Abstract: FR-PO0850
Identification of Urinary Vacuolar Casts Is Associated with Worse Kidney Prognosis
Session Information
- Glomerular Diseases: Practice and New Concepts Shaping Modern Care
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Glomerular Diseases
- 1402 Glomerular Diseases: Clinical, Outcomes, and Therapeutics
Authors
- Hunt-Tobey, Bridget, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Shankar, Nithyapriya, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Tupil, Ajay, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Bendersky, Maggie, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Li, Irene J., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Mora, Madison Bailey, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Perilloux, Stewart B., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Kriener, Kyleigh, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Anzalone, Amy S., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Yuen, Joanna, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Punukollu, Pooja A., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Asad, Maira, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Biggs, Erin, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Varghese, Vipin, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Velez, Juan Carlos Q., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
Group or Team Name
- Ochsner Nephrology
Background
We previously reported that vacuolar casts (VACUC) are a distinct type of casts identified by urinary sediment microscopy (uSEDI) that are associated with advanced proteinuric glomerulopathies. However, it remains unknown whether their presence carries prognostic value. We hypothesized that VACUC predict a greater risk for progression to end-stage kidney disease (ESKD).
Methods
Utilizing a prospective observational cohort of patients seen for nephrology consultation who completed uSEDI over a 7-yr period, we examined the relationship between presence of VACUC and renal outcomes at 6- and 12-months (mo) post uSEDI date (need for dialysis as ESKD, eGFR trajectory). Adjusted by demographics, serum creatinine (sCr) and urine protein-to-creatinine ratio (UPCR), VACUC association with ESKD was assessed by multivariable logistic regression, and longitudinal eGFR trajectory was evaluated by a repeated-measures linear mixed-effects model incorporating a VACUC-by-time interaction.
Results
Of 1,088 patients who completed uSEDI, after exclusion due to death, lack of UPCR or missing follow-up data, 552 patients were included. Median age 60, [42% women] were included. Median sCr and UPCR were 3.2 mg/dL and 0.8 g/g. VACUC were identified in 41 (7.4%). Mean UPCR was significantly higher in those with VACUC (6.0 vs. 2.1 g/g. p<0.0001). After adjusting for age, sex, race, sCr and UPCR, VACUC were associated with an adjusted OR for ESKD at 6 mo (n = 405) of 3.02 (1.24-7.32) and at 12 mo (n = 338) of 4.15 (1.58-10.87]. When restricted to glomerulopathies, the adjusted ORs for ESKD were stronger: 9.39 (2.45-36.0) at 6 mo (n = 126) and 9.91 (2.63-37.35) at 12 mo (n = 103). A linear mixed-effects model for longitudinal eGFR trajectory revealed a lower adjusted least-squares mean eGFR for those with VACUC [-9.88 ml/min at 6 mo, -10.43 ml/min at 12 mo; p=0.056].
Conclusion
Identification of urinary VACUC in patients with glomerulopathies is independently associated with a greater risk for progression to ESKD. Recognition of VACUC by uSEDI requires optimal microscopy and operator proficiency. Thus, development of an enhanced method of detection of urinary VACUC may result in broader clinical utility.