Noriko Ohisa

A Comparison of Urinary Albumin-Total Protein Ratio to Phase-Contrast Microscopic Examination of Urine Sediment for Differentiating Glomerular and Nonglomerular Bleeding

BACKGROUND Hematuria can be classified as either glomerular or nonglomerular, depending on the bleeding source. We recently reported that urinary albumin-total protein ratio is potentially useful for identifying the source of hematuria. STUDY DESIGN Diagnostic test study. SETTING & PARTICIPANTS 579 fresh urine specimens with microhematuria (> or =5 red blood cells/high-power field) collected from patients with the source of the hematuria confirmed on histopathologic and/or imaging studies and clinical criteria assessed. INDEX TEST Each urine specimen was evaluated morphologically by using phase-contrast microscopy and biochemically by using urinary albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio. REFERENCE TEST Each patient had a definitive clinical diagnosis established by means of biopsy (64.4%), imaging studies (21.2%), and routine optimal microscopic examination of urine sediment (14.3%). RESULTS Of 579 specimens, 329 were obtained from patients with glomerular disease and 250 were obtained from patients with nonglomerular disease. Mean urinary albumin-total protein, albumin-creatinine, and total protein-creatinine ratios for those with glomerular versus nonglomerular diseases were 0.73 +/- 0.11 versus 0.41 +/- 0.14 mg/mg (P < 0.001), 1,110 +/- 1,850 versus 220 +/- 560 mg/g (P < 0.001), and 1,600 +/- 3,010 versus 480 +/- 1,160 mg/g (P < 0.001), respectively. The percentage of patients with greater than 3% glomerular red cells was 83.3% versus 24.8% (P < 0.001). Receiver operating characteristic curve analysis showed that areas under the curve for albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio were 0.992, 0.781, and 0.688, respectively (P < 0.001, albumin-total protein versus albumin-creatinine; P < 0.001, albumin-total protein versus total protein-creatinine). At cutoff values of 0.59 mg/mg, 71 mg/g, and 265 mg/g, albumin-total protein ratio, albumin-creatinine ratio, and total protein-creatinine ratio had sensitivities and specificities of 97.3% and 100%, 78.9% and 61.1%, and 68.8% and 62.0% for detecting glomerular disease, respectively. Phase-contrast microscopy had sensitivity of 83.3% and specificity of 75.2% for detecting glomerular disease. LIMITATIONS Albumin-total protein ratio cannot be used in patients with urinary total protein less than 5 mg/dL (<0.05 g/L). Use of only 1 sample from 1 patient may not be sufficient to obtain definitive results. CONCLUSIONS Urinary albumin-total protein ratio is much more useful than phase-contrast microscopy for differentiating between glomerular and nonglomerular disease in patients with microscopic hematuria.

Evaluation of hematuria using the urinary albumin-to-total-protein ratio to differentiate glomerular and nonglomerular bleeding

BackgroundDepending on the etiology and pathophysiology of hematuria, urinary bleeding is classified as glomerular hematuria or nonglomerular hematuria. Nephritis is usually detected by the presence of proteinuria, especially elevated albumin excretion. In this study, we report on the use of the urinary albumin-to-total-protein ratio to accurately differentiate glomerular and nonglomerular bleeding.MethodsA total of 143 fresh, random urine specimens demonstrating microscopic hematuria (5 or more red blood cells per high-power field) from patients with the source of the hematuria confirmed by histopathology and/or clinical criteria were included in the study.ResultsOf the 143 specimens, 104 were from patients diagnosed with glomerular disease and 39 were from patients with nonglomerular disease. Corrected for urine concentration, the mean total-protein-to-creatinine (Cr) and albumin-to-Cr ratios in the glomerular disease group were 1.67 ± 2.71 g/g Cr and 1.15 ± 1.77 g/g Cr, respectively (P < 0.001). In the nonglomerular group, the mean total protein-to-Cr and albumin-to-Cr ratios were 0.19 ± 0.23 g/g Cr and 0.05 ± 0.06 g/g Cr, respectively (P < 0.001). However, considerable overlap in the ratios among glomerular and nonglomerular disease groups was observed. In contrast, the mean albumin-to-total protein ratios for glomerular and nonglomerular diseases were 0.72 ± 0.10 and 0.35 ± 0.17, respectively (P < 0.001). At a cutoff of 0.59, the albumin-to-total-protein ratio demonstrated a sensitivity of 97.1% (101 of 104 cases) in detecting glomerular disease.ConclusionsThe urinary albumin-to-total-protein ratio is potentially a useful index for the differentiation of glomerular and nonglomerular disease in the presence of microscopic hematuria.

Fractional Exhaled Nitric Oxide (feno) and Spirometry as Indicators of Inhalation Exposure to Chemical Agents in Pathology Workers

Objective: The objective of this study was to examine whether fractional exhaled nitric oxide (FeNO) and spirometry can be used as indices to evaluate adverse health effects of low-concentrated chemical inhalation exposure, mainly to formaldehyde. Methods: Thirty-three subjects (pathology technicians) and 30 controls (workers without handling any chemicals in the same hospitals) participated in this study. All participants underwent FeNO measurement and spirometry before and after 5 days of work. Results: FeNO significantly increased in the subjects with a history of asthma (P < 0.05), whereas forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1) decreased in the subjects (P < 0.05). Furthermore, work duration and pre-work levels of FEV1 in the subjects had a significant association. Conclusion: The results suggest that FeNO, FVC, and FEV1 represent effective health-effect indices of low-concentrated chemical inhalation exposure.