Renal Division, Peking University First Hospital, Institute of Nephrology, Peking University, Beijing, China.
Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, China.
Ren Fail. 2022 Dec;44(1):1038-1044. doi: 10.1080/0886022X.2022.2088388.
Although casts in urine may imply the underlying pathogenesis and the diagnosis, the waxy cast is poorly understood yet. We aim to investigate the association between waxy casts and clinicopathological indices. Patients undergone renal biopsy and urine sediment examination were enrolled. Waxy casts referred to those presented with a homogeneous melted wax appearance and pre-waxy casts referred to those in which one or more segments demonstrated a waxy-cast appearance. Multivariable logistic regression was used to assess the factors associated with waxy casts. In 1282 patients, the detection rate of waxy casts was 26.3%. If either waxy or pre-waxy cast was considered as a diagnostic marker for renal insufficiency (eGFR < 60 ml/min/1.73 m), the sensitivity was 0.58 and the specificity was 0.88. If the only waxy cast was considered as the diagnostic marker, the sensitivity was 0.29 and the specificity was 0.97. The patients with waxy or pre-waxy casts had higher blood pressure, more proteinuria, and worse renal function. Waxy or pre-waxy cast was independently associated with eGFR (odds ratio: 0.73 per 10 mL/min/1.73 m increase, 95% confidence interval: 0.69-0.77, < 0.001), proteinuria (odds ratio: 1.07 per 1 g/day increase, 95% confidence interval: 1.03-1.10, < 0.001) and pathological lesions. Waxy or pre-waxy casts are closely related to impaired renal function. Their presence is a specific indicator of renal insufficiency but is not sensitive enough.
尽管尿沉渣管型可提示潜在的发病机制和诊断，但蜡样管型仍知之甚少。我们旨在探讨蜡样管型与临床病理指标之间的关系。入组了接受肾活检和尿沉渣检查的患者。蜡样管型是指呈现均匀融化的蜡样外观的管型，而预蜡样管型是指一个或多个节段呈现蜡样管型外观的管型。多变量逻辑回归用于评估与蜡样管型相关的因素。在 1282 例患者中，蜡样管型的检出率为 26.3%。如果将蜡样管型或预蜡样管型均视为肾功能不全（eGFR < 60 ml/min/1.73 m）的诊断标志物，则灵敏度为 0.58，特异性为 0.88。如果仅将蜡样管型视为诊断标志物，则灵敏度为 0.29，特异性为 0.97。有蜡样管型或预蜡样管型的患者血压更高，蛋白尿更多，肾功能更差。蜡样管型或预蜡样管型与 eGFR 独立相关（每增加 10 ml/min/1.73 m 的比值比：0.73，95%置信区间：0.69-0.77， < 0.001）、蛋白尿（每增加 1 g/天的比值比：1.07，95%置信区间：1.03-1.10， < 0.001）和病理损伤。蜡样管型或预蜡样管型与肾功能受损密切相关。它们的存在是肾功能不全的特异性指标，但不够敏感。
