Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure

Romero-Candeira, Santiago; Fernández, Cleofé; Martín, César Casquet; Sánchez‐Paya, José; Hernández, Luís

doi:10.1016/s0002-9343(01)00726-4

Cited by 129 publications

(76 citation statements)

References 18 publications

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“…Diuretics can change level of many substances such as protein, albumin, LDH, cholesterol and cholinesterase in the pleural fluid [11,12]. However, Romero-Canderia et al [13] showed that the lowest changing markers are protein and albumin gradients. Similar to this study, we did not observe any conversion to exudate in pleural effusions of congestive heart failure patients, although they were using the diuretics.…”

Section: Discussionmentioning

confidence: 99%

Place of neopterin level in the differential diagnosis of tuberculosis pleurisy

Duksal¹,

Döngel

Duksal³

et al. 2013

Basic Clin Sci

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AbsractAim. Tuberculous pleurisy is one of the most common form of pulmonary tuberculosis, and may be confused with many other diseases. This study was designed to assess the diagnostic value of pleural fluid neopterin levels in patients with tuberculous pleurisy. Methods. A total of 57 patients [tuberculosis pleurisy (n=30), malignant pleural effusion (n=17), pleural effusion due to congestive heart failure (n=10)] were included in the study. The measurement of neopterin levels was conducted by the enzymeimmunassay method and Trinity-Biotech XL fully automatic ELISA kit device and neopterin IBL kit. Results. The neopterin levels in patients with tuberculous pleurisy were significantly higher than that of both malignancy and congestive heart failure (p<0.001). The neopterin levels of patients with congestive heart failure and malignancy were found as similar (p=0.920). There was no significant difference in the neopterin levels with regard to age and sex (p>0.05). Conclusions. Tuberculous pleurisy increases neopterin levels of pleural fluid when compared with malignancy and congestive heart failure. In this respect, neopterin level in the pleural fluid may be a useful diagnostic marker of tuberculous pleurisy.Keywords: Neopterin; pleural effusion; tuberculous pleurisy Özet Amaç. Tüberküloz plörezi akciğer tüberkülozunun en sık formlarından biri olup birçok hastalıkla karışabilir. Bu çalışma tüberküloz plörezili hastaların plevral sıvılarındaki neopterin seviyelerinin tanısal değerini belirlemek için yapılmıştır. Yöntem. Toplam 57 hasta [tüberküloz plörezi (n=30), malign plevral efüzyon (n=17) ve konjestif kalp yetmezliği

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Section: Discussionmentioning

confidence: 99%

Place of neopterin level in the differential diagnosis of tuberculosis pleurisy

Duksal¹,

Döngel

Duksal³

et al. 2013

Basic Clin Sci

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“…These effusions appear to be most commonly right sided (58%) or bilateral (26%), and are typically transudates [23]. Patients with cardiac effusions treated with diuretics are reported to have an increased pleural fluid protein level relative to its blood level, resulting in the effusion being classified as an exudate by Light's criteria [24]. In patients with an exudative effusion suspected of having a cardiac cause, correlation with echocardiography or NT-proBNP measurement may be helpful to clarify the aetiology; care should be taken to exclude other relevant potential causes, such as malignancy or pulmonary emboli.…”

Section: Cardiacmentioning

confidence: 99%

The management of benign non-infective pleural effusions

et al. 2016

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The evidence base concerning the management of benign pleural effusions has lagged behind that of malignant pleural effusions in which recent randomised trials are now informing current clinical practice and international guidelines.The causes of benign pleural effusions are broad, heterogenous and patients may benefit from individualised management targeted at both treating the underlying disease process and direct management of the fluid. Pleural effusions are very common in a number of non-malignant pathologies, such as decompensated heart failure, and following coronary artery bypass grafting. Pleural fluid analysis forms an important basis of the diagnostic evaluation, and more specific assays and imaging modalities are helpful in specific subpopulations.Options for management beyond treatment of the underlying disorder, whenever possible, include therapeutically aspirating the fluid, talc pleurodesis and insertion of an indwelling pleural catheter. Randomised trials will inform clinicians in the future as to the risks and benefits of these options providing a guide as to how best to manage patient symptoms in this challenging clinical setting. @ERSpublications Benign pleural effusion management is challenging and based on limited evidence. Treatment options are discussed http://ow.ly/10EOSN

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“…29 Albumin levels can also be used in this manner: a difference of more than 12 g/L between serum and fluid levels indicates a transudate. 30 Of note, a large percentage of exudates will be misclassified if these gradients are used as the only method of differentiating between transudates and exudates. 6 A pH less than 7.2 in infected effusions indicates a complicated parapneumonic effusion (empyema) until proved otherwise, and insertion of chest drain and fluid removal are priorities.…”

Section: Clinical Features Of Pleural Effusionsmentioning

confidence: 99%

“…Fluid lymphocytosis occurs in conditions such as tuberculosis, sarcoidosis, chylothorax, rheumatoid arthritis, and malignant neoplasm, including lymphoma. 30,31 Pleural fluid predominated by neutrophils is associated with pulmonary embolism, parapneumonic effusion, acute tuberculosis, and benign effusion related to exposure to asbestos. 31 A predominance of eosinophils in pleural fluid has no diagnostic value, and up to one-third of this type of effusion is never diagnosed.…”

Section: Clinical Features Of Pleural Effusionsmentioning

confidence: 99%

Diagnosis of Pleural Effusion: A Systematic Approach

McGrath

Anderson

2011

American Journal of Critical Care

121

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In most diseases related to pleural effusion, the fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. The many important characteristics of pleural fluid are described, as are other complementary investigations that can assist with the diagnosis of common and rare pleural effusions. For a systematic review of pleural effusion, a literature search for articles on the practical investigation and diagnosis of pleural effusion was done. Articles included guidelines, expert opinion, experimental and nonexperimental studies, literature reviews, and systematic reviews published from May 2003 through June 2009. The search yielded 1 guideline, 2 meta-analyses, 9 literature reviews, 1 randomized control trial, and 9 clinical studies. On the basis of class IIa or class I evidence from these articles, a step by step approach is recommended for investigating a pleural effusion, beginning with assessment of the medical history, clinical examination, radiology, pleural fluid evaluation, and finally, if no diagnosis is forthcoming, a pleural biopsy under image guidance or thoracoscopy.

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Influence of diuretics on the concentration of proteins and other components of pleural transudates in patients with heart failure

Cited by 129 publications

References 18 publications

Place of neopterin level in the differential diagnosis of tuberculosis pleurisy

Place of neopterin level in the differential diagnosis of tuberculosis pleurisy

The management of benign non-infective pleural effusions

Diagnosis of Pleural Effusion: A Systematic Approach

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