Anest. intenziv. Med. 2014;25(1):25-28

Focused on pre-renal acute kidney injury - has the time come to rewrite the textbooks?Intesive Care Medicine - Special Article

Matějovič Martin
I. interní klinika, Lékařská fakulta v Plzni, Univerzita Karlova v Praze
Biomedicínské centrum, Lékařská fakulta v Plzni, Univerzita Karlova v Praze, Fakultní nemocnice Plzeň

Acute kidney injury (AKI) represents a wide spectrum of changes ranging from purely "functional" to completely structural kidney damage. In medical textbooks, both the fractional excretion of sodium and serum blood urea nitrogen to creatinine ration have been long considered as valuable tools to differentiate between prerrenal AKI (PRA) and established acute tubular necrosis (ATN). Recent data suggest that these traditional biomarkers used to distinguish PRA from ATN are insufficiently reliable to be clinical relevant. This article is a brief commentary on the most recent studies evaluating the diagnostic value and prognostic ability of these widely accepted blood and urine parameters in critically ill patients.

Keywords: acute kidney Indry; fractional excretion of sodium; pre-renal azotemia

Received: July 1, 2013; Accepted: October 20, 2013; Published: February 1, 2014  Show citation

ACS AIP APA ASA Harvard Chicago Chicago Notes IEEE ISO690 MLA NLM Turabian Vancouver
Matějovič M. Focused on pre-renal acute kidney injury - has the time come to rewrite the textbooks? Anest. intenziv. Med. 2014;25(1):25-28.
Share...
Download citation
  • BibTeX (.bib)
  • Bookends (.ris)
  • EasyBib (.ris)
  • EndNote (.enw)
  • EndNote 8 (.xml)
  • ISI WoS (.isi)
  • Medlars (.medlars)
  • Mendeley (.ris)
  • MODS (.xml)
  • Papers (.ris)
  • RefWorks (.txt)
  • RefManager (.ris)
  • RIS (.ris)
  • MS Word (.xml)
  • Zotero (.ris)
    • Open full article

    References

    1. Matějovič, M. Desatero akutního selhání ledvin. Postgraduální medicína, 2011, 13, p. 27-34.
    2. Esson, M. L., Schrier, R. W. Diagnosis and treatment of acute tubular necrosis. Ann. Intern. Med., 2002, 137, 9, p. 744-752. Go to original source... Go to PubMed...
    3. Pons, B., Lautrette, A., Oziel, J., Dellamonica, J., Vermesh, R.,Ezingeard, E., Mariat, C., Bernardin, G., Zeni, F., Cohen, Y., Tardy, B., Souweine, B., Vincent, F., Darmon, M. Diagnostic accuracy of early urinary index changes in differentiating transient from persistent acute kidney injury in critically ill patients: multicenter cohort study. Crit. Care, 2013, 17, p. R56. Go to original source... Go to PubMed...
    4. Rachoin, J. S., Daher, R., Moussallem, C., Milcarek, B., Hunter, K., Schorr, C., Abboud, M., Henry, P., Weisberg, L. S. The fallacy of the BUN: creatinine ratio in critically ill patients. Nephrol. Dial. Transplant., 2012, 27, 6, p. 2248-2254. Go to original source... Go to PubMed...
    5. Fishberg, A. M. Prerenal azotemia and the pathology of renal blood flow. Bull. N. Y. Acad. Med., 1937, 13, p. 710-732. Go to PubMed...
    6. Takasu, O., Gaut, J. P., Watanabe, E., To, K., Fagley, R. E., Sato, B., Jarman, S., Efimov, I. R., Janks, D. L., Srivastava, A., Bhayani, S. B., Drewry, A., Swanson, P. E., Hotchkiss, R. S. Mechanisms of cardiac and renal dysfunction in patients dying of sepsis. Am. J. Respir. Crit. Care Med., 2013, 187, p. 509-517. Go to original source... Go to PubMed...
    7. Bagshaw, S. M., Langenberg, C., Bellomo, R. Urinary biochemistry and microscopy in septic acute renal failure: a systematic review. Am. J. Kidney Dis., 2006, 48, p. 695-705. Go to original source... Go to PubMed...
    8. Bagshaw, S. M., Bennett, M., Devarajan, P., Bellomo, R. Urine biochemistry in septic and non-septic acute kidney injury: a prospective observational study. J. Crit. Care, 2012. doi:pii: S0883-9441(12)00334-6. 10.1016/j.jcrc.2012.10.007.
    9. Claure-Del Granado, R., Macedo, E., Mehta, R. L. Urine microscopy in acute kidney injury: time for a change. Am. J. Kidney Dis., 2011, 57, p. 657-660. Go to original source... Go to PubMed...
    10. Macedo, E., Mehta, R. L. Prerenal failure: from old concepts to new paradigms. Curr. Opin. Crit. Care, 2009, 15, p. 467-473. Go to original source... Go to PubMed...
    11. Nickolas, T. L., Schmidt-Ott, K. M., Canetta, P. et al. Diagnostic and prognostic stratification in the emergency department using urinary biomarkers of nephron damage: a multicenter prospective cohort study. J. Am. Coll. Cardiol., 2012, 59, p. 246-255. Go to original source... Go to PubMed...
    12. Uchino, S., Bellomo, R., Bagshaw, S. M., Goldsmith, D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol. Dial. Transplant., 2010, 25, p. 1833-1839. Go to original source... Go to PubMed...
    13. Schneider, A. G., Bellomo, R. Urinalysis and pre-renal acute kidney injury: time to move on. Crit. Care, 2013, 17, 3, p. 141. Go to original source... Go to PubMed...
    14. Prowle, J., Bagshaw, S. M., Bellomo, R. Renal blood flow, fractional excretion of sodium and acute kidney injury: time for a new paradigm? Curr. Opin. Crit. Care, 2012, 18, 6, p. 585-592. Go to original source... Go to PubMed...

    Return to the content


    Anesteziologie a intenzivní medicína

    Madam, Sir,
    please be aware that the website on which you intend to enter, not the general public because it contains technical information about medicines, including advertisements relating to medicinal products. This information and communication professionals are solely under §2 of the Act n.40/1995 Coll. Is active persons authorized to prescribe or supply (hereinafter expert).
    Take note that if you are not an expert, you run the risk of danger to their health or the health of other persons, if you the obtained information improperly understood or interpreted, and especially advertising which may be part of this site, or whether you used it for self-diagnosis or medical treatment, whether in relation to each other in person or in relation to others.

    I declare:

    1. that I have met the above instruction
    2. I'm an expert within the meaning of the Act n.40/1995 Coll. the regulation of advertising, as amended, and I am aware of the risks that would be a person other than the expert input to these sites exhibited

    No
    Yes

    If your statement is not true, please be aware
    that brings the risk of danger to their health or the health of others.