Abstract: FR-PO061

Prospective Cohort Study Assessing the Role of Urine Microscopy in Diagnosis and Management 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

  • Nanavati, Arani D., Cleveland Clinic, Cleveland, Ohio, United States
  • Simon, James F., Cleveland Clinic, Cleveland, Ohio, United States
Background

Nephrologist-performed urine microscopy is a competency taught during training and encouraged in practice when working up acute kidney injury (AKI).Despite this its use in clinical practice has waned for multiple reasons. Available data showing that nephrologist-performed microscopy(NPM) positively impacts the diagnosis and management of AKI patients is limited to differentiating prerenal azotemia from ATN. We conducted a prospective cohort study at a tertiary care center to identify to what extent NPM aids in identifying the etiology and proposed management of AKI when all cases are considered.

Methods

Fresh urine samples were obtained from 113 patients with AKI on inpatient Nephrology consult service between September and December 2016. AKI was defined by at least stage 1 AKI as per the Kidney Disease Improving Global Outcomes definition [an increase of serum creatinine (SCr) by >0.3 mg/dl and/or increase >50%-100% from baseline]. Only cases reviewed by staff nephrologists were included. Nephrologists were provided with questionnaires before inspecting the urine sediment. They were asked to provide the proposed etiology of AKI and planned management prior to and after performing urine microscopy. A logistic regression model was created to investigate how often the etiology and proposed management changed based on urine sediment review and what variables may have increased the likelihood of either change.

Results

Presumptive etiology of AKI was changed with urine microscopy in 24%(n=27) of patients. Proposed management of AKI was changed in 12% of patients. Management remained unchanged in 98% of patients in whom diagnosis was unchanged after microscopy. But of 27 patients in whom the etiology was changed after urine microscopy, management was changed in 44% of cases (n=12) (p<0.001) (Fischer’s exact test). In a multivariable logistic regression model sepsis on presentation was found to be associated with higher odds of change in diagnosis of AKI after urine microscopy after adjusting for baseline and consult SCr (Odds ratio 4.19, 95% CI- 1.59-11.47, p= 0.004).

Conclusion

Nephrologist-performed urine microscopy plays a significant role in identifying the etiology and in management of patients with AKI in hospital. The likelihood was found to be higher in patients who were septic on presentation in our study.