Urinary diagnostic indices in acute renal failure. A prospective study

T. R. Miller; R. J. Anderson; S. L. Linas; W. L. Henrich; A. S. Berns; P. A. Gabow; R. W. Schrier

doi:10.7326/0003-4819-89-1-47

Urinary diagnostic indices in acute renal failure. A prospective study

T. R. Miller, R. J. Anderson, S. L. Linas, W. L. Henrich, A. S. Berns, P. A. Gabow, R. W. Schrier

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Abstract

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/liter, urine/plasma urea nitrogen ratio >8, and urine/plasma creatinine ratio >40. Conversely, a urine osmolality <350 mosm/kg, urine sodium concentration >40 meq/liter, 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.

Original language	English (US)
Pages (from-to)	47-50
Number of pages	4
Journal	Unknown Journal
Volume	89
Issue number	1
DOIs	https://doi.org/10.7326/0003-4819-89-1-47
State	Published - 1978

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Internal Medicine

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title = "Urinary diagnostic indices in acute renal failure. A prospective study",

abstract = "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/liter, urine/plasma urea nitrogen ratio >8, and urine/plasma creatinine ratio >40. Conversely, a urine osmolality <350 mosm/kg, urine sodium concentration >40 meq/liter, 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.",

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AU - Miller, T. R.

AU - Anderson, R. J.

AU - Linas, S. L.

AU - Henrich, W. L.

AU - Berns, A. S.

AU - Gabow, P. A.

AU - Schrier, R. W.

PY - 1978

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N2 - 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/liter, urine/plasma urea nitrogen ratio >8, and urine/plasma creatinine ratio >40. Conversely, a urine osmolality <350 mosm/kg, urine sodium concentration >40 meq/liter, 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.

AB - 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/liter, urine/plasma urea nitrogen ratio >8, and urine/plasma creatinine ratio >40. Conversely, a urine osmolality <350 mosm/kg, urine sodium concentration >40 meq/liter, 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.

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Urinary diagnostic indices in acute renal failure. A prospective study

Abstract

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