Evaluation of urine as a clinical specimen for diagnosis of hepatitis a

Abstract

The present study pertains to the evaluation of urine as a specimen for detection of anti-hepatitis A virus (anti-HAV) antibodies. Immunoglobulin M (IgM), IgG, and IgA capture enzyme-linked immunosorbent assays for hepatitis A were performed on paired serum and urine specimens collected from hepatitis A patients (n = 92), healthy individuals (n = 100), non-A hepatitis patients (n = 70), and patients with nonhepatic diseases (n = 64, including 37 renal disease patients). Hepatitis A patients seropositive for anti-HAV IgM showed 95.65% uropositivity. No false-positive reactions were observed in control groups. The uropositivity of anti-HAV IgM persisted during the convalescent phase of the disease. Anti-HAV IgG uropositivity correlated well with corresponding seropositivity in all groups (P > 0.05 for each). No significant difference between the proportions of serum and urine positivity for anti-HAV IgA was noted (P > 0.05 for each). Using seroreactivity as a "gold standard," the sensitivity and specificity for anti-HAV IgM, anti-HAV IgG, and anti-HAV IgA tests with urine as a specimen were found to be 95.65 and 100%, 97.76 and 76.47%, and 92.23 and 88.18%, respectively. Urine appears to be comparable to serum for diagnosis of recent and past infection with hepatitis A.

FIG. 1.

Scatter diagram displaying anti-HAV IgM activity in simultaneously collected serum and urine specimens from hepatitis A patients (n = 92), healthy controls (n = 98), non-A hepatitis patients (n = 70), and patients with nonhepatic diseases (n = 62).

FIG. 2.

Scatter diagram displaying anti-HAV IgG activity in simultaneously collected serum and urine specimens from hepatitis A patients (n = 80), healthy controls (n = 100), non-A hepatitis patients (n = 58), and patients with nonhepatic diseases (n = 64).

FIG. 3.

Scatter diagram displaying anti-HAV IgA activity in simultaneously collected serum and urine specimens from hepatitis A patients (n = 86), healthy controls (n = 100), non-A hepatitis patients (n = 66), patients with nonhepatic diseases (n = 64).