Abstract: SA-PO0066
Fractional Excretion of Urinary Sodium and Urinary Sediment Microscopy for Prediction of Early Response to Vasoconstrictors in Hepatorenal Syndrome
Session Information
- AKI: Clinical Diagnostics and Biomarkers
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Acute Kidney Injury
- 102 AKI: Clinical, Outcomes, and Trials
Authors
- Wickman, Terrance Joseph, Ochsner Health, New Orleans, Louisiana, United States
- Velasco-Gonzalez, Cruz, Ochsner Health, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology.
Background
Several biomarkers have been tested as predictors of therapeutic response (TR) to vasoconstrictor (VC) therapy in hepatorenal syndrome (HRS), but they have not performed optimally. We aimed to examine the value of fractional excretion of urinary sodium (FENa) (as functional biomarker) and/or evidence of acute tubular insult (ATI) by urinary sediment microscopy (uSEDI) (as injury biomarker) to predict TR to VC in HRS.
Methods
In a prospective observational cohort of AKI in cirrhosis, we searched for patients who met the ICA criteria for HRS and: 1) had a FENa < 1%, 2) did not have ≥ 6 “muddy brown” granular casts (MBGC) per low power field (lpf) by uSEDI [deemed overt ATI (Perazella score ≥ 2, i.e.., not HRS)], 3) were treated with a VC [midodrine/octreotide (M/O), norepinephrine (NE) or terlipressin (T)], and 4) achieved ≥ 5 mmHg rise in mean arterial pressure (MAP); over a 7-year period. ATI score by uSEDI was classified as: 0: bland or hyaline casts (HyC); 1: HyC >> MBGC or MBGC 0-1/lpf; 3: MBGC 2-5/lpf and ≥ HyC. TR to VC was defined as ≥ 30% reduction in serum creatinine (sCr) within 7-10 days without need for dialysis by day 14. Area under the receiver-operator curve (AUROC) for FENa and uSEDI as predictors of TR were estimated.
Results
Among 76 patients with HRS treated with a VC, 70 (53 NE, 13 T, 4 M/O), with complete data were included (39% women, mean age 52, sCr 3.9 mg/dL, MELD 32). Median MAP rise was 15 mmHg (5-25). TR was achieved by 36 (51%). Median FENa was 0.18% (0.07-0.63). FENa AUROC for TR was 0.82 (cutoff 0.18%, p<0.001). uSEDI score 0 (n=38) was associated with -31% change in sCr vs -3% for those with score 2 (n=17) (p=0.008). Thus, uSEDI AUROC for TR was 0.70 (p=0.007). Renal tubular epithelial cell casts were not discriminatory. Combining FENa and uSEDI led to an improved AUROC for TR of 0.87 (p<0.001). Furthermore, combining FENa, uSEDI ATI score and mean 1st 72 hrs increase in MAP (OR 2.4 for each 5-mmHg rise) led to an AUROC for TR of 0.91 (p<0.001).
Conclusion
The combination of very low FENa (< 0.18%), absence of overt ATI by uSEDI, and sustained rise in MAP leads to high probability of TR to VC in HRS. Utilizing FENa value and uSEDI findings may facilitate proper patient selection for the use of VC in HRS.