Abstract: SA-PO1141
Are Waxy Casts in the Urinary Sediment Associated with Advanced Kidney Disease?
Session Information
- CKD: Patient-Oriented Care and Case Reports
October 26, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: CKD (Non-Dialysis)
- 2302 CKD (Non-Dialysis): Clinical, Outcomes, and Trials
Authors
- Mohammed, Khalid M.G, Tanta University, Tanta, Gharbia, Egypt
- Varghese, Vipin, University of Michigan, Ann Arbor, Michigan, United States
- Chalmers, Dustin R., Louisiana State University, Baton Rouge, Louisiana, United States
- Mohamed, Muner, Ochsner Health, New Orleans, Louisiana, United States
- Velez, Juan Carlos Q., Ochsner Health, New Orleans, Louisiana, United States
Group or Team Name
- Ochsner Nephrology.
Background
Casts are clusters of urinary sediment elements formed in the kidney tubules, and the contents of the cast indicate the nature of clinical associations. The waxy casts probably represent the last stage of granular or cellular cast degeneration. Such casts thought to be form in chronic kidney disease when there is renal stasis and tubular atrophy.
Methods
We reviewed cases at Ochsner Medical Center who underwent kidney biopsies and have waxy casts in their urinary sediments around the same time of kidney biopsy. The pathology reports were reviewed and we collected the pathological findings of the presence of acute tubular injury (ATI), glomerular diseases (GD) and the pathological markers of chronic kidney disease which includes the percentage of interstitial fibrosis and tubular atrophy (IFTA) and global sclerosis (GS). We used the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to assess the significance of clinical association between the presence of waxy casts and different combinations of the above mentioned pathological findings.
Results
We have total 100 patients who underwent kidney biopsy and have microscopic examination of their urinary sediments. In relation to the pathological finding waxy casts seen in 15 of 58 with ATI (sensitivity 26, specificity 21, PPV 63, and NPV 57), in 6 of 26 with ATI/IFTA (sensitivity 18, specificity 27, PPV 33, and NPV 45), in 6 of 23 with GD/IFTA (sensitivity 25, specificity 27, PPV 50, and NPV 53), in 9 of 32 with ATI/GD/IFTA (sensitivity 38, specificity 19, PPV 67, and NPV 43), in 6 of 25 with ATI/GS (sensitivity 17, specificity 26, PPV 17, and NPV 26), in 6 of 23 with GD/GS (sensitivity 20, specificity 28, PPV 17, and NPV 24) and in 9 of 31 with ATI/GD/GS (sensitivity 40, specificity 27, PPV 22, and NPV 14). Serum creatinine levels were
Conclusion
Waxy casts are not specific or pathognomic findings for chronic kidney disease, their presence in urinary sediment should be interpreted carefully in addition to the other clinical findings.