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ACP presidential address: screening for presymptomatic disease

Article Abstract:

In general, when a disease is diagnosed in the early stages, the changes for a complete cure are the greatest. Screening for a disease before symptoms have a chance to develop provides the best opportunity for diagnosing a disease in its earliest stage. Screening tests for diabetes, high blood pressure, heart disease, and iron deficiency are good examples. For screening to be effective, the test that is used must be sensitive (able to identify people with the disease) and specific (should give a negative test result for people without the disease). Also, the test must be reliable and reproducible. A range of test values that are considered to be 'normal' should be established. Test results that fall outside of the normal range indicate that something may be wrong and that further tests should be performed. The disorder that is tested for should be an important public health concern, and effective treatments should be available. One problem with mass screening programs is ensuring that the people with test results that suggest something is wrong actually receive follow-up tests. Several studies have shown that many patients with abnormal test results do not receive proper medical care. In one study, 117 people participating in a diabetes screening clinic were diagnosed with diabetes, but only half of them received proper follow-up care. In another study, 424 subjects were referred for a follow-up visit after testing positive for high blood cholesterol. Only 65 percent of these patients received proper medical care. Another problem is getting people to take the prescribed medications when they test positive for a disease but do not have any symptoms. Screening tests must be proven to be effective before public screening programs are begun; screening should be performed under medical supervision; and people at greatest risk for the disease or condition should be screened. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Medical screening, Health screening

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Beta2-glycoprotein-1 (apolipoprotein H) excretion in chronic renal tubular disorders: comparison with other protein markers of tubular malfunction

Article Abstract:

Patients with chronic kidney disease have increased levels of small proteins in their urine because the tubules of the kidneys are not filtering and reabsorbing molecules properly. These proteins can be detected and used as markers for early detection of kidney disease. The levels of one protein known as beta2-glycoprotein-1 (apolipoprotein H; apo H) were examined in 60 patients with kidney disease. Apo H was found to be increased in 49 (82 percent) of the patients. This was compared with other proteins that are presently used to detect renal disease. Alpha1-microglobulin was found in increased levels in 77 percent of the patients; retinol-binding protein, in 75 percent; and beta2-microglobulin, in 52 percent of the patients. Activity of the enzyme N-acetyl-beta-D-glucosaminidase was found in 59 percent of the patients. These results demonstrate that apo H is detected more frequently in patients with kidney disease than the other proteins presently used as markers. In addition, apo H did not degrade in urine over long periods of time and, therefore, is a reliable indicator of disease. Some of the other proteins presently used as markers, such as beta2-microglobulin, degrade in urine over long periods of time and are not reliable markers of disease. (Consumer Summary produced by Reliance Medical Information, Inc.)

Glycoproteins, Apolipoproteins

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Are renal microgranulomas related to inflammatory tubular destruction?

Article Abstract:

The two cases of renal microgranuloma formation arising as a result of inflammatory tubular destruction, one in a patient with Crohn's disease who was taking sulfasalazine and the other in acute renal allograft reject, are discussed. Non-specific inflammatory tubular destructions are considered as a cause of renal microgranuloma formation, in addition to systemic granulomatous diseases.

United States, Science & research, Research, Case studies, Crohn's disease, Granuloma

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