Non-diabetic glycosuria as a diagnostic clue for acute tubulointerstitial nephritis in patients with azotemia.

Publisher: Informa Healthcare Country of Publication: England NLM ID: 8701128 Publication Model: Print Cited Medium: Internet ISSN: 1525-6049 (Electronic) Linking ISSN: 0886022X NLM ISO Abbreviation: Ren Fail Subsets: MEDLINE

Publication: London : Informa Healthcare
Original Publication: New York, N.Y. : M. Dekker, c1987-

Azotemia/*etiology ; Glycosuria/*etiology ; Kidney/*pathology ; Nephritis, Interstitial/*diagnosis ; Nephritis, Interstitial/*urine; Adult ; Aged ; Biopsy ; Creatinine/blood ; Female ; Humans ; Hypokalemia/etiology ; Male ; Middle Aged ; Nephritis, Interstitial/blood ; Nephritis, Interstitial/pathology ; Proteinuria/etiology ; Retrospective Studies ; Sensitivity and Specificity

Background: Glycosuria is one of the manifestations of acute tubulointerstitial nephritis (ATIN), but may also be observed in other renal diseases. In this study, we investigated the value of non-diabetic glycosuria as a diagnostic clue for ATIN.
Methods: We retrospectively reviewed the medical records of adult patients who underwent a kidney biopsy as an evaluation for serum creatinine > 1.4 mg/dL. Patients with proteinuria in the nephrotic range, diabetes mellitus, or transplanted kidney were excluded. The laboratory abnormalities suggestive of tubular injury were compared between 28 patients (14 men and 14 women, mean age 48.5 ± 14.1 years) with ATIN and 116 patients (76 men and 40 women, mean age 53.1 ± 15.0 years) with other diagnoses.
Results: In ATIN, glycosuria (≥ 1+ on dipstick; 68%) was more frequent than hypophosphatemia (18%), hypouricemia (18%), hypokalemia (18%), and tubular proteinuria (40%). In other diagnoses, glycosuria (≥ 1+) was detected in 7 (6%) patients; 6 of them had the histological diagnosis of antineutrophil cytoplasmic antibody-associated glomerulonephritis. The presence of glycosuria (≥ 1+) had 68% sensitivity and 94% specificity for ATIN, with the positive likelihood ratio of 11.24 and the negative likelihood ratio of 0.34. Pyuria and low total CO 2 were equally and more sensitive (68% and 71%, respectively) than glycosuria (≥ 1+), but had no diagnostic value due to low specificities (58% and 60%, respectively).
Conclusion: In non-diabetic, non-nephrotic patients undergoing a kidney biopsy for azotemia, 1+ or higher glycosuria, if present, was a good predictor of the diagnosis of ATIN.

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Keywords: Acute tubulointerstitial nephritis; anti-neutrophil cytoplasmic antibody; glycosuria; hypokalemia; hypophosphatemia; hypouricemia

AYI8EX34EU (Creatinine)

Acute Tubulointerstitial Nephritis

Date Created: 20200928 Date Completed: 20210721 Latest Revision: 20210721

20221213

PMC7534193

10.1080/0886022X.2020.1824923

32985319