The usefulness of urinary sediment in intensive care, a forgotten tool



urine cytochemistry, urine sediment, sepsis, acute kidney injury, heart failure


A urinary sediment is a tool used for years to characterize renal manifestations of primary and secondary diseases, which requires standardization and learning to interpret it. In patients admitted to the intensive care unit, it is often not performed, or several factors must be taken into account for its interpretation due to the patient's hemodynamic status, glomerular filtration, tubular excretion, water reabsorption, and solutes. In addition to the acid-base balance, which can vary significantly in critically ill patients with different pathophysiological conditions? A review of the conditions for the interpretation of urinalysis is presented.


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Cavanaugh C, Perazella MA. Urine Sediment Examination in the Diagnosis and Management of Kidney Disease: Core Curriculum 2019. Am J Kidney Dis. febrero de 2019;73 (2):258-72.

La A, Koyner JL. Urine Sediment Exam Provides More Diagnostic Information in AKI than Novel Urinary Biomarkers: CON. Kidney360. 28 de abril de 2022;3(4):600-3.

Fogazzi GB, Ferrari B, Garigali G, Simonini P, Consonni D. Urinary sediment findings in acute interstitial nephritis. Am J Kidney Dis. agosto de 2012;60(2):330-2.

Pajaro-Galvis N, Rico-Fontalvo J, Daza-Arnedo R, Cardona-Blanco MX, Abuabara-Franco E, et al. Biomarkers in acute kidney injury. J Clini Nephrol. 2020; 4: 027-035. DOI: 10.29328/journal.jcn.1001056

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. noviembre de 2008;3 (6):1615-9.

Umbrello M, Formenti P, Chiumello D. Urine Electrolytes in the Intensive Care Unit: From Pathophysiology to Clinical Practice. Anesth Analg. noviembre de 2020;131(5):1456-70.

Saha MK, Massicotte-Azarniouch D, Reynolds ML, Mottl AK, Falk RJ, Jennette JC, et al. Glomerular Hematuria and the Utility of Urine Microscopy: A Review. Am J Kidney Dis. septiembre de 2022;80 (3):383-92.

Li N, Zhou WJ, Chi DX, Yuan C, Xie M, Li Z, et al. Association between urine microscopy and severe acute kidney injury in critically ill patients following non-cardiac surgery: a prospective cohort study. Ann Palliat Med. julio de 2022;11 (7):2327-37.

Clarke K, Hall CL, Wiley Z, Tejedor SC, Kim JS, Reif L, et al. Catheter-Associated Urinary Tract Infections in Adults: Diagnosis, Treatment, and Prevention. J Hosp Med. septiembre de 2020;15 (9):552-6.

Lee SP, Vasilopoulos T, Gallagher TJ. Sensitivity and specificity of urinalysis samples in critically ill patients. Anaesthesiol Intensive Ther. 2017;49 (3):204-9.

Vincent JL, Sakr Y, Sprung CL, Ranieri VM, Reinhart K, Gerlach H, et al. Sepsis in European intensive care units: results of the SOAP study. Crit Care Med. febrero de 2006;34 (2):344-53.

Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. noviembre de 2021;47(11):1181-247.

Nisula S, Kaukonen KM, Vaara ST, Korhonen AM, Poukkanen M, Karlsson S, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study. Intensive Care Med . marzo de 2013;39(3):420-8.

Bagshaw SM, Bellomo R. Urine abnormalities in acute kidney injury and sepsis. Contrib Nephrol. 2010;165:274-83.

Bagshaw SM, Bennett M, Devarajan P, Bellomo R. Urine biochemistry in septic and non-septic acute kidney injury: a prospective observational study. J Crit Care. agosto de 2013;28 (4):371-8.

Vanmassenhove J, Glorieux G, Hoste E, Dhondt A, Vanholder R, Van Biesen W. Urinary output and fractional excretion of sodium and urea as indicators of transient versus intrinsic acute kidney injury during early sepsis. Crit Care. 13 de octubre de 2013;17 (5):R234.

Perazella MA, Coca SG, Hall IE, Iyanam U, Koraishy M, Parikh CR. Urine Microscopy Is Associated with Severity and Worsening of Acute Kidney Injury in Hospitalized Patients. Clin J Am Soc Nephrol . marzo de 2010;5 (3):402-8.

Varghese V, Rivera MS, Alalwan AA, Alghamdi AM, Gonzalez ME, Velez JCQ. Diagnostic Utility of Serial Microscopic Examination of the Urinary Sediment in Acute Kidney Injury. Kidney360. 25 de febrero de 2021;2 (2):182-91.

Palsson R, Colona MR, Hoenig MP, Lundquist AL, Novak JE, Perazella MA, et al. Assessment of Interobserver Reliability of Nephrologist Examination of Urine Sediment. JAMA Netw Open. 3 de agosto de 2020;3 (8):e2013959.

Schinstock CA, Semret MH, Wagner SJ, Borland TM, Bryant SC, Kashani KB, et al. Urinalysis is more specific and urinary neutrophil gelatinase-associated lipocalin is more sensitive for early detection of acute kidney injury. Nephrol Dial Transplant. mayo de 2013;28 (5):1175-85.

Zhou H, Zhang Z, Dobrinina M, Dong Y, Kang Z, Chereshnev V, et al. Urinalysis, but Not Blood Biochemistry, Detects the Early Renal Impairment in Patients with COVID-19. Diagnostics (Basel). 27 de febrero de 2022;12 (3):602.

Kamel KS, Halperin ML. Use of Urine Electrolytes and Urine Osmolality in the Clinical Diagnosis of Fluid, Electrolytes, and Acid-Base Disorders. Kidney Int Rep. mayo de 2021;6 (5):1211-24.

Maciel AT, Vitorio D. Urine biochemistry assessment in critically ill patients: controversies and future perspectives. J Clin Monit Comput. junio de 2017;31 (3):539-46.

Chen DN, Du J, Xie Y, Li M, Wang RL, Tian R. Relationship between early serum sodium and potassium levels and AKI severity and prognosis in oliguric AKI patients. Int Urol Nephrol. junio de 2021;53 (6):1171-87.

Maciel AT, Park M, Macedo E. Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study. BMC Anesthesiol. 10 de octubre de 2013;13 (1):31.

Bihari S, Peake SL, Seppelt I, Williams P, Bersten A, George Institute for Global Health, et al. Sodium administration in critically ill patients in Australia and New Zealand: a multicentre point prevalence study. Crit Care Resusc. diciembre de 2013;15(4):294-300.

Belcher JM, Parikh CR, Garcia-Tsao G. Acute kidney injury in patients with cirrhosis: perils and promise. Clin Gastroenterol Hepatol. diciembre de 2013;11 (12):1550-8.

Longhini C, Molino C, Fabbian F. Cardiorenal syndrome: still not a defined entity. Clin Exp Nephrol. febrero de 2010;14 (1):12-21.

Burns AR, Ho KM. Urinary potassium excretion and its association with acute kidney injury in the intensive care unit. J Crit Care. agosto de 2018; 46:58-62.

Kumar NS, Kumar GN, Misra KC, Rao M, Chitithoti S, Prakash SY. Association between Urinary Potassium Excretion and Acute Kidney Injury in Critically Ill Patients.Indian J Crit Care Med. julio de 2021;25 (7):768-72.

Neyra JA, Canepa-Escaro F, Li X, Manllo J, Adams-Huet B, Yee J, et al. Association of Hyperchloremia With Hospital Mortality in Critically Ill Septic Patients. Crit Care Med. septiembre de 2015;43 (9):1938-44.

Sadan O, Singbartl K, Kandiah PA, Martin KS, Samuels OB. Hyperchloremia Is Associated With Acute Kidney Injury in Patients With Subarachnoid Hemorrhage.Crit Care Med . agosto de 2017;45 (8):1382-8.

Komaru Y, Doi K, Matsuura R, Yoshida T, Miyamoto Y, Yoshimoto K, et al. Urinary chloride concentration as a prognostic marker in critically ill patients. Nephrology (Carlton). mayo de 2020;25 (5):384-9.

Felker GM, Ellison DH, Mullens W, Cox ZL, Testani JM. Diuretic Therapy for Patients With Heart Failure: JACC State-of-the-Art Review. J Am Coll Cardiol. 17 de marzo de 2020;75 (10):1178-95.

Higuchi S, Kabeya Y, Matsushita K, Yamasaki S, Ohnishi H, Yoshino H. Urinary cast is a useful predictor of acute kidney injury in acute heart failure. Sci Rep. 13 de marzo de 2019;9 (1):4352



How to Cite

Rico Fontalvo, J., Daza Arnedo, R., Gutiérrez Ariza, J., Soto Guerrero, O., Suarez Romero, B., Vásquez Jiménez, Ángel, Rodelo, D., Díaz Suárez, E., Rodríguez Yánez, T., Ortiz Márquez, V., & Vázquez Jiménez, L. C. (2023). The usefulness of urinary sediment in intensive care, a forgotten tool. Anales of the Faculty of Medical Sciences, 56(2), 69–81. Retrieved from