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PLoS One. 2015 Apr 21;10(4):e0123323. doi: 10.1371/journal.pone.0123323. eCollection 2015.

Is Urinary Lipoarabinomannan the Result of Renal Tuberculosis? Assessment of the Renal Histology in an Autopsy Cohort of Ugandan HIV-Infected Adults.

Author information

1
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
2
Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda.
3
Department of Pathology, College of Health Sciences, Makerere University, Kampala, Uganda; Department of Pathology, Mulago Hospital Complex, Kampala, Uganda.
4
Department of Pathology, University Hospital Antwerp, University of Antwerp, Belgium.
5
Department of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
6
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda.
7
Joint Pathology Center, Silver Spring, United States of America.
8
Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium; Department of Epidemiology and Social Medicine, University of Antwerp, Belgium.
9
Infectious Diseases Institute, Makerere University College of Health Sciences, Kampala, Uganda; Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.

Abstract

OBJECTIVE:

The detection of urinary lipoarabinomannan (LAM), a mycobacterial cell wall component, is used to diagnose tuberculosis (TB). How LAM enters the urine is not known. To investigate if urinary LAM-positivity is the result of renal TB infection we correlated the outcomes of urinary LAM-antigen testing to renal histology in an autopsy cohort of hospitalized, Ugandan, HIV-infected adults.

METHODS:

We performed a complete autopsy, including renal sampling, in HIV-infected adults that died during hospitalization after written informed consent was obtained from the next of kin. Urine was collected postmortem through post-mortem catheterisation or by bladder puncture and tested for LAM with both a lateral flow assay (LFA) and an ELISA assay. Two pathologists assessed the kidney histology. We correlated the LAM-assay results and the histology findings.

RESULTS:

Of the 13/36 (36%) patients with a positive urinary LAM ELISA and/or LFA, 8/13 (62%) had renal TB. The remaining 5 LAM-positive patients had disseminated TB without renal involvement. Of the 23 LAM-negative patients, 3 had disseminated TB without renal involvement. The remaining LAM-negative patients had no TB infection and died mostly of fungal and bacterial infections. LAM LFA had a sensitivity of 81% and specificity of 100% to diagnose TB at any location, and the LAM ELISA a sensitivity of 63% and a specificity of 100%. 54% (7/13) LAM LFA-positive patients were not on anti-TB treatment at the time of death.

CONCLUSION:

Renal TB infection explained LAM-positivity in the majority of patients. Patients with disseminated TB without renal involvement can also be diagnosed with LAM. This suggests that other mechanisms that lead to urinary LAM-positivity exist in a minority of patients.

PMID:
25897661
PMCID:
PMC4405591
DOI:
10.1371/journal.pone.0123323
[Indexed for MEDLINE]
Free PMC Article

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