Assessment of fractional excretion of urea for early diagnosis of cardiac surgery associated acute kidney injury

Varela, Carlos Federico; Greloni, Gustavo; Schreck, Carlos; Bratti, Griselda; Medina, A.; Marenchino, Ricardo; Pizarro, Rodolfo; Belziti, César; Rosa-Díez, Guillermo

doi:10.3109/0886022x.2015.1087800

Cited by 16 publications

(7 citation statements)

References 28 publications

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“…ARF is a frequently encountered disease in clinical nephrology with a high mortality rate 26 . Oxygenation and oxidative stress are accepted to be a reason for AKI during renal I/R 27 , which damages the tubular and endothelial cells by oxidative stress, ROS generation, and acute inflammation 28 .…”

Section: Discussionmentioning

confidence: 99%

Casticin Mitigates Renal Damage Injured by Ischemia Reperfusion: A Biochemical Study

Topdağı¹,

Tanyeli²,

Akdemir³

et al. 2021

jamp

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Renal ischemia-reperfusion is a severe health condition that may be dangerous and even cause death. This research aims to search the protective effects of casticin on renal injury induced by ischemia-reperfusion. Study groups included sham, ischemia-reperfusion, 5 mg/kg casticin+ischemia reperfusion, and 10 mg/kg casticin+ischemia reperfusion groups. Some antioxidant, inflammatory, and oxidant parameters were examined in renal tissues obtained following the experiment. We found that the inflammatory and oxidant biomarkers elevated and antioxidants declined in the ischemia-reperfusion group. However, the antioxidant values raised, and inflammatory values declined in treatment groups. These results have shown us that casticin may be a potent molecule against oxidative renal damage following ischemia-reperfusion.

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Section: Discussionmentioning

confidence: 99%

Casticin Mitigates Renal Damage Injured by Ischemia Reperfusion: A Biochemical Study

Topdağı¹,

Tanyeli²,

Akdemir³

et al. 2021

jamp

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“…A large drop in RBF leads to a decrease in GFR, resulting in the so-called pre-renal azotemia or “functional” kidney failure [6]. If the condition persists, acute tubular necrosis (“structural” kidney failure) occurs [6,7,15,16].…”

Section: Discussionmentioning

confidence: 99%

“…Creatinine is not reabsorbed or excreted in the renal tubules, thus the ratio of sodium, urea, and uric acid clearance to creatinine clearance (i.e., fractional excretion of these substances) is decreased [18]. Decreased fractional excretion of sodium (FeNa), urea (FeUrea), and lithium (FeLi) [11,15,16,18,19] allows the distinction between pre-renal azotemia and renal failure. In hypoperfusion, the urea to creatinine ratio (sUrea/Cr) increases [18].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Markers of Renal Hypoperfusion, Hemoconcentration, and Proteinuria after Extreme Physical Exercise

et al. 2019

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Background and Objectives: Physical exercise increases the blood perfusion of muscles, but decreases the renal blood flow. There are several markers of renal hypoperfusion which are used in the differential diagnosis of acute kidney failure. Albuminuria is observed after almost any exercise. The aim of this study was to assess changes in renal hypoperfusion and albuminuria after a 100-km race. Materials and Methods: A total of 27 males who finished a 100-km run were studied. The mean age of the runners was 38.04 ± 5.64 years. The exclusion criteria were a history of kidney disease, glomerular filtration rate (GFR) <60 ml/min, and proteinuria. Blood and urine were collected before and after the race. The urinary albumin/creatinine ratio (ACR), fractional excretion of urea (FeUrea) and sodium (FeNa), plasma urea/creatinine ratio (sUrea/Cr), urine/plasma creatinine ratio (u/pCr), urinary sodium to potassium ratio (uNa/K), and urinary potassium to urinary potassium plus sodium ratio (uK/(K+Na)) were calculated. Results: After the race, significant changes in albuminuria and markers of renal hypoperfusion (FeNa, FeUrea, sUrea/Cr, u/sCr, urinary Na, uNa/K, uK/(K+Na)) were found. Fifteen runners (55.56%) had severe renal hypoperfusion (FeUrea <35, uNa/K <1, and uK/(Na+K) >0.5) after the race. The mean ACR increased from 6.28 ± 3.84 mg/g to 48.43 ± 51.64 mg/g (p < 0.001). The ACR was higher in the group with severe renal hypoperfusion (59.42 ± 59.86 vs. 34.68 ± 37.04 mg/g), but without statistical significance. Conclusions: More than 50% of the runners had severe renal hypoperfusion after extreme exercise. Changes in renal hemodynamics are probably an important, but not the only, factor of post-exercise proteinuria.

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“…We chose to investigate type 1 which is closest to the original NLHBI definition and where renal hemodynamics may be more involved; nevertheless, endothelial dysfunction has also been recognized as a contributor to the crosstalk between cardiac and renal dysfunction, which is critical to CRS . The decreased nitric oxide production from that dysfunction is also known to affect the fractional excretion of sodium but not urea , which has recently been found to be the most useful biomarker in distinguishing acute renal injury after cardiac surgery . Therefore, the handling of urea may be a better biomarker than sodium for evaluation of reversibility in CRS.…”

Section: Discussionmentioning

confidence: 99%

Use of the Fractional Excretion of Urea in an Azotemic Nonoliguric State: Type 1 Cardiorenal Syndrome

et al. 2018

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The fractional excretion of urea is a useful tool to evaluate renal function in oliguric states; however, it remains unexplored in nonoliguric states. We evaluated its use to predict responses in patients with type 1 cardiorenal syndrome. This was a prospective observational study of 116 patients with type 1 cardiorenal syndrome referred over a 4-year period. Fractional excretion of urea and sodium, ejection fraction, mean arterial pressure, age, sex, diabetes, brain natriuretic peptide (BNP), serum sodium and blood urea nitrogen were analyzed for effects upon serum creatinine and survival. Improvement of renal function correlated most significantly with FeUrea (P = 0.00001) followed by the FeNa (P = 0.005) but no other variable studied reached significance. Survival was best predicted by improvement of the serum creatinine at 24 h (P = 0.005) and 7 days after all inotropes were stopped (P = 0.001). A limitation of this study is that it cannot be extrapolated to all cardiorenal syndrome patients other than type 1. Also, the study was not randomized and those with potentially worse disease have had worse outcomes due merely to worse underlying disease. The success of the FeUrea may possibly be related to interference of dobutamine on creatinine levels. Despite being a nonoliguric state, the FeUrea appears to provide insight to those patients with type 1 cardiorenal syndrome whose renal function (as measured by serum creatinine) and survival might improve.

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Assessment of fractional excretion of urea for early diagnosis of cardiac surgery associated acute kidney injury

Abstract: FeU is useful as an early biomarker to predict AKI after CS and it is comparable to the new biomarker NGAL.

Cited by 16 publications

References 28 publications

Casticin Mitigates Renal Damage Injured by Ischemia Reperfusion: A Biochemical Study

Casticin Mitigates Renal Damage Injured by Ischemia Reperfusion: A Biochemical Study

Biochemical Markers of Renal Hypoperfusion, Hemoconcentration, and Proteinuria after Extreme Physical Exercise

Use of the Fractional Excretion of Urea in an Azotemic Nonoliguric State: Type 1 Cardiorenal Syndrome

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