EUH Morning Report: How should ESR and CRP be utilized during clinical decision-making?

The Bottom Line:

“The acute phase reactants ESR and CRP are used clinically for diagnosis and monitoring of inflammatory conditions such as infections, trauma, infarction, neoplasm, inflammatory arthritis, and systemic autoimmune disease. However, because ESR and CRP lack sensitivity or specificity, they should not be used exclusively for diagnosis.” (Bray, p. 319)

EUH Morning Report: What is the utility of fecal calprotectin in the diagnosis and management of inflammatory bowel disease?

The Bottom Line:

Fecal calprotectin (FC) is a nonspecific marker of intestinal inflammation. FC has been shown to have high sensitivity and specificity for differentiating between IBD and functional gastrointestinal disorders in both adults and children. It is useful in differentiating between organic and non-organic gastrointestinal disease.

“Using cut-off values of 50 µg/g and 100 µg/g, the estimated demand for colonoscopies was reduced by 50% and 67%, respectively.” (Burri & Beglinger, 2012)

Article of interest: Urine Eosinophils for Acute Interstitial Nephritis

Lusica M, et al. Urine Eosinophils for Acute Interstitial Nephritis. J Hosp Med. 2017 May;12(5):343-345.

Full-text for Emory users.

RECOMMENDATIONS:

• Urine eosinophils should not be used in the diagnosis of AIN.
• The clinical diagnosis of drug-associated AIN should be based on excluding other possible likely etiologies of AKI and confirming the history of drug exposure. This is reinforced when kidney function improves upon discontinuation of offending agent.
• Kidney biopsy is the gold standard for AIN and should be performed if the clinical picture is unclear or the renal function is not improving upon discontinuation of offending agent.
• UEs are seen in other AKI etiologies, such as pyelonephritis, acute tubular necrosis, atheroembolic renal disease, and glomerulonephritis.

EUH Morning Report: What is the accuracy of BUN/Creatinine ratio (>20) for predicting pre-renal as etiology for ARF?

The Bottom Line: BUN/Cr is not sensitive or specific in predicting pre-renal vs intrinsic cause of acute kidney injury.

Fig 4. Receiver operating curve analysis of predictive performance of blood urea nitrogen to creatinine ratio (BCR)