Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A; Acute Kidney Injury Network: Acute Kidney Injury Network: Report of an initiative to improve outcomes in acute kidney injury. Crit Care 11: R31, 2007 - PMC - PubMed
    1. Perlmutter M, Grossman SL, Rothenberg S, Dobkin G: Urineserum urea nitrogen ratio; simple test of renal function in acute azotemia and oliguria. JAMA 170: 1533–1537, 1959 - PubMed
    1. Miller TR, Anderson RJ, Linas SL, Henrich WL, Berns AS, Gabow PA, Schrier RW: Urinary diagnostic indices in acute renal failure: A prospective study. Ann Intern Med 89: 47–50, 1978 - PubMed
    1. Bock HA: Pathophysiology of acute renal failure in septic shock: From prerenal to renal failure. Kidney Int Suppl 64: S15–S18, 1998 - PubMed
    1. Klahr S, Miller SB: Acute oliguria. N Engl J Med 338: 671–675, 1998 - PubMed

Publication types

MeSH terms