Kidney Week

Abstract: TH-PO0765

Numerous Hyaline Casts in Urinary Sediment Is a Prominent Feature of Hepatorenal Syndrome

Session Information

• AKI: Critical Care, CKRT, Cardiorenal Syndromes, and Clinical Outcomes
  October 22, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Acute Kidney Injury

• 102 AKI: Clinical, Outcomes, and Trials

Authors

• Bendersky, Maggie, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Maggie Bendersky

• Asad, Maira, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Maira Asad, MBBS

• Tupil, Ajay, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Ajay Tupil

• Li, Irene J., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Irene J. Li, MS

• Hunt-Tobey, Bridget, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Bridget Hunt-Tobey, MS

• Shankar, Nithyapriya, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Nithyapriya Shankar

• Anzalone, Amy S., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Amy S. Anzalone, DO

• Yuen, Joanna, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Joanna Yuen, DO, MA

• Punukollu, Pooja A., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Pooja A. Punukollu

• Varghese, Vipin, The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Vipin Varghese, MD

• Velez, Juan Carlos Q., The University of Queensland Faculty of Medicine, Herston, Queensland, Australia

Juan Carlos Q. Velez, MD, FASN

Group or Team Name

• Ochsner Nephrology

Background

Urinary sediment microscopy (uSEDI) is a powerful diagnostic tool to assess acute kidney injury (AKI) in patients with cirrhosis to distinguish overt acute tubular injury (ATI) from hepatorenal syndrome (HRS), prerenal azotemia, acute glomerulonephritis or others. While absence of abundant dark granular casts is deemed consistent with HRS as an exclusion criterion, inclusionary elements of uSEDI are not normally considered. We previously reported that urinary hyaline casts (HYC) are prevalent in AKI in cirrhosis. We aimed to closely examine the frequency and clinical significance of identification of HYC in HRS.

Methods

Utilizing a prospective observational cohort of patients seen for nephrology consultation who completed uSEDI over a 7-yr period, we examined the uSEDI findings in patients with cirrhosis. Presence of HYC was defined as ≥10% of low power fields. Abundant HYC was considered ≥50% lpf with ≥6 HYC/lpf. Partial HRS resolution was defined as ≥30% fall in serum creatinine (sCr) within 2-7 days of vasoconstrictor therapy.

Results

301 patients [median age 57 (20-88), 41% women, 78% white] were included. Median sCr was 3.1 (1.3-12.6) mg/dL. The most common cause of cirrhosis were alcoholic (55%) and MASH (18%). HYC were identified in 73/124 (58.8%) of cases diagnosed as HRS, in 11/18 (61%) of prerenal azotemia and in 8/12 (66.7%) of congestive nephropathy, whereas only in 39/134 (29%) of ATI. Among the 124 HRS cases, 84 (68%) were treated with a vasoconstrictor and achieved ≥5 mmHg rise in mean arterial pressure (MAP). Among those, isolated HYC without coexisting granular or waxy casts were found in 26 (30.9%). In most cases, 24/26 (92.3%), their presence qualified as Abundant HYC [mean quantification 12 (3-40) HYC/lpf in 80% (10-100) of lpf]. Partial HRS resolution was seen in 15/26 (58%). There was a non-significant trend for an inverse correlation between abundance of HYC/lpf and the percentage fall in sCr (r=-0.244, p=0.114), and the magnitude of the correlation coefficient increased when the analysis was limited to those with ≥15 mmHg MAP rise (n=10) (r=-0.365, p=0.15).

Conclusion

Abundant HYC in uSEDI are a common feature of HRS and are associated with good probability of partial HRS resolution.