O papel da Urina-1 e microscopia urinária no diagnóstico da injúria renal aguda

Camila Lima; Maria de Fatima Correa; Etienne  Macedo

Autores

Camila Lima Universidade de São Paulo – Escola de Enfermagem – Departamento de Enfermagem Médico Cirúrgica – São Paulo (SP) – Brasil. https://orcid.org/0000-0003-3930-1081
Maria de Fatima Correa Hospital Israelita Albert Einstein – Curso de Enfermagem – São Paulo (SP) – Brasil. https://orcid.org/0000-0003-1819-4002
Etienne Macedo Universidade de São Paulo – Departamento de Medicina – Divisão de Nefrologia – São Paulo (SP) – Brasil | University of California – Department of Medicine – Nephrology Division – San Diego (CA) – USA. https://orcid.org/0000-0002-3669-6519

Palavras-chave:

Injúria Renal Aguda, Biomarcadores, Transplante Hepático, Diálise

Resumo

Introdução: A injúria renal aguda (IRA) é uma complicação comum na unidade de terapia intensiva. A urina-1 (U-1) é uma ferramenta frequentemente esquecida para avaliar IRA e, além disso, não existe um consenso baseado em evidências sobre seu uso. O objetivo do estudo foi investigar o papel da U-1 e da microscopia urinária (MU) no diagnóstico da IRA grave e a necessidade de terapia de substituição renal (TSR) em pacientes submetidos ao transplante hepático (TH). Métodos: Nossa hipótese foi determinar se os parâmetros urinários disponíveis, U-1 e MU, estão associados ao diagnóstico da IRA grave e à necessidade de TSR. Avaliamos U-1 e MU em 6 horas após o TH. O critério utilizado para o diagnóstico da IRA foi o Kidney Disease Improving Global Outcomes (KDIGO), baseado apenas na creatinina sérica em 1 semana. Resultados: Oitenta e sete pacientes desenvolveram IRA na 1ª semana após o TH. O diagnóstico de IRA grave (KDIGO 2 e 3) foi encontrado em 59 pacientes. Seis horas após o TH, as variáveis na U-1 foram preditoras de IRA grave, com área sob a curva [area under the curve (AUC)]: 0,65 para proteínas, 0,68 para leucócitos e 0,63 para eritrócitos. Na determinação de TSR, essas variáveis tiveram melhor desempenho com AUC: 0,72 para proteínas, 0,69 para leucócitos e 0,68 para eritrócitos. Os grupos não IRA e IRA apresentaram distribuição semelhante na MU. Conclusão: Parâmetros simples e usuais na prática clínica, como proteinúria, eritrocitúria e leucocitúria, podem ser ferramentas valiosas para o diagnóstico da IRA grave e da necessidade de TSR.

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