Utility of a urine sediment score in hyperbilirubinemia/hyperbilirubinuria

Poloni, José Antônio Tesser; Perazella, Mark A.; Keitel, Elizete; Marroni, Cláudio Augusto; Leite, Samantha B; Rotta, Liane Nanci

doi:10.5414/cn109673

Cited by 16 publications

(11 citation statements)

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“…Therefore, ATI scores are expected to be less predictive of poor renal outcomes in this population. Secondly, in patients with pronounced hyperbilirrubinemia, RTEC and RTECC can be found even in the absence of AKI (16). Therefore, misleading ATI scores can be found in that subgroup.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury

et al. 2021

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Background. Microscopic examination of the urinary sediment (MicrExUrSed) is an established diagnostic tool for acute kidney injury (AKI). Single inspection of urine during the course of AKI is a mere snapshot affected by timing. We hypothesized that longitudinal MicrExUrSed provides information not identified in a single inspection. Methods. MicrExUrSed was undertaken in patients with AKI stage >= 2 and suspected intrinsic cause of AKI seen for nephrology consultation over a 2-year period. MicrExUrSed was performed on the day of consultation and repeated at a second (2 - 3 days later) and/or third (4 - 10 days later) interval. Cast scores were assigned to each specimen. Chawla scores (CS) 3 to 4 and Perazella scores (PS) 2 to 4 were categorized as consistent with acute tubular injury (ATI), whereas CS 1 to 2 and PS 0 to 1 were categorized as non-diagnostic for ATI (non-ATI). Non-recovering AKI was defined as a rise in serum creatinine (sCr) ≥ 0.1 mg/dL between microscopy intervals. Results. At least 2 consecutive MicrExUrSed were performed in 121 patients [46% women, mean age 61 ± 14, mean sCr at consult of 3.3 +/- 1.9 mg/dL]. On day 1, a CS and PS consistent with non-ATI was assigned to 64 (53%) and 70 (58%) patients, respectively. After a subsequent MicrExUrSed, CS and PS changed to ATI in 14 (22%) and 16 (23%) patients. Thus, 20 - 24% of patients only revealed evidence of ATI after serial MicrExUrSed was performed. Patients with non-recovering AKI were more likely to change their PS to ATI category [odds ratio: 5.8 (CI:1.7-19.3; p=0.005) and positive likelihood ratio: 2.0 (CI: 1.3-2.9)]. Conclusion. Serial MicrExUrSed revealed diagnostic findings of ATI not identified in a single examination. A repeat MicrExUrSed may be warranted in cases of AKI of unclear etiology or not recovering.

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Section: Discussionmentioning

confidence: 99%

Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury

et al. 2021

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“…Pathological casts are a very important part of urine sediment examinations and are the main indicator for determining whether there is pathological parenchymal damage of the kidney. 10 The traditional view is that the presence of casts in the urine is usually accompanied by positive protein test results. However, in practical daily work, it is uncommon for a urine analyzer to report abnormal cast with negative urinary protein results.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic value of urinary microprotein concentration for patients with negative urinary protein test results and positive urinary casts on microscopic examination

Zheng

Wang

Chen

et al. 2020

Clinical Laboratory Analysis

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“…Hyaline or lightly granular casts may be misinterpreted as dark granular casts. Although renal tubular epithelial cell casts (RTECC) are often found in specimens of patients with cirrhosis with AKI (27), they can also be identified in patients with hyperbilirubinemia without AKI (28). RTECC can also be seen in cases of acute cholemic tubulopathy.…”

Section: Abnormal Urinary Sediment Microscopymentioning

confidence: 99%

Hepatorenal Syndrome Type 1: From Diagnosis Ascertainment to Goal-Oriented Pharmacologic Therapy

Velez

2022

Kidney360

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Hepatorenal syndrome type 1 (HRS-1) is a serious form of acute kidney injury (AKI) that affects individuals with advanced cirrhosis with ascites. Prompt and accurate diagnosis is essential for effective implementation of therapeutic measures that can favorably alter its clinical course. Despite decades of investigation, HRS-1 continues to be primarily a diagnosis of exclusion. While the diagnostic criteria dictated by the International Club of Ascites (ICA) provide a useful framework to approach the diagnosis of HRS-1, they do not fully reflect the complexity of clinical scenarios that is often encountered in patients with cirrhosis and AKI. Thus, diagnostic uncertainty is often faced. In particular, the distinction between HRS-1 and acute tubular injury (ATI) is challenging with the currently available clinical tools. Because treatment of HRS-1 differs from that of ATI, distinguishing these 2 causes of AKI has direct implications in management. Therefore, the use if the ICA criteria should be enhanced with a more individualized approach and attention to the other phenotypic aspects of HRS-1 and other types of AKI. Liver transplantation is the most effective treatment for HRS-1 but it is only available to a small fraction of the affected patients worldwide. Thus, pharmacological therapy is necessary. Vasoconstrictors aimed to increase mean arterial pressure constitute the most effective approach. Administration of intravenous albumin is an established co-adjuvant therapy. However, the risk for fluid overload in patients with cirrhosis with AKI is not negligible and interventions intended to expand or remove volume should be tailored to the specific needs of the patient. Norepinephrine and terlipressin are the most effective vasoconstrictors and their use should be determined by availability, ease of administration and attention to optimal risk/benefit balance for each clinical scenario.

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Utility of a urine sediment score in hyperbilirubinemia/hyperbilirubinuria

Cited by 16 publications

References 0 publications

Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury

Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury

Diagnostic value of urinary microprotein concentration for patients with negative urinary protein test results and positive urinary casts on microscopic examination

Hepatorenal Syndrome Type 1: From Diagnosis Ascertainment to Goal-Oriented Pharmacologic Therapy

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