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Kidney Week

Abstract: FR-PO075

Utility of Urinary Microscopy Score to Identify Patients with Subclinical AKI and Subsequent Clinical AKI

Session Information

Category: Acute Kidney Injury

  • 101 AKI: Epidemiology, Risk Factors, and Prevention

Authors

  • Claure-Del Granado, Rolando, Division of Nephrology, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia, Plurinational State of
  • Torrico-Moreira, Diego, Division of Nephrology, Hospital Obrero No 2 - CNS, Cochabamba, Bolivia, Plurinational State of
  • Yang, Jason W., University of California San Diego School of Medicine, La Jolla, California, United States
  • Lee, Pei Lun, University of California San Diego School of Medicine, La Jolla, California, United States
  • Malhotra, Rakesh, University of California San Diego School of Medicine, La Jolla, California, United States
  • Zhang, Jingyao, University of California San Diego School of Medicine, La Jolla, California, United States
Background

ADQI group has proposed a new AKI classification to recognize early stage of AKI termed subclinical (1S) using functional and structural biomarkers. However, these novel structural biomarkers are not available in resource-limited settings. We propose that urinary sediment score (USS), which reflects kidney structural damage could detect subclinical AKI and subsequent development of clinical AKI.

Methods

We included 103 consecutive hospitalized patients who were at moderate to high-risk of AKI using AKI Risk Assessment algorithm (Rizo-Topete et al. Blood Purif. 2017;43(1-3):82-88). Fresh urine was obtained and examined and urine sediment was assigned a score (Perazella et al. score Clin J Am Soc Nephrol 2010 Mar;5(3):402-8.) from 1 to 3 at admission, at 48 hours and at day 7. Renal function was followed up daily up to 7 days. We defined subclinical AKI (ADQI stage 1S) as a urinary sediment score (USS) ≥2 in the absence of rise in serum creatinine (sCr). Clinical AKI was defined by KDIGO sCr criteria and classified using the new propossed ADQI classification (1A, 1B, 2A, 2B, 3A or 3B) depending on the presence or absence of elevated damage (USS) or functional (sCr) biomarkers. We analyzed the predictive value of this scoring system for the subsequent development of clinical AKI, need of kidney replacement therapy (KRT) and mortality.

Results

Among 103 patients, 38% (39/103) have a USS ≥ 2 and were classified as AKI-1S. At 48 hours, 80% (31/39) patients of the AKI-1S group developed clinical AKI. At 7 days, only 9 % of patients with a USS ≤ 1 developed clinical AKI vs. 75% of AKI-1S patients; p < 0.0001. A USS ≥ 2 at admission have a good performance in predicting clinical AKI with a ROC-AUC 0.84 (95% CI 0.75-0.92); p < 0.0001. Need of KRT (10.3% vs. 1.6%; p = 0.05) was higher in patients with AKI-1S vs. patients with normal kidney function who later developed clinical AKI. Mortality was also higher in patients who developed AKI-1S versus patients with normal kidney function at admission (43.6% vs. 14.6%; p = 0.008).

Conclusion

Urine sediment score can identify early phase of AKI and will be useful tool to refine the diagnostic and staging criteria for AKI especially in resource-limited settings.