombotic thrombocytopenic purpura (TTP) versus hemolytic and uremic syndrome (HUS) is critical for the prompt initiation of specific therapies. Objective: To evaluate the diagnostic performance of the proteinuria/creatininuria ratio (PU/CU) for TTP versus HUS. Patients/Methods: In a retrospective study, in association with the “French Score” (FS) (platelets < 30 G/L and serum creatinine level < 200 µmol/L), we assessed PU/CU for the diagnosis of TTP in patients above the age of 15 with thrombotic microangiopathy (TMA). Patients with a history of kidney disease or with on-going cancer, allograft or pregnancy were excluded from the analysis. Results: Between February 2011 and April 2019, we identified 124 TMA. Fifty-six TMA patients for whom PU/CU were available, including 35 TTP and 21 HUS cases, were considered. Using receiver–operating characteristic curves (ROC), those with a threshold of 1.5 g/g for the PU/CU had a 77% sensitivity (95% CI (63, 94)) and a 90% specificity (95% CI (71, 100)) for TTP diagnosis compared with those having an 80% sensitivity (95% CI (66, 92)) and a 90% specificity (95% CI (76, 100) with a FS of 2. In comparison, a composite score, defined as a FS of 2 or a PU/CU ≤ 1.5 g/g, improved sensitivity to 99.6% (95% CI (93, 100)) for TTP diagnosis and enabled us to reclassify seven false-negative TTP patients. Conclusions: The addition of urinary PU/CU upon admission of patients with TMA is a fast and readily available test that can aid in the differential diagnosis of TTP versus HUS alongside traditional scoring.https://www.mdpi.com/2077-0383/11/3/648diagnosisdifferentialhemolytic-uremic syndromeproteinuriapurpurathrombotic thrombocytopenic |
| spellingShingle | Laure Burguet Benjamin Taton Mathilde Prezelin-Reydit Sébastien Rubin Walter Picard Didier Gruson Anne Ryman Cécile Contin-Bordes Paul Coppo Christian Combe Yahsou Delmas Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis Journal of Clinical Medicine diagnosis differential hemolytic-uremic syndrome proteinuria purpura thrombotic thrombocytopenic |
| title | Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis |
| title_full | Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis |
| title_fullStr | Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis |
| title_full_unstemmed | Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis |
| title_short | Urine Protein/Creatinine Ratio in Thrombotic Microangiopathies: A Simple Test to Facilitate Thrombotic Thrombocytopenic Purpura and Hemolytic and Uremic Syndrome Diagnosis |
| title_sort | urine protein creatinine ratio in thrombotic microangiopathies a simple test to facilitate thrombotic thrombocytopenic purpura and hemolytic and uremic syndrome diagnosis |
| topic | diagnosis differential hemolytic-uremic syndrome proteinuria purpura thrombotic thrombocytopenic |
| url | https://www.mdpi.com/2077-0383/11/3/648 |
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