Vipin Varghese1,2, Maria Soledad Rivera1, Ali A Alalwan2, Ayman M Alghamdi2, Manuel E Gonzalez3, Juan Carlos Q Velez1,2. 1. Ochsner Clinical School, The University of Queensland, New Orleans, Louisiana. 2. Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana. 3. Division of Nephrology, Department of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
Abstract
Background: Microscopic 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. Methods: MicrExUrSed 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. Results: At 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). Conclusions: Serial 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.
Background: Microscopic 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. Methods: MicrExUrSed 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. Results: At 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). Conclusions: Serial 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.
Authors: Mark A Perazella; Steven G Coca; Isaac E Hall; Umo Iyanam; Madiha Koraishy; Chirag R Parikh Journal: Clin J Am Soc Nephrol Date: 2010-01-14 Impact factor: 8.237
Authors: Andrew S Allegretti; Guillermo Ortiz; Julia Wenger; Joseph J Deferio; Joshua Wibecan; Sahir Kalim; Hector Tamez; Raymond T Chung; S Ananth Karumanchi; Ravi I Thadhani Journal: Int J Nephrol Date: 2015-07-22
Authors: Vipin Varghese; Maria S Rivera; Ali Alalwan; Ayman M Alghamdi; Akanksh Ramanand; Sumayyah M Khan; Jose E Najul-Seda; Juan Carlos Q Velez Journal: Kidney360 Date: 2022-01-19