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| Urine microscopy and neutrophil-lymphocyte ratio are early predictors of acute kidney injury in patients with urinary tract infection |
Sreerag Kanaa,Rajesh Nachiappa Ganesha,*( ),Deepanjali Surendranb,Rajendra G. Kulkarnic,Ravi Kishore Bobbilib,Jose Olickal Jebyd
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a Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
b Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
c Department of Immunohaematology and Transfusion Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
d Department of Preventive and Social Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India |
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Abstract Objective Urinary tract infection (UTI) is a common cause of morbidity and hospitalisation in the population worldwide. Upper UTI is indolent and causes subclinical acute kidney injury (AKI) resulting in preventable cause of scarring of renal parenchyma. We explored urinary and serum levels of kidney injury molecule-1 (KIM-1), haematological parameters and quantitative urine microscopy parameters to predict kidney injury.
Methods Neutrophil-lymphocyte ratio (NLR) is obtained by dividing absolute neutrophil count with absolute lymphocyte count. Quantitative urine sediment microscopy was performed and correlated with clinical, biochemical and haematological findings to predict AKI in patients with UTI. Quantitative ELISA was performed for serum and urine levels of KIM-1. Seventy two adult patients with UTI were enrolled, 45 of whom had AKI while 27 were in the non-AKI group.
Results NLR (p=0.005) and renal tubular epithelial cell-granular cast score in quantitative urine microscopy (p=0.008) are strong predictors of AKI in patients with UTI while rest of quantitative urine microscopy parameters and serum and urinary levels of KIM-1 molecule were not found to be useful in prediction of AKI.
Conclusion NLR in haemogram is a novel and useful biomarker for predicting AKI in patients with UTI.
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Received: 13 February 2019
Available online: 21 January 2020
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Corresponding Authors:
Rajesh Nachiappa Ganesh
E-mail: drngrajesh@gmail.com
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| Granular casts (per LPF) | | RTE cells (per HPF) | 0 (0 point) | 1-5 (1 point) | ≥6 (2 points) | | 0 (0 point) | 0 | 1 | 2 | | 1-5 (1 point) | 1 | 2 | 3 | | ≥6 (2 points) | 2 | 3 | 4 |
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RTE cell-granular cast scoring systema.
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| Characteristics | AKI (n=45) | No AKI (n=27) | p-Value | | Age, year, mean±SD | 53.4±14.8 | 52.2±12.4 | 0.71 | | Male sex, n (%) | 26 (58) | 11 (41) | 0.16 | | Female sex, n (%) | 19 (42) | 16 (59) | 0.16 | | ANC, median (IQR for ANC) | 8900 (7400-12 180) | 7350 (5825-10 140) | 0.14 | | ALC, median (IQR for ALC) | 1400 (1100-2005) | 1820 (1520-2430) | 0.04 | | Diabetes, n (%) | 22 (48.9) | 14 (51.9) | 0.81 | | Hypertension, n (%) | 6 (13.3) | 5 (18.5) | 0.55 |
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Basic demographic data of patients in study group.
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| Creatinine | Mean±SD | p-Value | | AKI (n=45) | No AKI (n=27) | | Day 1 | 3.8±3.1 | 1.14±0.5) | <0.001 | | Day 3a | 3.22±2.4 | 1.10±0.04 | <0.001 | | Day 5b | 2.83±1.2 | 1.18±0.4 | 0.001 |
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Significance of rise in creatinine in AKI.
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| RTE-granular cast score | n (%) | AKI, n (%) No AKI, n (%) | p-Value | | <2 | 54 (100) | 29 (53.7) | 25 (46.3) | 0.008 | | ≥2 | 18 (100) | 16 (88.9) | 2 (11.1) |
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RTE cell-granular cast score (Perazella scoring system).
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| KIM-1 | AKI (n=45), mean±SD | No AKI (n=27), mean±SD | p-Value | | Urine | 3.22±1.4 | 3.33±1.3 | 0.75 | | Serum | 2.91±1.5 | 2.98±1.2a | 0.85 |
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Kidney injury molecule (KIM)-1 in patients with and without AKI.
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Receive operator characteristics curve of neutrophil-lymphocyte ratio to predict acute kidney injury.
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| Cut-off threshold | Sensitivity (%) | Specificity (%) | AUC | p-Value | | 3.4 | 86.0 | 53.8 | 0.704 (95% CI: 0.574-0.835) | 0.005 | | 4.2 | 72.1 | 65.9 | | 6.9 | 51.2 | 80.8 |
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ROC values for neutrophil-lymphocyte ratio.
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| Variables | Serum creatinine, n (%) | NLR total, n (%) | Relative risk | p-Value | | AKI | No AKI | | NLR | | | | 1.77 | 0.003 | | AKI present (≥4.2) | 31 (77.5) | 9 (22.5) | 40 (100) | | AKI absent (<4.2) | 14 (43.8) | 18 (56.2) | 32 (100) | | Serum creatinine total | 45 (62.5) | 27 (37.5) | 72 (100) |
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Association between serum creatinine and NLR.
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| [1] |
Gonzalez CM, Schaeffer AJ. Treatment of urinary tract infection: what’s old, what’s new, and what works. World J Urol 1999; 17:372e82.
|
| [2] |
Drekonja DM, Johnson JR. Urinary tract infections. Prim Care 2008; 35:345e67.
|
| [3] |
Mahon CR, Lehman DC, Manuselis G. Textbook of diagnostic microbiology. 5th ed. Saunders:Elsevier; 2015. p887.
|
| [4] |
Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL. Harrison’s manual of medicine. 16 ed. New York: McGraw-Hill Medical; 2005. p724e8.
|
| [5] |
Gupta K, Trautner BW. Urinary tract infections, pyelonephritis,and prostatitis. In: Fauci A, Braunwald E, Kasper D,Hauser S, Longo D, Jameson L, et al., editors. Harrison’s principles of internal medicine. 17th ed. New York: McGraw Hill Publishers; 2001. p1820e7.
|
| [6] |
Hsiao CY, Yang HY, Hsiao MC, Hung PH, Wang MC . Risk factors for development of acute kidney injury in patients with urinary tract infection. PLoS One 2015;10:e0133835. https://doi.org/10.1371/journal.pone. 0133835.
|
| [7] |
Schiffl H, Lang SM. Update on biomarkers of acute kidney injury: moving closer to clinical impact? Mol Diagn Ther 2012; 16:199e207.
|
| [8] |
Bagshaw SM, Haase M, Haase-Fielitz A, Bennett M, Devarajan P, Bellomo R. A prospective evaluation of urine microscopy in septic and non-septic acute kidney injury. Nephrol Dial Transplant 2012; 27:582e8.
|
| [9] |
Lines S, Lewington A. Acute kidney injury. Clin Med 2009; 9:273e7.
|
| [10] |
Kidney Disease Improving Global Outcomes AKI Guideline Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl 2012; 2:1e138.
|
| [11] |
Waikar SS, Liu KD, Chertow GM. Diagnosis, epidemiology and outcomes of acute kidney injury. Clin J Am Soc Nephrol 2008; 3:844e61.
|
| [12] |
Vaidya VS, Waikar SS, Ferguson MA, Collings FB, Sunderland K, Gioules C, et al. Urinary biomarkers for sensitive and specific detection of acute kidney injury in humans. Clin Transl Sci 2008; 1:200e8.
|
| [13] |
Safdar OY, Shalaby M. Neutrophil gelatinase-associated lipocalin as an early marker for the diagnosis of urinary tract infections in Saudi children. J Nephrol Therapeut 2015; 5:6e9.
|
| [14] |
Perazella MA, Coca SG, Kanbay M, Brewster UC, Parikh CR. Diagnostic value of urine microscopy for differential diagnosis of acute kidney injury in hospitalized patients. Clin J Am Soc Nephrol 2008; 3:1615e9.
|
| [15] |
Perazella MA. The urine sediment as a biomarker of kidney disease. Am J Kidney Dis 2015; 66:748e55.
|
| [16] |
Han SY, Lee IR, Park SJ, Kim JH, Shin JI. Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection. Korean J Pediatr 2016; 59:139e44.
|
| [17] |
Yilmaz H, Cakmak M, Inan O, Darcin T, Akcay A. Can neutrophilelymphocyte ratio be independent risk factor for predicting acute kidney injury in patients with severe sepsis? Ren Fail 2015; 37:225e9.
|
| [18] |
Baerheim A, Albrektsen G, Eriksen AG, Laerum E, Sandberg S. Quantification of pyuria by two methods correlation and interobserver agreement. Scand J Prim Health Care 1989; 7:83e6.
|
| [19] |
Viswanathan V, Janifer J, Geethalakshmi S, Satyavani K. Prevalence of lower urinary tract infection in South Indian type 2 diabetic subjects. Indian J Nephrol 2009; 19:107e11.
|
| [20] |
Sangamithra V, Sneka P, Praveen S, Manonmoney J. Incidence of catheter associated urinary tract infection in medical ICU in a tertiary care hospital. Int J Curr Microbiol Appl Sci 2017; 6:662e9.
|
| [21] |
Chawla LS, Dommu A, Berger A, Shih S, Patel SS. Urinary sediment cast scoring index for acute kidney injury: a pilot study. Nephron Clin Pract 2008; 110:145e50.
|
| [22] |
Han WK, Bailly V, Abichandani R, Thadhani R, Bonventre JV. Kidney injury molecule-1 (KIM-1): a novel biomarker for human renal proximal tubule injury. Kidney Int 2002; 62:237e44.
|
| [23] |
Vaidya VS, Ramirez V, Ichimura T, Bobadilla NA, Bonventre JV. Urinary kidney injury molecule-1: a sensitive quantitative biomarker for early detection of kidney tubular injury. Am J Physiol Ren Physiol 2006; 290:517e29.
|
| [24] |
Lee HE, Lee SH, Baek M, Choi H, Park K. Urinary measurement of neutrophil gelatinase associated lipocalin and kidney injury molecule-1 helps diagnose acute pyelonephritis in a preclinical model. J Biomark 2013; 6:1e6.
|
| [25] |
Xie Y, Wang Q, Wang C, Che X, Shao X, Xu Y, et al. Association between the levels of urine kidney injury molecule-1 and the progression of acute kidney injury in the elderly. PloS One 2017; 12:1e12.
|
| [26] |
Bagshaw SM, Bellomo R. Early diagnosis of acute kidney injury. Curr Opin Crit Care 2007; 13:638e44.
|
| [27] |
Petrovic S, Bogavac-Stanojevic N, Peco-Antic A, Ivanisevic I, Kotur-Stevuljevic J, Paripovic D, et al. Clinical application neutrophil gelatinase-associated lipocalin and kidney injury molecule-1 as indicators of inflammation persistence and acute kidney injury in children with urinary tract infection. BioMed Res Int 2013:947157. https://doi.org/10.1155/2013/947157.
|
| [28] |
Martini A, Sfakianos JP, Paulucci DJ, Abaza R, Eun DD, Bhandari A, et al. Predicting acute kidney injury after robotassisted partial nephrectomy: implications for patient selection and postoperative management. Urol Oncol Semin Orig Investig 2019; 37:445e51.
|
| [29] |
Bravi CA, Vertosick E, Benfante N, Tin A, Sjoberg D, Hakimi AA, et al. Impact of acute kidney injury and its duration on long-term renal function after partial nephrectomy. Eur Urol 2019; 76:398e403.
|
| [30] |
Martini A, Cumarasamy S, Hemal AK, Badani KK . Renal cell carcinoma:the oncological outcomeis not the only endpoint. Transl Androl Urol 2019;8:S93e5.
|
| [31] |
Martini A, Cumarasamy S, Beksac AT, Abaza R, Eun DD, Bhandari A, et al. A nomogram to predict significant estimated glomerular filtration rate reduction after robotic partial nephrectomy. Eur Urol 2018; 74:833e9.
|
|
|
|
