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, et al. Urinary Diagnostic Indices in Acute Renal Failure: A Prospective Study. Ann Intern Med. 1978;89:47–50. doi: https://doi.org/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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