Urinary diagnostic indices in acute renal failure: a prospective study
TR Miller, RJ Anderson, SL LINAS… - Annals of internal …, 1978 - acpjournals.org
TR Miller, RJ Anderson, SL LINAS, WL HENRICH, AS BERNS, PA GABOW, RW SCHRIER
Annals of internal medicine, 1978•acpjournals.orgA prospective analysis of the value of urinary diagnostic indices in ascertaining the cause of
acute renal failure was undertaken. Our results show that in the setting of acute oliguria a
diagnosis of potentially reversible prerenal azotemia is likely with urine osmolality> 500
mosm/kg H2O, urine sodium concentration< 20 meq/litre, urine/plasma urea nitrogen ratio>
8, and urine/plasma creatinine ratio> 40. Conversely, a urine osmolality< 350 mosm/kg,
urine sodium concentration> 40 meq/litre, urine/plasma urea nitrogen ratio< 3, and …
acute renal failure was undertaken. Our results show that in the setting of acute oliguria a
diagnosis of potentially reversible prerenal azotemia is likely with urine osmolality> 500
mosm/kg H2O, urine sodium concentration< 20 meq/litre, urine/plasma urea nitrogen ratio>
8, and urine/plasma creatinine ratio> 40. Conversely, a urine osmolality< 350 mosm/kg,
urine sodium concentration> 40 meq/litre, urine/plasma urea nitrogen ratio< 3, and …
A prospective analysis of the value of urinary diagnostic indices in ascertaining the cause of acute renal failure was undertaken. Our results show that in the setting of acute oliguria a diagnosis of potentially reversible prerenal azotemia is likely with urine osmolality > 500 mosm/kg H2O, urine sodium concentration < 20 meq/litre, urine/plasma urea nitrogen ratio > 8, and urine/plasma creatinine ratio > 40. Conversely, a urine osmolality < 350 mosm/kg, urine sodium concentration > 40 meq/litre, urine/plasma urea nitrogen ratio < 3, and urine/plasma creatinine ratio < 20 suggest acute tubular necrosis. A significant number of oliguric patients will not have urinary indices that fall within these guidelines. In this setting, urine sodium concentration divided by the urine-to-plasma creatinine ratio (the renal failure index) and the fractional excretion of filtered sodium provide a reliable means of differentiating reversible prerenal azotemia from acute tubular necrosis.
acpjournals.org