Identification of acute porphyria: evaluation of a commercial screening test for urinary porphobilinogen

A commercial semi-quantitative kit (Trace) for urinary porphobilinogen (PBG) in which urine is pre-treated with ion-exchange resin and the colour of the Ehrlich-PBG adduct matched against a set of surrogate standards was compared with qualitative screening methods (Watson-Schwartz) in common use. Twenty samples in which PEG had been quantitated were blindly tested by both methods in each of 13 typical user laboratories. For urine samples with raised PEG: 123 out of 129 results were positive when tested with the Trace kit. Using qualitative tests routinely in use in the various laboratories only 45 out of 119 results were unequivocally positive. Sixteen out of 91 results for pigmented urine samples with normal PEG were reported as positive using qualitative screening tests, but only one using the Trace kit. Therefore, the Trace method is far more sensitive and specific than the qualitative screening tests. It is recommended that Watson-Schwartz-type screening tests should be abandoned and, ideally, all urine samples analysed by quantitative methods. However, the Trace method is a convenient alternative which is adequate for the initial screening of symptomatic patients.