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Open Access Highly Accessed Research article

Proteinuria and hematuria are associated with acute kidney injury and mortality in critically ill patients: a retrospective observational study

Seung Seok Han1, Shin Young Ahn12, Jiwon Ryu3, Seon Ha Baek12, Ho Jun Chin12, Ki Young Na12, Dong-Wan Chae12 and Sejoong Kim124*

Author Affiliations

1 Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea

2 Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Korea

3 Department of Internal Medicine, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Korea

4 Department of Biomedical Engineering, University of Michigan, Ann Arbor, USA

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BMC Nephrology 2014, 15:93  doi:10.1186/1471-2369-15-93

Published: 18 June 2014

Abstract

Background

Proteinuria and hematuria are both important health issues; however, the nature of the association between these findings and acute kidney injury (AKI) or mortality remains unresolved in critically ill patients.

Methods

Proteinuria and hematuria were measured by a dipstick test and scored using a scale ranging from a negative result to 3+ in 1883 patients admitted to the intensive care unit. AKI was defined according to the Kidney Disease: Improving Global Outcomes (KDIGO) guidelines. The odds ratios (ORs) for AKI and 3-year mortality were calculated after adjustment for multiple covariates according to the degree of proteinuria or hematuria. For evaluating the synergistic effect on mortality among proteinuria, hematuria, and AKI, the relative excess risk due to interaction (RERI) was used.

Results

Proteinuria and hematuria increased the ORs for AKI: the ORs of proteinuria were 1.66 (+/−), 1.86 (1+), 2.18 (2+), and 4.74 (3+) compared with non-proteinuria; the ORs of hematuria were 1.31 (+/−), 1.58 (1+), 2.63 (2+), and 2.52 (3+) compared with non-hematuria. The correlations between the mortality risk and proteinuria or hematuria were all significant and graded (Ptrend < 0.001). There was a relative excess risk of mortality when both AKI and proteinuria or hematuria were considered together: the synergy indexes were 1.30 and 1.23 for proteinuria and hematuria, respectively.

Conclusions

Proteinuria and hematuria are associated with the risks of AKI and mortality in critically ill patients. Additionally, these findings had a synergistic effect with AKI on mortality.

Keywords:
Acute kidney injury; Hematuria; Intensive care unit; Mortality; Proteinuria