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Kidney Week

Abstract: PO0870

Quality Improvement Project: Examining Urine Sediment and Microscopic Findings in COVID-19 AKI Patients

Session Information

Category: Coronavirus (COVID-19)

  • 000 Coronavirus (COVID-19)

Authors

  • Gelaidan, Abdulhadi Talal, Emory University School of Medicine, Atlanta, Georgia, United States
  • Rajabalan, Ajai S., Emory University School of Medicine, Atlanta, Georgia, United States
  • Lea, Janice P., Emory University School of Medicine, Atlanta, Georgia, United States
  • Navarrete, Jose E., Emory University School of Medicine, Atlanta, Georgia, United States
  • Cobb, Jason, Emory University School of Medicine, Atlanta, Georgia, United States
Background

The examination of the urine microscopy manually is common in the work-up of AKI. SARS-CoV-2 has been detected in urine samples of infected patients. There have been safety concerns about the handling of urine samples in patient under investigation and COVID-19 confirmed cases. Limitations in personal protective equipment have provided challenges. There has been limited reports of urine microscopic findings during the COVID-19 pandemic. We developed a QI project examining the urine sediment of COVID-19 AKI patients from digital pictures provided by the IRIS IQ200 Microscopy System.

Methods

This QI project took place at Emory University Hospital Midtown. We retrospectively evaluated baseline characteristics, labs, and urine volume. The urinalysis and urine sediment were evaluated for each patient by digital images produced by the IRIS IQ200 Microscopy System.

Results

A total of 17 African American patients with a mean age of 71±12.5 years (range, 55 to 98); 64.7 % were female. Comorbidities included hypertension (94.1%), diabetes (58.8%), CAD (11.9%) and CKD (52.9%). Average serum creatinine was 3.1 mg/dL. 8 patients (47%) were oliguric; 4 patients had FENa < 1%. 8 patients (47%) had 2+ proteinuria. 9 patients (52.9%) had a positive leukocyte esterase and all were nitrate negative. 8 patients (47%) had ATN with visible muddy brown casts. 6 patients (35%) had ≥ 5 rbc/hpf and 11 patients (65%) had ≥ 5 wbc/hpf. 8 patients (47%) had shock requiring vasopressor support, 8 patients (47%) required dialysis and 13 patients (76.5%) required mechanical ventilation.

Conclusion

Urinalysis and urine microscopy are important in evaluation of AKI, and there is a paucity of data about findings in COVID-19 AKI patients. Without conclusive evidence of the infective potential of urine samples, it is much needed at this time to device a safe alternative to manual urine microscopic examination. Almost half of our patients had ATN and we were able to arrive at the diagnosis using digital images from this automated urine microscopy system. Use of such technology will help nephrologists safely examine urine sediments and minimize exposure to COVID-19.