Etiology of pleural effusion in Chronic Kidney Disease patients and its correlation with neopterin levels.

Abstract

Background: Literature is showing elevated levels of neopterin levels both in serum as well as pleural fluid in CKD patients. It is not clear whether there is difference in neopterin levels, in pleural fluids of different aetiologies, in CKD patients. We tried to correlate the neopterin levels in different aetiologies of pleural effusion.

Objective: To study the etiology of pleural effusion in chronic kidney disease patients and to determine the correlation of neopterin levels in aetiology of pleural effusion in chronic kidney disease patients.

Study-Design: Prospective Hospital-based study.

Participants: Total 41 patient, 28 (68.3%) males and 13 (31.7%) females, mean age (±SD) 54.24 (±11.8) in years, underlying CKD with pleural effusion were enrolled in the study.

Material & Methods: Pleural fluid analysis was done in every patient to find the etiology. Pleuroscopy and pleural biopsy also done when indicated. Both serum and pleural fluid samples were collected, centrifuged and stored at -80ºC. Neopterin levels were determined by Human Neopterin ELISA kit.

Results: Out of total 41 patients in our study 18 (43.9%) patients had exudative pleural effusion of unknown aetiology.8 (19.5%) patients had pleural effusion as a part of volume overload, due to non-compliance to haemodialysis, 5 (12.2%) patients had parapneumonic pleural effusion, 4 (9.8%) patients had CCF, 3 (7.3%) patients had tubercular pleural effusion and 3 (7.3%) patients had uremic pleural effusion.

We found that, pleural fluid neopterin levels were highest in uremic pleural effusion 14.5nmol/L (±22.1) followed by 4.9nmol/L (±9.8) in pleural effusion due to unknown aetiology (probably uremic, but not confirmed by pleural biopsy) , whereas low in pleural effusion of tubercular, parapneumonic, CCF and volume overload aetiology, 2.6nmol/L (±2.3) , 1.06nmol/L (±1.2) , 1.2nmol/L (±1.2) and 1.8nmol/L (±2.6) respectively.

Conclusions: Pleural fluid neopterin levels were significantly higher in uremic pleural effusion as compared to parapneumonic pleural effusion, and pleural effusion due to CCF and volume overload in CKD patients but statistically insignificantly higher when compared to tubercular pleural effusion. Pair wise comparison was performed by Duncan’s Multiple range test (DMRT) .