Urinary sediment suggests lupus nephritis histology

Abstract

Objectives The objective of this paper was to evaluate correlations between kidney biopsy indexes (activity and chronicity) and urinary sediment findings; the secondary objective was to find which components of urinary sediment can discriminate proliferative from other classes of lupus nephritis. Methods Lupus nephritis patients scheduled for a kidney biopsy were included in our study. The morning before the kidney biopsy, we took urine samples from each patient. Receiver operating characteristic (ROC) curves were plotted to determine the area under the curve (AUC) of each test for detecting proliferative lupus nephritis; a classification tree was calculated to select a set of values that best-predicted lupus nephritis classes. Results We included 51 patients, 36 of whom were women (70.6%). Correlations of lupus nephritis activity index with the counts in the urinary sediment of erythrocytes (isomorphic and dysmorphic), acanthocytes, and leukocytes were 0.65 ( p < 0.0001) 0.62 ( p < 0.0001) and 0.22 ( p = 0.1228), respectively. Correlations of lupus nephritis chronicity index with the counts of erythrocytes, acanthocytes, and leukocytes were 0.60 ( p ≤ 0.0001), 0.52 ( p = 0.0001) and 0.17 ( p = 0.2300), respectively. Our classification tree had an accuracy of 84.3%. Conclusions Evaluation of urine sediment reflects lupus nephritis histology.

Class IV Lupus Nephritis in the Setting of Serologically Quiescent Disease and Normal Urine Sediment in a Patient with Late-Onset Systemic Lupus Erythematosus

“…Although proteinuria measured in 24-hour urine samples or the urine PC ratio is the principal urinary biomarkers for assessing LN, they do not necessarily relate to the histological changes in LN [18]. The presence of acanthocytes or erythrocytes in the urine sediments of patients with proliferative lupus nephritis has been shown to have an 82% positive predictive value (PPV) and 71–85% negative predictive value (NPV), respectively [19]. Interestingly, low total complement hemolytic activity (CH 50 ) and decreased C3 and C4 levels have been found in about 75% of SLE patients with focal nephritis and 90% in patients with diffuse nephritis [20].…”

Treatment of lupus nephritis – past, present and (near) future

“…In SLE patients, urinary sediment can be an important tool and can suggest the histological LN class. 52 Urinalysis and urinary sediment findings can also help predict relapses in LN 53 and in ANCA -vasculitis. 54 Conversely, worsening renal function combined with the absence of inflammatory changes in the urinary sediment can indicate non -immune mechanisms at play, which will not benefit from immunosuppression.…”

Automated urinalysis combining physicochemical analysis, on-board centrifugation, and digital imaging in one system: A multicenter performance evaluation of the cobas 6500 urine work area

“…Urinalysis is a very common technique used in clinical practice, providing crucial information on the functioning of the kidneys and other organ systems, and aiding clinical decision-making in various diseases, such as diabetes, glomerulonephritis, and suspected urinary tract infections (UTIs) [[1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13]]. Routine urinalysis involves a two-step approach after initial macroscopic examination, consisting of both physicochemical evaluation and microscopic examination of urine sediment to differentiate and quantify clinically relevant urine particles [[14], [15], [16], [17], [18]].…”