Skip to main content
Antimicrobial Agents and Chemotherapy logoLink to Antimicrobial Agents and Chemotherapy
. 1979 Oct;16(4):468–474. doi: 10.1128/aac.16.4.468

Urinary casts as an indicator of renal tubular damage in patients receiving aminoglycosides.

J J Schentag, F M Gengo, M E Plaut, D Danner, A Mangione, W J Jusko
PMCID: PMC352884  PMID: 518076

Abstract

We assessed the value of quantitative cast excretion as an early marker of renal tubular damage in 154 seriously ill patients. One hundred twenty-four of these received aminoglycoside antibiotics, and 30 of the 124 experienced a rise in serum creatinine of 0.5 mg/dl or more during therapy. The remaining 30 of the 154 patients were treated with other antibiotics and served as controls. Casts were quantitated in random urines collected before morning diuretic doses. Cast counts in control patients averaged 44 +/- 51 casts during the intensive care unit admission. Patients given aminoglycosides without a significant rise in serum creatinine of 0.5 mg/dl or more excreted 153 +/- 196 casts, significantly more than controls. In comparison to both the control and nontoxic patients, the 30 nephrotoxic patients excreted significantly more casts (625 +/- 364) and were significantly higher as early as 9 days before serum creatinine first rose. Daily urinary cast counts are a rapid and inexpensive means of identifying early renal tubular damage in critically ill patients given aminoglycosides.

Full text

PDF
472

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Addis T. THE NUMBER OF FORMED ELEMENTS IN THE URINARY SEDIMENT OF NORMAL INDIVIDUALS. J Clin Invest. 1926 Jun;2(5):409–415. doi: 10.1172/JCI100055. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burton J. R., Rowe J. W. Letter: Quantitation of casts in urine sediment. Ann Intern Med. 1975 Oct;83(4):518–519. doi: 10.7326/0003-4819-83-4-518. [DOI] [PubMed] [Google Scholar]
  3. Fredriksson A. Renal handling of beta2-microglobulin in experimental renal disease. Scand J Clin Lab Invest. 1975 Oct;35(6):591–600. doi: 10.1080/00365517509095785. [DOI] [PubMed] [Google Scholar]
  4. Haber M. H., Lindner L. E. The surface ultrastructure of urinary casts. Am J Clin Pathol. 1977 Nov;68(5):547–552. doi: 10.1093/ajcp/68.5.547. [DOI] [PubMed] [Google Scholar]
  5. Imhof P. R., Hushak J., Schumann G., Dukor P., Wagner J., Keller H. M. Excretion of urinary casts after the administration of diuretics. Br Med J. 1972 Apr 22;2(5807):199–202. doi: 10.1136/bmj.2.5807.199. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Mondorf A. W., Zegelman M., Klose J., Hendus J., Breier J. Comparative studies on the action of aminoglycosides and cephalosporins on the proximal tubule of the human kidney. J Antimicrob Chemother. 1978 May;4 (Suppl A):53–57. doi: 10.1093/jac/4.suppl_a.53. [DOI] [PubMed] [Google Scholar]
  7. Peterson P. A., Evrin P. E., Berggård I. Differentiation of glomerular, tubular, and normal proteinuria: determinations of urinary excretion of beta-2-macroglobulin, albumin, and total protein. J Clin Invest. 1969 Jul;48(7):1189–1198. doi: 10.1172/JCI106083. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. SCHREINER G. E. The identification and clinical significance of casts. AMA Arch Intern Med. 1957 Mar;99(3):356–369. doi: 10.1001/archinte.1957.00260030036004. [DOI] [PubMed] [Google Scholar]
  9. Schentag J. J., Cumbo T. J., Jusko W. J., Plaut M. E. Gentamicin tissue accumulation and nephrotoxic reactions. JAMA. 1978 Nov 3;240(19):2067–2069. [PubMed] [Google Scholar]
  10. Schentag J. J., Sutfin T. A., Plaut M. E., Jusko W. J. Early detection of aminoglycoside nephrotoxicity with urinary beta-2-microglobulin. J Med. 1978;9(3):201–210. [PubMed] [Google Scholar]
  11. Schumann G. B., Harris S., Henry J. B. An improved technic for examining urinary casts and a review of their significance. Am J Clin Pathol. 1978 Jan;69(1):18–23. doi: 10.1093/ajcp/69.1.18. [DOI] [PubMed] [Google Scholar]
  12. Stewart H. J., Moore N. S. THE NUMBER OF FORMED ELEMENTS IN THE URINARY SEDIMENT OF PATIENTS SUFFERING FROM HEART DISEASE, WITH PARTICULAR REFERENCE TO THE STATE OF HEART FAILURE. J Clin Invest. 1930 Dec;9(3):409–421. doi: 10.1172/JCI100314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Stroo W. E., Hook J. B. Enzymes of renal origin in urine as indicators of nephrotoxicity. Toxicol Appl Pharmacol. 1977 Mar;39(3):423–434. doi: 10.1016/0041-008x(77)90135-1. [DOI] [PubMed] [Google Scholar]

Articles from Antimicrobial Agents and Chemotherapy are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES