PMID- 18784207
OWN - NLM
STAT- MEDLINE
DCOM- 20090106
LR  - 20211020
IS  - 1555-905X (Electronic)
IS  - 1555-9041 (Print)
IS  - 1555-9041 (Linking)
VI  - 3
IP  - 6
DP  - 2008 Nov
TI  - Diagnostic value of urine microscopy for differential diagnosis of acute kidney 
      injury in hospitalized patients.
PG  - 1615-9
LID - 10.2215/CJN.02860608 [doi]
AB  - BACKGROUND AND OBJECTIVES: Urine microscopy is the oldest and one of the most 
      commonly used tests for differential diagnosis of acute kidney injury (AKI), but 
      its performance has not been adequately studied in the setting of AKI. DESIGN, 
      SETTING, PARTICIPANTS, & MEASUREMENTS: Fresh urine samples were obtained from 267 
      consecutive patients with AKI, and urinary sediment was examined. The cause of 
      AKI was assessed at two time points: (1) Before urine microscopy diagnosis and 
      (2) after patient discharge or death (final diagnosis). A urinary scoring system 
      also was created on the basis of casts and renal tubular epithelial cells (RTEC) 
      to differentiate acute tubular necrosis (ATN) from prerenal AKI. RESULTS: The 
      urinary sediment scoring system was highly predictive of the final diagnosis of 
      ATN. In patients with a high pretest probability of ATN (initial diagnosis of 
      ATN), any casts or RTEC (score > or =2) resulted in very high positive predictive 
      value and low negative predictive value for a final diagnosis of ATN. In patients 
      with a low pretest probability of ATN (initial diagnosis of prerenal AKI), lack 
      of casts or RTEC on urinary sediment examination had a sensitivity of 0.73 and 
      specificity of 0.75 for a final diagnosis of prerenal AKI. The negative 
      predictive value of lack of casts or RTEC in patients with low pretest 
      probability of disease was 91%. CONCLUSIONS: Urine sediment examination is a 
      valuable diagnostic tool for confirming the diagnosis of ATN. A score of > or =2 
      on an ATN urinary sediment scoring system is an extremely strong predictor of 
      ATN.
FAU - Perazella, Mark A
AU  - Perazella MA
AD  - Section of Nephrology, Yale University School of Medicine, New Haven, CT 
      06520-8029, USA. mark.perazella@yale.edu
FAU - Coca, Steven G
AU  - Coca SG
FAU - Kanbay, Mehmet
AU  - Kanbay M
FAU - Brewster, Ursula C
AU  - Brewster UC
FAU - Parikh, Chirag R
AU  - Parikh CR
LA  - eng
PT  - Journal Article
DEP - 20080910
PL  - United States
TA  - Clin J Am Soc Nephrol
JT  - Clinical journal of the American Society of Nephrology : CJASN
JID - 101271570
SB  - IM
CIN - Clin J Am Soc Nephrol. 2009 Apr;4(4):691-3. PMID: 19339423
CIN - Clin J Am Soc Nephrol. 2011 Oct;6(10):2332-4. PMID: 21921150
MH  - Acute Disease
MH  - Cross-Sectional Studies
MH  - Diagnosis, Differential
MH  - Epithelial Cells/pathology
MH  - Humans
MH  - *Inpatients
MH  - Kidney Diseases/*diagnosis/urine
MH  - Kidney Tubular Necrosis, Acute/*diagnosis/urine
MH  - *Microscopy
MH  - Microscopy, Polarization
MH  - Predictive Value of Tests
MH  - Sensitivity and Specificity
MH  - Urinalysis/*methods
MH  - Urine/cytology
PMC - PMC2572284
EDAT- 2008/09/12 09:00
MHDA- 2009/01/07 09:00
PMCR- 2009/11/01
CRDT- 2008/09/12 09:00
PHST- 2008/09/12 09:00 [pubmed]
PHST- 2009/01/07 09:00 [medline]
PHST- 2008/09/12 09:00 [entrez]
PHST- 2009/11/01 00:00 [pmc-release]
AID - CJN.02860608 [pii]
AID - 0608 [pii]
AID - 10.2215/CJN.02860608 [doi]
PST - ppublish
SO  - Clin J Am Soc Nephrol. 2008 Nov;3(6):1615-9. doi: 10.2215/CJN.02860608. Epub 2008 
      Sep 10.