Urine assessment in the critically ill: a matter of both quantity and quality

Maciel, Alexandre Toledo; Park, Marcelo

doi:10.5935/0103-507x.20130032

Cited by 8 publications

(5 citation statements)

References 6 publications

(7 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, their role has been questioned by many[13]. Recently, new emphasis has been placed on urine and acid-base status in monitoring the decelopment of AKI[18,24]. In our study, we evaluated SIDu values in patients with and without AKI.…”

Section: Discussionmentioning

confidence: 99%

Urinary Strong Ion Difference as a Marker of Renal Dysfunction. A Retrospective Analysis

et al. 2016

View full text Add to dashboard Cite

IntroductionThe kidneys play a crucial role in the regulation of electrolytes and acid-base homeostasis. Urinary Strong Ion Difference (SIDu = NaU + KU—ClU) represents an important aspect of renal acid-base regulation. We evaluated the role of SIDu as a marker of renal dysfunction in critically ill patients.Materials and MethodsPatients admitted to the Medical Intensive Care Unit with a diagnosis of AKI for whom concomitant urinary samples available for SIDu calculation were retrospectively reviewed and staged according to KDIGO criteria for 3 days from inclusion. Patients were classified as Recovered (R-AKI) or Persistent-AKI (P-AKI) whether they exited KDIGO criteria within the 3-day observation period or not. A control group with normal renal function and normal serum acid-base and electrolytes was prospectively recruited in order to identify reference SIDu values.ResultsOne-hundred-and-forty-three patients with a diagnosis of AKI were included: 77 with R-AKI, and 66 with P-AKI. Thirty-six controls were recruited. Patients with P-AKI had more severe renal dysfunction and higher mortality than patients with R-AKI (SCr 2.23(IQR:1.68–3.45) and 1.81(IQR1.5–2.5) mg/dl respectively, p<0.001; 24-h UO 1297(950) and 2100(1094) ml respectively, p = 0.003); 30-d mortality, 39% and 13% respectively; p<0.001). SIDu significantly differed between groups, with rising values from controls to P-AKI groups (16.4(12), 30(24) and 47.3(21.5) mEq/l respectively, p<0.001).DiscussionSIDu may be a simple and inexpensive tool in AKI patients’ evaluation. Further research is needed to evaluate the ability of SIDu to identify patients with renal dysfunction before derangements in serum creatinine or urine output are observed.

show abstract

Section: Discussionmentioning

confidence: 99%

Urinary Strong Ion Difference as a Marker of Renal Dysfunction. A Retrospective Analysis

et al. 2016

View full text Add to dashboard Cite

show abstract

“…( 25 , 26 ) In critically ill patients, metabolic acidosis is relevant, multifactorial, and related to clinical outcomes. ( 27 , 28 ) These patients present reduced sodium and chloride renal excretion, ( 10 , 11 , 29 ) together with chloride shift from the extravascular to the intravascular compartments added to exogenous load during fluid resuscitation, ( 30 ) frequently resulting in hyperchloremia. ( 27 , 31 ) Therefore, we speculate that these factors most likely differentiate the responses of critically ill patients from stable patients when they are exposed to hypercapnia in terms of chloride and SIDai modulations.…”

Section: Discussionmentioning

confidence: 99%

Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome

Romano¹,

Correia²,

Mendes³

et al. 2016

Revista Brasileira De Terapia Intensiva

Self Cite

View full text Add to dashboard Cite

ObjectiveHypercapnia resulting from protective ventilation in acute respiratory distress syndrome triggers metabolic pH compensation, which is not entirely characterized. We aimed to describe this metabolic compensation.MethodsThe data were retrieved from a prospective collected database. Variables from patients' admission and from hypercapnia installation until the third day after installation were gathered. Forty-one patients with acute respiratory distress syndrome were analyzed, including twenty-six with persistent hypercapnia (PaCO2 > 50mmHg > 24 hours) and 15 non-hypercapnic (control group). An acid-base quantitative physicochemical approach was used for the analysis.ResultsThe mean ages in the hypercapnic and control groups were 48 ± 18 years and 44 ± 14 years, respectively. After the induction of hypercapnia, pH markedly decreased and gradually improved in the ensuing 72 hours, consistent with increases in the standard base excess. The metabolic acid-base adaptation occurred because of decreases in the serum lactate and strong ion gap and increases in the inorganic apparent strong ion difference. Furthermore, the elevation in the inorganic apparent strong ion difference occurred due to slight increases in serum sodium, magnesium, potassium and calcium. Serum chloride did not decrease for up to 72 hours after the initiation of hypercapnia.ConclusionIn this explanatory study, the results indicate that metabolic acid-base adaptation, which is triggered by acute persistent hypercapnia in patients with acute respiratory distress syndrome, is complex. Furthermore, further rapid increases in the standard base excess of hypercapnic patients involve decreases in serum lactate and unmeasured anions and increases in the inorganic apparent strong ion difference by means of slight increases in serum sodium, magnesium, calcium, and potassium. Serum chloride is not reduced.

show abstract

“…On the other hand, a disproportional reduction in CrU may compromise creatinine excretion even in the presence of a theoretically adequate or augmented UO: the classic “non-oliguric” AKI, previously called non-oliguric acute renal failure ( 29 , 30 ). In practical terms, both quantity and “quality” of the urine ( 31 ) are equally relevant to renal function evaluation and the “quality” of the urine can be assessed to a large extent by UB.…”

Section: Improving the Interpretation Of Serum Creatinine And Urine O...mentioning

confidence: 99%

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

2022

View full text Add to dashboard Cite

Urine biochemistry (UB) remains a controversial tool in acute kidney injury (AKI) monitoring, being considered to be of limited value both in terms of AKI diagnosis and prognosis. However, many criticisms can be made to the studies that have established the so called “pre-renal paradigm” (used for decades as the essential physiological basis for UB assessment in AKI) as well as to more recent studies suggesting that UB has no utility in daily clinical practice. The aim of this article is to describe our hypothesis on how to interpret simple and widely recognized urine biochemical parameters from a novel perspective, propose the rationale for their sequential assessment and demonstrate their usefulness in AKI monitoring, especially in the critical care setting.

show abstract

Urine assessment in the critically ill: a matter of both quantity and quality

Cited by 8 publications

References 6 publications

Urinary Strong Ion Difference as a Marker of Renal Dysfunction. A Retrospective Analysis

Urinary Strong Ion Difference as a Marker of Renal Dysfunction. A Retrospective Analysis

Metabolic acid-base adaptation triggered by acute persistent hypercapnia in mechanically ventilated patients with acute respiratory distress syndrome

Urine biochemistry assessment in the sequential evaluation of renal function: Time to think outside the box

Contact Info

Product

Resources

About