title: Utility of adenosine deaminase (ADA), PCR & thoracoscopy in differentiating tuberculous & non-tuberculous pleural effusion complicating chronic kidney disease.
abstract: OBJECTIVE
  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.
  
  
  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.
authors.forename: Sravan
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Pulmonary Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
authors.forename: Ritesh
authors.initials: R
authors.lastname: Agarwal
authors.forename: Amanjit
authors.initials: A
authors.lastname: Bal
authors.forename: Kusum
authors.initials: K
authors.lastname: Sharma
authors.forename: Navneet
authors.initials: N
authors.lastname: Singh
authors.forename: Ashutosh N
authors.initials: AN
authors.lastname: Aggarwal
authors.forename: Indu
authors.initials: I
authors.lastname: Verma
authors.forename: Satyawati V
authors.initials: SV
authors.lastname: Rana
authors.forename: Vivekanand
authors.initials: V
authors.lastname: Jha
mesh_terms: D000243:Adenosine Deaminase / Q000378:metabolism*; D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010994:Pleura / Q000201:enzymology / Q000473:pathology; D010996:Pleural Effusion / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000503:physiopathology; D013906:Thoracoscopy; D014376:Tuberculosis / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology
chemical_list: D000243:Adenosine Deaminase