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Abstract: SA-PO125

Comparative Analyses of Classical Urinary Discriminators in Pre- vs. Biopsy-Proven Intrarenal AKI

Session Information

Category: Acute Kidney Injury

  • 102 AKI: Clinical, Outcomes, and Trials

Author

  • Russwurm, Martin, Philipps-University Marburg, University Hospital,Center for Internal Medicine, Renal Division, Marburg, Germany

Group or Team Name

  • AG Translational Nephrology.
Background

The clinical distinction between prerenal and intrarenal acute kidney injury (AKI) remains challenging. Many biomarkers have been proposed, yet no comprehensive analyses of their performance has been conducted.

Methods

Classcial Urine AKI-Biomarkers of patients with biopsy-proven intrarenal AKI and prerenal AKI have been compared.

Results

Kindey urine composition handling showed alterations according to severity (Figure 1) of AKI in most discriminators. ROC analyses (of AKI 3 prerenal vs. intrarenal) showed some discriminatory power of the investigated classical biomarkers (Figure 2). Best performance was observed with BUN-to-creatinine-ratio (area-under-the-roc / AUROC = 0.79; sensitivity 60%, specificity 83%), worst with urine sodium concentration (AUROC 0.6; sensitivity 50%, specificity 68%). The ratio of FEUrea devided by BUN-to-creatinine-ratio yielded the best discriminatory power (AUROC 0.83; sensitivity 80%, specificity 73%).

Conclusion

This analysis is the first to comprehensively compare the discriminatory power of classic urine biomarkers to distinguish between prerenal and intrarenal AKI. To foster reliabilty the intrarenal group was based on kidney biopsy diagnosis. Overall, most parameters showed medium performance. We identified a new ratio (FEUra devided by BUN-to-creatinine-ratio), which performed best according to AUROC analysis.