目的 验证尿沉渣评分（USS）对肾前性急性肾损伤（AKI）与急性肾小管坏死（ATN）的鉴别价值，评估USS与AKI严重程度及预后的相关性，为优化AKI分层管理提供依据。方法 回顾性分析2021年3月至2022年2月在郑州市中医院治疗的120 AKI患者，根据肾组织活检及改良FENa-UA诊断标准分为肾前性AKI组（n=68）与ATN组（n=52），于入院日检测USS、血清胱抑素C（Cys-C）及尿中性粒细胞明胶酶相关脂质运载蛋白（NGAL），分析USS诊断效能。结果 ATN组USS高于肾前性组（P＜0.001），且评分随AKI分期升高而增加（P＜0.001）。USS诊断肾前性AKI的ROC曲线下面积（AUC）为0.892，联合Cys-C与NGAL后AUC提升至0.941，灵敏度与特异度分别达90.12%和88.51%。结论 USS通过量化肾小管结构性损伤，可早期鉴别肾前性AKI与ATN，其与Cys-C、NGAL的联合应用提高诊断准确性，且对AKI预后具有重要价值，为临床分层管理提供客观依据。

       Objective To validate the discriminative value of urinary sediment score（USS）in differentiating prerenal acute kidney injury（AKI）from acute tubular necrosis（ATN），and to evaluate the correlation between USS and AKI severity/prognosis，providing evidence for optimizing stratified AKI management．Methods A retrospective analysis was conducted on 120 AKI patients treated at Zhengzhou Traditional Chinese Medicine Hospital from March 2021 to February 2022．According to renal tissue biopsy and modified FENa-UA diagnostic criteria，patients were divided into a prerenal AKI group（n=68）and an ATN group（n=52）．On the day of admission，USS，serum cystatin C（Cys-C），and urinary neutrophil gelatinase-associated lipocalin（NGAL）were measured to analyze the diagnostic performance of USS．Results USS was significantly higher in ATN group than prerenal group（P＜0.001），and increased with advancing AKI stages（P＜0.001）．The area under the ROC curve（AUC）of USS for diagnosing prerenal AKI was 0.892，which improved to 0.941 when combined with Cys-C and NGAL，yielding sensitivity and specificity of 90.12% and 88.51%，respectively．Conclusions USS quantifies structural damage to the renal tubules，allowing for early differentiation between prerenal AKI and ATN．Its combined use with Cys-C and NGAL improves diagnostic accuracy and is of significant value in predicting AKI prognosis，providing an objective basis for clinical stratified management．