Does combining urine sediment examination to renal cell arrest and damage biomarkers improve prediction of progression and mortality of sepsis associated acute kidney injury?

Summary

In 96 patients with stage 1–2 SA-AKI, combining urine sediment scoring at day 3 with uTIMP-2*IGFBP7 and uKIM-1 markedly improved prediction of AKI progression (AUC up to 0.979) and mortality (AUC up to 0.807) versus biomarkers alone. Nearly half progressed to stage 3 and one-third died.

Key Findings

• Prospective cohort of 96 stage 1–2 SA-AKI patients; 48% progressed to stage 3 and 33.3% died.
• uTIMP-2*IGFBP7 predicted AKI progression with AUC 0.837; uKIM-1 AUC 0.657.
• Adding day-3 urine sediment (Perazella and Chawla scores) raised progression AUC to 0.977–0.979 and mortality AUC to 0.796–0.807.
• Trial registered (NCT06064487), with serial biomarker and sediment assessments at days 1, 3, and 7.

Clinical Implications

Incorporate day-3 urine sediment scoring with uTIMP-2*IGFBP7 (and KIM-1 where available) to identify SA-AKI patients at high risk for progression and death, enabling earlier nephrology consultation and kidney-protective strategies.

Limitations

• Single-cohort sample with modest size (n=96) limits generalizability
• External validation and assessment of clinical impact on management decisions are needed

Future Directions

Multicenter validation, integration into risk scores, and interventional studies testing biomarker- and sediment-guided management to reduce SA-AKI progression.