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. 2010 Mar;5(3):402-8.
doi: 10.2215/CJN.06960909. Epub 2010 Jan 14.

Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients

Mark A Perazella  1 , Steven G Coca, Isaac E Hall, Umo Iyanam, Madiha Koraishy, Chirag R Parikh
Affiliations

Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients

Mark A Perazella et al. Clin J Am Soc Nephrol. 2010 Mar.

Abstract

Background and objectives: Serum creatinine concentration at the time of nephrology consultation is not necessarily indicative of the severity of acute kidney injury (AKI). Although urine microscopy is useful to differentiate AKI, its role in predicting adverse clinical outcomes has not been well described.

Design, setting, participants, & measurements: The relationship between urine microscopy findings at the time of nephrology consultation for AKI and clinical outcomes was evaluated prospectively. A urinary sediment scoring system was created on the basis of the number of renal tubular epithelial cells and granular casts. The primary outcome was worsening of AKI (progressing to higher AKI Network stage, dialysis, or death) during hospitalization.

Results: Of 249 patients consulted for AKI, 197 had acute tubular necrosis or prerenal AKI and were included in the analysis. At consultation, 80 (40%) had stage 1, 53 (27%) had stage 2, and 66 (33%) had stage 3 AKI. The urinary sediment combined scores were lowest in those with stage 1 and highest in stage 3 AKI. Seventy-nine patients (40%) experienced worsening of AKI from the time of consultation. The urinary scoring system was significantly associated with increased risk of worsening AKI (adjusted relative risk: 7.3; 95% confidence interval: 4.5 to 9.7 for worsening with score of > or =3 versus score of 0) and was more predictive than AKI Network stage at the time of consultation.

Conclusions: The urinary sediment score may be a useful tool to predict worsening of AKI due to either acute tubular necrosis or prerenal AKI during hospitalization.

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Figures

Figure 1.
Figure 1.
(a) High-powered view of urinary RTE cells. (b) Low-powered view of urinary granular casts. Magnifications: ×400 in a; ×100 in b. The arrows point to RTE cells.
Figure 2.
Figure 2.
(a) Patient outcomes by urinary sediment score. (b) Patient outcomes by AKIN stage.
Figure 3.
Figure 3.
Sensitivity analyses: urine sediment score and outcomes.
See this image and copyright information in PMC

Comment in

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