Fractional excretion of trace lithium and uric acid in acute renal failure

The early distinction between prerenal azotemia, characterized by an avid proximal tubular sodium reabsorption, and ATN, in which proximal tubule function is depressed, remains an important but difficult clinical task. Indices of acute renal failure based on urinary sodium excretion may be helpful b...

Full description

Saved in:
Bibliographic Details
Published in:Journal of the American Society of Nephrology 1994-01, Vol.4 (7), p.1429-1437
Main Authors: Steinhäuslin, F, Burnier, M, Magnin, J L, Munafo, A, Buclin, T, Diezi, J, Biollaz, J
Format: Article
Language:English
Subjects:
Acute Kidney Injury - diagnosis
Acute Kidney Injury - drug therapy
Acute Kidney Injury - urine
Adult
Aged
Diagnosis, Differential
Diuretics - therapeutic use
Female
Humans
Kidney Tubular Necrosis, Acute - diagnosis
Kidney Tubular Necrosis, Acute - drug therapy
Kidney Tubular Necrosis, Acute - urine
Lithium - urine
Male
Middle Aged
Oliguria - urine
Sodium - urine
Uremia - diagnosis
Uremia - drug therapy
Uremia - urine
Uric Acid - urine
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:The early distinction between prerenal azotemia, characterized by an avid proximal tubular sodium reabsorption, and ATN, in which proximal tubule function is depressed, remains an important but difficult clinical task. Indices of acute renal failure based on urinary sodium excretion may be helpful but have several limitations, among which is the use of diuretics. The effectiveness of the fractional excretion of uric acid (FEUA) and that of endogenous lithium (FELi) in the diagnosis of acute renal failure has been evaluated in an unselected group of 46 patients, 28 with prerenal azotemia and 18 with ATN. In the entire group, FELi concurred with the clinical diagnosis in 78% of the patients, whereas the fractional excretion of sodium (FENa) and FEUA were in agreement in only 63 and 50%, respectively. FELi was more sensitive to identify hemodynamic renal failure, because 93% of prerenal failure patients had a low FELi, contrasting with a low FEUA in only 68% and a low FENa in 75%. The major reason for the discrepancy between FENa and FELi was the administration of diuretics. In both acute renal failure groups, FENa was higher in the subgroups receiving diuretics. In contrast, diuretic therapy had no effect on FELi in either group. These results suggest that FELi is more accurate than either FENa or FEUA for distinguishing prerenal azotemia from ATN. The superiority of FELi appears especially relevant in patients treated with the usual diuretics.
ISSN:1046-6673
DOI:10.1681/asn.v471429