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Kidney Week

Abstract: PO0264

Accuracy of Nephrologist Performed Urine Microscopy in Predicting Pathologic Diagnosis in Patients with AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials


  • Fawaz, Adam, Cleveland Clinic, Cleveland, Ohio, United States
  • Bassil, Elias, Cleveland Clinic, Cleveland, Ohio, United States
  • Simon, James F., Cleveland Clinic, Cleveland, Ohio, United States
  • Arrigain, Susana, Cleveland Clinic, Cleveland, Ohio, United States
  • Schold, Jesse D., Cleveland Clinic, Cleveland, Ohio, United States
  • Daou, Remy, Universite Saint-Joseph, Beirut, Lebanon
  • Taliercio, Jonathan J., Cleveland Clinic, Cleveland, Ohio, United States
  • Mehdi, Ali, Cleveland Clinic, Cleveland, Ohio, United States
  • Nakhoul, Georges, Cleveland Clinic, Cleveland, Ohio, United States

Urinalysis is a commonly performed diagnostic test in clinical laboratories and automated urine technology is becoming the standard for providing urinalysis data to clinicians. Time constraints, and automated technology reporting has resulted in a decline in clinicians performing their own urine sediment exam. We hereby look at the diagnostic accuracy of sediment suggested diagnoses in predicting the respective pathologic diagnoses


Using our Electronic Medical Records, we identified 33 adult patients with acute kidney injury with documented nephrologist performed urine microscopy and a kidney biopsy within one week of the sediment analysis. We performed chart review to ascertain the suggested diagnosis based on urine sediment analysis and compared it to the respective pathologic diagnoses identified on the subsequent kidney biopsy. We categorized the sediment findings into four categories: Bland, suggestive of acute tubular injury (sATI), suggestive of glomerulonephritis (sGN), and suggestive of acute interstitial nephritis (sAIN). Pathologic findings were categorized into ATI, GN, and AIN.


The cohort demographics consisted of 18 (54.6%) male patients, 23 whites (69.7%), and a mean age of 56.6 years. Sediment analyses was bland in 6 patients (8.45%) with 5 (15.15%) sATI, 22 (66.67%) sGN, and no sAIN cases. All 5 cases with sATI on sediment analysis showed ATI on the kidney biopsy. Similarly, all 22 cases with sGN on the sediment had a pathologic diagnosis consistent with GN on the biopsy. Of the 6 patients with bland sediment analyses, 3 showed ATN pathologically while the other 3 had GN on the kidney biopsy


Urine sediment examination remains an important test than can provide important information about kidney disease. Our data shows 100% agreement between sediment analyses suggestive of ATI or GN and the pathologic diagnoses. This is important in patients in whom a kidney biopsy might be contraindicated precluding the luxury of a pathologic diagnosis. While a suggestive sediment analysis seems to carry a high predictive value, the negative predictive value of a bland sediment was low however. Overall, we believe urine sediment analysis is an important skill for the nephrologist with important patient care implications.