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

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

Research output: Contribution to journalArticle

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 ≥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.

Original languageEnglish (US)
Pages (from-to)402-408
Number of pages7
JournalClinical Journal of the American Society of Nephrology
Volume5
Issue number3
DOIs
StatePublished - Mar 1 2010

Fingerprint

Acute Kidney Injury
Microscopy
Urine
Referral and Consultation
Nephrology
Hospitalization
Necrosis
Dialysis
Creatinine
Epithelial Cells
Confidence Intervals

ASJC Scopus subject areas

  • Nephrology
  • Transplantation
  • Epidemiology
  • Critical Care and Intensive Care Medicine

Cite this

Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients. / Perazella, Mark A.; Coca, Steven G.; Hall, Isaac E.; Iyanam, Umo; Koraishy, Madiha; Parikh, Chirag.

In: Clinical Journal of the American Society of Nephrology, Vol. 5, No. 3, 01.03.2010, p. 402-408.

Research output: Contribution to journalArticle

Perazella, Mark A. ; Coca, Steven G. ; Hall, Isaac E. ; Iyanam, Umo ; Koraishy, Madiha ; Parikh, Chirag. / Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients. In: Clinical Journal of the American Society of Nephrology. 2010 ; Vol. 5, No. 3. pp. 402-408.
@article{b9f4559b6fa64a3f90e176e95e133be7,
title = "Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients",
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 ≥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.",
author = "Perazella, {Mark A.} and Coca, {Steven G.} and Hall, {Isaac E.} and Umo Iyanam and Madiha Koraishy and Chirag Parikh",
year = "2010",
month = "3",
day = "1",
doi = "10.2215/CJN.06960909",
language = "English (US)",
volume = "5",
pages = "402--408",
journal = "Clinical journal of the American Society of Nephrology : CJASN",
issn = "1555-9041",
publisher = "American Society of Nephrology",
number = "3",

}

TY - JOUR

T1 - Urine microscopy is associated with severity and worsening of acute kidney injury in hospitalized patients

AU - Perazella, Mark A.

AU - Coca, Steven G.

AU - Hall, Isaac E.

AU - Iyanam, Umo

AU - Koraishy, Madiha

AU - Parikh, Chirag

PY - 2010/3/1

Y1 - 2010/3/1

N2 - 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 ≥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.

AB - 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 ≥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.

UR - http://www.scopus.com/inward/record.url?scp=77749245869&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77749245869&partnerID=8YFLogxK

U2 - 10.2215/CJN.06960909

DO - 10.2215/CJN.06960909

M3 - Article

C2 - 20089493

AN - SCOPUS:77749245869

VL - 5

SP - 402

EP - 408

JO - Clinical journal of the American Society of Nephrology : CJASN

JF - Clinical journal of the American Society of Nephrology : CJASN

SN - 1555-9041

IS - 3

ER -