1243 IMPACT OF RENAL FUNCTION ON THE DIAGNOSTIC ACCURACY OF URINE-BASED TESTS FOR THE DETECTION OF BLADDER CANCER
2011-04-01

You have accessJournal of UrologyBladder Cancer: Detection and Screening1 Apr 20111243 IMPACT OF RENAL FUNCTION ON THE DIAGNOSTIC ACCURACY OF URINE-BASED TESTS FOR THE DETECTION OF BLADDER CANCER Joeg Henenlotter, Mark Witstruk, Viktoria Wagner, Ursula Kuehs, Georgios Gakis, Tilman Todenhoefer, Saladin Alloussi, Stefan Aufderklamm, Arnulf Stenzl, and Christian Schwentner Joeg HenenlotterJoeg Henenlotter Tuebingen, Germany More articles by this author , Mark WitstrukMark Witstruk Tuebingen, Germany More articles by this author , Viktoria WagnerViktoria Wagner Tuebingen, Germany More articles by this author , Ursula KuehsUrsula Kuehs Tuebingen, Germany More articles by this author , Georgios GakisGeorgios Gakis Tuebingen, Germany More articles by this author , Tilman TodenhoeferTilman Todenhoefer Tuebingen, Germany More articles by this author , Saladin AlloussiSaladin Alloussi Tuebingen, Germany More articles by this author , Stefan AufderklammStefan Aufderklamm Tuebingen, Germany More articles by this author , Arnulf StenzlArnulf Stenzl Tuebingen, Germany More articles by this author , and Christian SchwentnerChristian Schwentner Tuebingen, Germany More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.914AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In case of hematuria (HU) non-invasive urine-based tests are applied for the detection of bladder cancer (BC). The performance of urine cytology and molecular markers remains insufficient. This is due to influencing variables such as mechanical manipulation or infection. Since many affected patients are elderly and suffer from renal insufficiency, associated proteinuria itself may be an influencing factor. No data are available regarding the accuracy of urine based cancer tests in conjunction with renal excretory function. Herein, we specifically address this issue. METHODS The study included spontaneously voided urine samples of 449 patients with HU suspicious for BC without any prior history of urothelial malignancy. Histological results were available in all. Urine cytology and the molecular tests uCyt+ (Diagnocure), UroVysion (Vysis), NMP22 ELISA (Matritech) were performed. Renal function was classified into normal, reduced and severely reduced function by serum creatinine (<1.2–3.5< mg/dl), glomerular filtration rate (GFR, >90–40> ml/min), urine protein concentration (<12.5–149< mg/dl) and a standard algorithm involving all 3 parameters. Rates of false positive results were compared by contingency analyses dependent on renal function following the defined criteria. RESULTS 382 (85.1%) patients did not show BC in histology. In those, there was a tendency towards increased rates of false positive results with regards to blood based creatinine and GFR thresholds. In the GFR group the NMP22 test showed 22.0% false positives for the normal group and 46.7% for the remaining (p=0.0565), respectively. Similar tendencies could be observed regarding proteinuria. Indeterminate significance was detected by separating those with severely reduced function for uCyt+ (0.08) and in the normal group for UroVysion (0.06). Proteinuria was a significant influencing variable for urine cytology (with 7.3/9.9 and 30.4% false positives, p=0.0017) remaining significant according to the algorithm (p=0.04), particularly in the group with severely reduced function (0.0123). CONCLUSIONS Renal excretory function appears to influence the accuracy of urine-based BC diagnostics. These effects may be mediated by excessive proteinuria and successive cellular interaction. Only cytology was significantly dependent on renal function yielding poor results in those with compromised kidneys. Importantly, molecular test are less susceptible to such influences. Renal function should be considered for the appropriate interpretation of urine-based BC-tests. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e497-e498 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joeg Henenlotter Tuebingen, Germany More articles by this author Mark Witstruk Tuebingen, Germany More articles by this author Viktoria Wagner Tuebingen, Germany More articles by this author Ursula Kuehs Tuebingen, Germany More articles by this author Georgios Gakis Tuebingen, Germany More articles by this author Tilman Todenhoefer Tuebingen, Germany More articles by this author Saladin Alloussi Tuebingen, Germany More articles by this author Stefan Aufderklamm Tuebingen, Germany More articles by this author Arnulf Stenzl Tuebingen, Germany More articles by this author Christian Schwentner Tuebingen, Germany More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...