The separation of transudates and exudates with particular reference to the protein gradient

Current Opinion in Pulmonary Medicine
Santiago Romero-Candeira, L Hernández

Abstract

The separation of pleural transudates from exudates, as the first step in the study of pleural effusions of unknown cause, is generally accepted as a useful practice. However, the optimal way to do this remains moot. New and more sophisticated biochemical markers have been proposed together, with new approaches to the interpretation of the results. Nevertheless, new studies have consolidated the criteria of Light et al. as those with a better accuracy. Effective diuresis increases the concentration of most pleural biochemical parameters used to differentiate transudates from exudates and appears as the main cause of the failures of this dichotomic approach. Among the alternative criteria proposed for identifying transudates in the setting of diuresis, the total protein gradient between serum and pleural fluid seems to be the most cost effective. Together with clinical judgment, the use of biochemical criteria seems mandatory. The criteria of Light et al. remain those of election. In the setting of effective diuresis, the use of the protein gradient is recommended. Although new and more sophisticated markers have been tested, it seems that looking for the causes of misclassification, when applying the criteria that to date have ...Continue Reading

References

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Citations

Oct 23, 2012·American Journal of Therapeutics·Kiran BaikatiSury Anand
Mar 20, 2013·Current Opinion in Pulmonary Medicine·José M Porcel
Mar 1, 2012·Respirology : Official Journal of the Asian Pacific Society of Respirology·Silvia BielsaRichard W Light
Sep 22, 2009·International Journal of Clinical Practice·E E McGrathP B Anderson
Jan 25, 2007·Clinical Chemistry and Laboratory Medicine : CCLM·Aureli EsquerdaJosé M Porcel
May 2, 2015·Medicine·Hung-Jen ChenRichard W Light
Aug 1, 2007·Clinical Chemistry and Laboratory Medicine : CCLM·Mathie P G LeersVolkher Scharnhorst
May 24, 2006·Clinics in Chest Medicine·Richard W Light
Sep 2, 2006·Archivos de bronconeumología·Victoria Villena GarridoUNKNOWN Area de Tecnicas y Trasplantes. SEPAR
Oct 26, 2013·Critical Reviews in Clinical Laboratory Sciences·Darci R Block, Alicia Algeciras-Schimnich
Apr 22, 2006·Respiratory Medicine·J M PorcelRichard W Light
Dec 3, 2014·La Revue de médecine interne·J PastréO Sanchez
Sep 1, 2016·Hospital Practice·Rana Khazar Al-ZoubiOsama Yousef
May 7, 2014·The Open Respiratory Medicine Journal·Rogério RufinoCláudia Henrique da Costa
Mar 3, 2011·American Journal of Critical Care : an Official Publication, American Association of Critical-Care Nurses·Emmet E McGrath, Paul B Anderson

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