Anales de Medicina Interna
versión impresa ISSN 0212-7199
ALBALADEJO OTON, M. D.; GONZALEZ CUEVA, M. M.; ALVAREZ LOPEZ, R. y MARTINEZ HERNANDEZ, P.. The use of a simple algorithm to improve proteinuria diagnosis in clinical laboratories. An. Med. Interna (Madrid) [online]. 2005, vol.22, n.10, pp.461-464. ISSN 0212-7199.
Background and objective: When proteinuria appears, a differential diagnosis must determine its origin. The object of this work has been to evaluate the results after the laboratory implantation of an algorithm for the screening and diagnosis of proteinuria. Material and methods: From a total of 30,718 processed urines, a 30 mg/dl or higher protein concentration was obtained in 639, recommending a new sample to confirm and differenciate proteinuria. We received 207, to which total protein, creatinine, albumin and alpha-1-microglobulin were quantificated, together with pseudoperoxidase and leucocite esterase from dipstick. The results were introduced in an expert system (UPES and its application Protis), allowing differenciate hematuria, leucocituria and proteinuria and suggesting the assessment of other parameters, like IgG, alpha-2-macroglobulin, light chain kappa/lambda, when necessary. Results: From 207 urinalysis assayed for selective proteinuria, 39 were normal, 96 were classified as primary glomerulopathy, 26 as secondary glomerulopathy and 5 as tubulo-interstitial nephropathy. A differential diagnosis of hematuria was made in 58 of these urines. Besides, kappa light chains were detected in a sample from a patient with a normal serum protein graph, which were confirmed by inmune fixation. Conclusion: With the proposed algorithm, the information obtained from a urine sample increases substantially, allowing detection and differentiation of proteinuria and providing suggestions for the clinical evaluation of the patient.
Palabras clave : Proteinuria; Diagnosis; Algorithm.