Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass
Abstract Introduction: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing cardiac surgery and 2.3% requires renal replacement therapy (RRT). The current diagnostic criteria for AKI by increased serum creatinine levels have limitations and new biomarkers are being tested. Urine sediment may be considered a biomarker and it can help to differentiate pre-renal (functional) from renal (intrinsic) AKI. Aims: To investigate the microscopic urinalysis in the AKI diagnosis in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24 h after the surgery. We looked for renal tubular epithelial cells (RTEC) and granular casts (GC) and associated the results with AKI development as defined by KDIGO criteria. Results: Twenty three patients (20.17 %) developed AKI according to the serum creatinine criterion and 76 (66.67 %) by the urine output criterion. Four patients required RRT. Mortality was 3.51 %. The use of urine creatinine criterion to predict AKI showed a sensitivity of 34.78 % and specificity of 86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of 0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI: 0.465-0.680). Conclusion: RTEC and GC in urine sample detected by microscopy is a highly specific biomarker for early AKI diagnosis after cardiac surgery.
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Sociedade Brasileira de Nefrologia
2020
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oai:scielo:S0101-280020200001000182020-04-17Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypassGoldani,João CarlosPoloni,José AntônioKlaus,FabianoKist,RogerPacheco,Larissa SgariaKeitel,Elizete Acute Kidney Injury Thoracic Surgery Biomarkers Abstract Introduction: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing cardiac surgery and 2.3% requires renal replacement therapy (RRT). The current diagnostic criteria for AKI by increased serum creatinine levels have limitations and new biomarkers are being tested. Urine sediment may be considered a biomarker and it can help to differentiate pre-renal (functional) from renal (intrinsic) AKI. Aims: To investigate the microscopic urinalysis in the AKI diagnosis in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24 h after the surgery. We looked for renal tubular epithelial cells (RTEC) and granular casts (GC) and associated the results with AKI development as defined by KDIGO criteria. Results: Twenty three patients (20.17 %) developed AKI according to the serum creatinine criterion and 76 (66.67 %) by the urine output criterion. Four patients required RRT. Mortality was 3.51 %. The use of urine creatinine criterion to predict AKI showed a sensitivity of 34.78 % and specificity of 86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of 0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI: 0.465-0.680). Conclusion: RTEC and GC in urine sample detected by microscopy is a highly specific biomarker for early AKI diagnosis after cardiac surgery.info:eu-repo/semantics/openAccessSociedade Brasileira de NefrologiaBrazilian Journal of Nephrology v.42 n.1 20202020-03-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002020000100018en10.1590/2175-8239-jbn-2018-0133 |
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Goldani,João Carlos Poloni,José Antônio Klaus,Fabiano Kist,Roger Pacheco,Larissa Sgaria Keitel,Elizete |
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Goldani,João Carlos Poloni,José Antônio Klaus,Fabiano Kist,Roger Pacheco,Larissa Sgaria Keitel,Elizete Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
author_facet |
Goldani,João Carlos Poloni,José Antônio Klaus,Fabiano Kist,Roger Pacheco,Larissa Sgaria Keitel,Elizete |
author_sort |
Goldani,João Carlos |
title |
Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
title_short |
Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
title_full |
Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
title_fullStr |
Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
title_full_unstemmed |
Urine microscopy as a biomarker of Acute Kidney Injury following cardiac surgery with cardiopulmonary bypass |
title_sort |
urine microscopy as a biomarker of acute kidney injury following cardiac surgery with cardiopulmonary bypass |
description |
Abstract Introduction: Acute kidney injury (AKI) occurs in about 22% of the patients undergoing cardiac surgery and 2.3% requires renal replacement therapy (RRT). The current diagnostic criteria for AKI by increased serum creatinine levels have limitations and new biomarkers are being tested. Urine sediment may be considered a biomarker and it can help to differentiate pre-renal (functional) from renal (intrinsic) AKI. Aims: To investigate the microscopic urinalysis in the AKI diagnosis in patients undergoing cardiac surgery with cardiopulmonary bypass. Methods: One hundred and fourteen patients, mean age 62.3 years, 67.5 % male, with creatinine 0.91 mg/dL (SD 0.22) had a urine sample examined in the first 24 h after the surgery. We looked for renal tubular epithelial cells (RTEC) and granular casts (GC) and associated the results with AKI development as defined by KDIGO criteria. Results: Twenty three patients (20.17 %) developed AKI according to the serum creatinine criterion and 76 (66.67 %) by the urine output criterion. Four patients required RRT. Mortality was 3.51 %. The use of urine creatinine criterion to predict AKI showed a sensitivity of 34.78 % and specificity of 86.81 %, positive likelihood ratio of 2.64 and negative likelihood ratio of 0.75, AUC-ROC of 0.584 (95%CI: 0.445-0.723). For the urine output criterion sensitivity was 23.68 % and specificity 92.11 %, AUC-ROC was 0.573 (95%CI: 0.465-0.680). Conclusion: RTEC and GC in urine sample detected by microscopy is a highly specific biomarker for early AKI diagnosis after cardiac surgery. |
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Sociedade Brasileira de Nefrologia |
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2020 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002020000100018 |
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