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Kidney Week

Abstract: TH-PO055

Urinary Sediment Microscopy as a Diagnostic Tool in Patients With End-Stage Liver Disease With AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical‚ Outcomes‚ and Trials

Authors

  • Varghese, Vipin, Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Sultan, Mohammad Tanvir, Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Chalmers, Dustin, Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Cacioppo, Paula Anne, Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Uddin, Durin Y., Department of Internal Medicine, Ochsner Clinic Foundation, New Orleans, Louisiana, United States
  • Velez, Juan Carlos Q., Department of Nephrology, Ochsner Clinic Foundation, New Orleans, Louisiana, United States

Group or Team Name

  • Ochsner Nephrology
Background

Microscopic examination of the urinary sediment (MicrExUrSed) is a useful diagnostic tool in acute kidney injury (AKI). MicrExUrSed findings in patients with end-stage liver disease (ESLD) with AKI have not been well characterized. Hepatorenal syndrome type 1 (HRS-1), a type of AKI in ESLD, is difficult to diagnose despite the International Club of Ascites (ICA) criteria. Thus, we hypothesized that MicrExUrSed findings in ESLD differ from those in the absence of ESLD, and that they may aid in diagnosis of AKI, specifically to distinguish HRS-1 from acute tubular injury (ATI).

Methods

MicrExUrSed was performed in patients with AKI stage ≥ 2 with or without ESLD over a 3-year period. Data were collected prospectively. The percentage of low power fields (LPF) containing hyaline casts (HC), waxy casts (WxC), renal tubular epithelial cell casts (RTECC), granular casts (GC), and muddy brown granular casts (MBGC) was assessed. HRS-1 was defined by the ICA criteria and urine Na (uNa) <20 mEq/L. The presence of GC was used to determine the diagnosis of ATI.

Results

Distribution of casts by percentage of LPF containing casts differed between the ESLD (n=185) and non-ESLD (n=421) groups. HC, RTECC, and GC were identified more often in ESLD compared to non-ESLD [42 vs 7% (p<0.0001); 30 vs 9% (p<0.0001) and 54 vs 26% (p<0.0001) for HC, RTECC and GC, respectively]. No difference in frequency of WxC (22 vs 19%, p=0.39) or MBGC (21 vs 24%, p=0.42) was found. In the ESLD group, total bilirubin level was significantly higher for those with RTECC [24.9 vs. 9.4 mg/dL (p<0.0001)] suggesting potential pathogenesis of bile cast tubulopathy. A diagnosis of HRS-1 (based on ICA + uNa) was assigned to 51/185 (27%) of patients with ESLD and AKI. Among them, 27/51 (53%) were converted to ATI based on the presence of GC.

Conclusion

MicrExUrSed can aid in the diagnosis of AKI in ESLD by identifying those with evidence of ATI, i.e., not consistent with HRS-1. Additionally, the spectrum of MicrExUrSed findings in patients with ESLD differs from that of patients without ESLD. Higher frequency of HC in ESLD may reflect more frequent tubular stasis consistent with their disease state. More studies are needed to examine the clinical implications of RTECC seen in those with higher total bilirubin.