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Kidney Week

Abstract: FR-PO073

Evaluation of the Clinical Utility of Urinary Sediment in Predicting Prognosis of AKI

Session Information

  • AKI Clinical: Predictors
    November 03, 2017 | Location: Hall H, Morial Convention Center
    Abstract Time: 10:00 AM - 10:00 AM

Category: Acute Kidney Injury

  • 003 AKI: Clinical and Translational

Authors

  • Lee, Mingfeng, St. Luke's international hospital, Tokyo, Japan
  • Nagahama, Masahiko, St. Luke's international hospital, Tokyo, ToKyo, Japan
  • Komatsu, Yasuhiro, St. Lukes International Hospital, Tokyo, Japan
Background

Urinary sediment is helpful for differential diagnosis of acute kidney injury (AKI), but evidence is lacking whether urinary sediment findings are related to prognosis of AKI. In this study, we evaluate the relationship between urinary cast and prognosis of AKI.

Methods

We retrospectively collected the data from the patients who developed AKI during hospitalization at our hospital between April 2011 and March 2016. AKI was defined by KDIGO definition (either increase in S-Cr of ≥0.3 mg/dl within 48 hours or ≥50% within 7 days). Known risk factors for AKI, such as baseline CKD stage and comorbidities as well as urinalysis at the time of AKI were obtained. Patients with CKD stage 5, including on maintenance dialysis, received kidney transplantation, or age<18yr were excluded. We set our primary endpoint as “long term prognosis of AKI: recovery of renal function 3 months after AKI”, and secondary endpoint as “short term prognosis of AKI: the receipt of renal replacement therapy (RRT) during the hospitalization”. Baseline S-Cr level was defined as the lowest outpatient value within 6 months before admission. Risk factors for AKI were sought using univariate and multivariate logistic regression.

Results

We identified 833 patients for the study. The mean age of the patients was 68.4±16 (mean+/-S.D.) yr, the male ratio was 60.6%. Among them, 292 patients (35.1%) showed granular cast at the time of AKI, 51 patients (6.1%) needed RRT during hospitalization and 146 patients (17.5%) showed worsened renal function 3 months after AKI. On multivariate logistic regression analysis, baseline CKD stage was associated with both “long term prognosis of AKI” (OR=2.01, P=0.04) and “short term prognosis of AKI” (OR=8.95, P<0.001). In contrast, the presence of granular cast was associated with “short term prognosis of AKI” (OR=2.9, P=0.001), but was not with “long term prognosis of AKI” (P=0.26).

Conclusion

The presence of granular cast at the time of AKI can predict the need for RRT during hospitalization, but cannot predict recovery of renal function 3 months after AKI. Our study underscores the importance of urinalysis not only for diagnosis but also for “short term prognosis”. Baseline renal function affects renal function recovery.