THOMAS R. MILLER, M.D.; ROBERT J. ANDERSON, M.D.; STUART L LINAS, M.D.; WILLIAM L HENRICH, M.D.; ARNOLD S. BERNS, M.D.; PATRICIA A. GABOW, M.D.; ROBERT W. SCHRIER, M.D., F.A.C.P.
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.
MILLER TR, ANDERSON RJ, LINAS SL, HENRICH WL, BERNS AS, GABOW PA, et al. Urinary Diagnostic Indices in Acute Renal Failure: A Prospective Study. Ann Intern Med. ;89:47–50. doi: 10.7326/0003-4819-89-1-47
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Published: Ann Intern Med. 1978;89(1):47-50.
Acute Kidney Injury, Nephrology.
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