Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury

Author:

Varghese Vipin,Rivera Maria Soledad,Alalwan Ali A.,Alghamdi Ayman M.,Gonzalez Manuel E.,Velez Juan Carlos Q.

Abstract

BackgroundMicroscopic examination of the urinary sediment (MicrExUrSed) is an established diagnostic tool for AKI. However, single inspection of a urine specimen during AKI is a mere snapshot affected by timing. We hypothesized that longitudinal MicrExUrSed provides information otherwise not identified in a single inspection.MethodsMicrExUrSed was undertaken in patients with AKI stage ≥2 and suspected intrinsic cause of AKI seen for nephrology consultation over a 2-year period. MicrExUrSed was performed on the day of consultation and repeated at a second (2–3 days later) and/or third (4–10 days later) interval. Cast scores were assigned to each specimen. Chawla scores (CS) 3–4 and Perazella scores (PS) 2–4 were categorized as consistent with acute tubular injury (ATI), whereas CS 1–2 and PS 0–1 were categorized as nondiagnostic for ATI (non-ATI). Nonrecovering AKI was defined as a rise in serum creatinine (sCr) ≥0.1 mg/dl between microscopy intervals.ResultsAt least two consecutive MicrExUrSed were performed in 121 patients (46% women, mean age 61±14, mean sCr at consult of 3.3±1.9 mg/dl). On day 1, a CS and PS consistent with non-ATI was assigned to 64 (53%) and 70 (58%) patients, respectively. After a subsequent MicrExUrSed, CS and PS changed to ATI in 14 (22%) and 16 (23%) patients. Thus, 20%–24% of patients only revealed evidence of ATI after serial MicrExUrSed was performed. Patients with nonrecovering AKI were more likely to change their PS to the ATI category (odds ratio, 5.8; 95% CI, 1.7 to 19.3; P=0.005 and positive likelihood ratio, 2.0; 95% CI, 1.3 to 2.9).ConclusionsSerial MicrExUrSed revealed diagnostic findings of ATI otherwise not identified in a single examination. A repeat MicrExUrSed may be warranted in patients AKI of unclear etiology that are not recovering.

Funder

Ochsner Health System

Publisher

American Society of Nephrology (ASN)

Subject

General Medicine

Cited by 8 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3