It is increasingly recognized that cirrhotic or cholestatic buy NVP-LDE225 patients show abnormal renal histology with glomerular and tubulointerstitial lesions that may not be noted by routine renal function tests. Microscopic urinanalysis is readily available, inexpensive and noninvasive, and currently considered to be a well-suited surrogate parameter for structural kidney damage. We hypothesized that cirrhotic or cholestatic patients with
preserved renal function (eGFR >60 ml/min) upon routine laboratory evaluation frequently show structural renal injury reflected by a pathologic urine cytology. This may represent a herald of subsequent impaired renal function. Aim: To find a useful non-invasive clinical test to identify early structural kidney injury EX 527 nmr in liver patients. Material and Methods: We collected blood and urine samples from a total of 150 patients [liver cirrhosis Child Pugh score class A (n=41), B (n=38), C (n=28), obstructive cholestasis (n=19), and age-matched healthy living kidney donors (n=24]. Patients with diabetes, insufficiently treated arterial hypertension or preexisting kidney disease were excluded. Freshly voided urine samples were analyzed by automatic flow cytometry (Sysmex UF 1000) and microscopic urinanalysis after Papanicolaou
staining of a smear preparation of the urine sedimentation. The specimens were
analyzed for presence and number of renal tubular epithelial cells (RTEC) and granular casts (GC). Results: Serum creatinine (SCr) concentrations (in mg/dL) and GFR determined by the CKD-EPI equation (in ml/h/1.73m2) were normal amongst all groups (0.76±0.16 medchemexpress and 102±15 in Childs A group, 0.78±0.17 and 101±12 in Childs B group, 0.84±0.23 and 95±19 in Childs C group, 0.85±0.2 and 93±21 in cholestasis group, 0.78±0.11 and 93.6±12.4 in living kidney donors). RTEC and GC as sensitive markers of tubular epithelial kidney injury were frequently found in liver cirrhosis (RTEC in 15%, GC in 8%) and cholestasis (RTEC in 33%, GC in 20%), whereas none of the healthy living kidney donors showed RTEC or GC upon urine cytology. Presence of RTEC significantly correlated with serum bile acid levels (correlation coefficient 0.207; p 0.015) Conclusions: Patients with cirrhosis or cholestasis and normal kidney function show RTEC and GC at increased numbers compared to controls. Microscopic urinanalysis may represent a useful, noninvasive and cheap diagnostic test to identify patients at high risk for AKI or subclinical kidney injury which needs to be evaluated in prospective clinical trials. Disclosures: none.