Diagnostic performance of serum blood urea nitrogen to creatinine ratio for distinguishing prerenal from intrinsic acute kidney injury in the emergency department

Abstract

BackgroundThe blood urea nitrogen to creatinine ratio (BCR) has been used since the early 1940s to help clinicians differentiate between prerenal acute kidney injury (PR AKI) and intrinsic AKI (I AKI). This ratio is simple to use and often put forward as a reliable diagnostic tool even though little scientific evidence supports this. The aim of this study was to determine whether BCR is a reliable tool for distinguishing PR AKI from I AKI.MethodsWe conducted a retrospective observational study over a 13 months period, in the Emergency Department (ED) of Nantes University Hospital. Eligible for inclusion were all adult patients consecutively admitted to the ED with a creatinine >133 μmol/L (1.5 mg/dL).ResultsSixty thousand one hundred sixty patients were consecutively admitted to the ED. 2756 patients had plasma creatinine levels in excess of 133 μmol/L, 1653 were excluded, leaving 1103 patients for definitive inclusion.Mean age was 75.7 ± 14.8 years old, 498 (45%) patients had PR AKI and 605 (55%) I AKI. BCR was 90.55 ± 39.32 and 91.29 ± 39.79 in PR AKI and I AKI groups respectively. There was no statistical difference between mean BCR of the PR AKI and I AKI groups, p = 0.758. The area under the ROC curve was 0.5 indicating that BCR had no capacity to discriminate between PR AKI and I AKI.ConclusionsOur study is the largest to investigate the diagnostic performance of BCR. BCR is not a reliable parameter for distinguishing prerenal AKI from intrinsic AKI.

Soft drink consumption during and following exercise in the heat elevates biomarkers of acute kidney injury

“…BUN:creatinine in the present study was approximately 10:1 in the Soft Drink trial at post-exercise, suggestive of an intrarenal derived AKI. However, recent evidence suggests that diagnostic efficacy of BUN:creatinine is unclear (31), particularly considering that there currently is no consensus definition of pre-renal failure (30).…”

LncRNA TapSAKI promotes inflammation injury in HK-2 cells and urine derived sepsis-induced kidney injury

“…Sepsis is a systemic inflammatory response syndrome caused by bacterial, viral or fungal infection which causes organ injuries, and the incidence of acute kidney injury in patients with severe sepsis can reach up to 60% . Acute kidney injury can be diagnosed by increased blood urea nitrogen (BUN) and serum creatinine . However, treatment of sepsis‐induced kidney injury is not satisfactory.…”

“…[1] Acute kidney injury can be diagnosed by increased blood urea nitrogen (BUN) and serum creatinine. [2,3] However, treatment of sepsis-induced kidney injury is not satisfactory. Therefore, it is necessary to find effective therapeutic targets for sepsis-induced kidney injury.…”

Genome-wide association analysis identifies multiple loci associated with kidney disease-related traits in Korean populations

“…Traditionally, blood urea nitrogen (BUN) and serum creatinine levels have been used as surrogate markers of kidney function deterioration. BUN reflects the amount of nitrogen in the blood and is produced as a waste product of protein metabolism [ 2 , 3 ]. Serum creatinine is a representative biochemical indicator of kidney function and is produced by the breakdown of muscle creatine phosphate.…”