Oyaert Matthijs, Delanghe Joris, Brouwers Annelies, Bové Thierry, Schaubroeck Hannah, Delrue Charlotte, Vandenberghe Wim, Speeckaert Marijn, Hoste Eric
Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
Intensive Care Med. 2025 May 5. doi: 10.1007/s00134-025-07909-x.
Acute kidney injury (AKI) is a common clinical complication of cardiac surgeries. Although urinary particle analysis is useful for differentiating AKI, its value in AKI diagnosis has not yet been well described. We sought to determine the contribution of urinary particle analysis to the diagnosis of AKI.
Two-hundred and thirty-nine adult patients were prospectively included after cardiac surgery. The diagnostic performance of urinary particle analysis at different time points after intensive care unit (ICU) admission was evaluated. AKI was diagnosed and classified according to the KDIGO definitions. Urinary particles, including renal tubular epithelial cells (RTEC) and non-hyaline casts, Nephrocheck, urinary alpha-1-microglobulin and urinary γ-glutamyltransferase (GGT) levels were measured at 4, 12 and 24 h after ICU admission and evaluated against different endpoints.
Of the 239 patients included, 39 (16.3%) had AKI stage 1, 121 (50.6%) had stage 2, and 15 (6.3%) stage 3. In the early postoperative period, urinary alpha-1-microglobulin and Nephrocheck were good predictors of AKI stage ≥ 1 within 48 h after ICU admission (primary endpoint) and AKI stage ≥ 2 (1st secondary endpoint), respectively. Furthermore, at 12 h and 24 h after ICU admission, RTEC had the highest predictive value for AKI up to 48 h after ICU admission based on serum creatinine alone and for all AKI criteria up to 7 days after ICU admission. Correction of the obtained counts for the hydration status did not improve the obtained results.
Urinary particle analysis with RTEC is useful for the early diagnosis of AKI following cardiac surgery, especially at 12 h and 24 h after ICU admission.
急性肾损伤（AKI）是心脏手术常见的临床并发症。尽管尿颗粒分析有助于鉴别AKI，但其在AKI诊断中的价值尚未得到充分描述。我们旨在确定尿颗粒分析对AKI诊断的贡献。
前瞻性纳入239例心脏手术后的成年患者。评估重症监护病房（ICU）入院后不同时间点尿颗粒分析的诊断性能。根据KDIGO定义诊断并分类AKI。在ICU入院后4、12和24小时测量尿颗粒，包括肾小管上皮细胞（RTEC）和非透明管型、Nephrocheck、尿α1微球蛋白和尿γ-谷氨酰转移酶（GGT）水平，并针对不同终点进行评估。
纳入的239例患者中，39例（16.3%）为1期AKI，121例（50.6%）为2期，15例（6.3%）为3期。在术后早期，尿α1微球蛋白和Nephrocheck分别是ICU入院后48小时内AKI≥1期（主要终点）和AKI≥2期（第一次要终点）的良好预测指标。此外，在ICU入院后12小时和24小时，仅基于血清肌酐，RTEC对ICU入院后48小时内的AKI以及ICU入院后7天内所有AKI标准具有最高的预测价值。对所获得的计数进行水化状态校正并不能改善结果。
RTEC尿颗粒分析有助于心脏手术后AKI的早期诊断，尤其是在ICU入院后12小时和24小时。
