Transient versus Persistent Acute Kidney Injury and the Diagnostic Performance of Fractional Excretion of Urea in Critically Ill Patients

Wlodzimirow, Kama A.; Abu‐Hanna, Ameen; Royakkers, Annick A. N. M.; Spronk, Peter E.; Hofstra, Lieuwe S.; Kuiper, Michael; Schultz, Marcus J.; Bouman, Catherine S. C.

doi:10.1159/000357678

Cited by 18 publications

(10 citation statements)

References 42 publications

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“…It is important to recognize these datasets contained very small numbers of patients with ATI, limiting the strength and generalizability of the scientific evidence. Other studies have failed to consistently demonstrate any utility to FeUr, particularly in those with CKD or critical illness …”

Section: Why There Is Little Reason To Routinely Order Fena and Feur mentioning

confidence: 99%

Urinary fractional excretion indices in the evaluation of acute kidney injury

Pahwa

Sperati

2015

Journal of Hospital Medicine

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Section: Why There Is Little Reason To Routinely Order Fena and Feur mentioning

confidence: 99%

Urinary fractional excretion indices in the evaluation of acute kidney injury

Pahwa

Sperati

2015

Journal of Hospital Medicine

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“…The classical distinction between prerenal (functional) and structural AKI is of little relevance in critically ill patients [6], particularly in those with sepsis-associated AKI, which is more closely related to renal microcirculatory dysfunction than to a decrease in global renal blood flow [7,8]. Most recent studies assessing the ability of urine biochemistry and derived indices to discriminate between transient and persistent AKI in critically ill patients have reported conflicting findings and relatively limited performances incompatible with use in clinical practice [9][10][11][12][13][14][15].…”

Section: Introductionmentioning

confidence: 99%

Urine cell cycle arrest biomarkers distinguish poorly between transient and persistent AKI in early septic shock: a prospective, multicenter study

Titeca-Beauport

Daubin²,

Vong

et al. 2020

Crit Care

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Background The urine biomarkers tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have been validated for predicting and stratifying AKI. In this study, we analyzed the utility of these biomarkers for distinguishing between transient and persistent AKI in the early phase of septic shock. Methods We performed a prospective, multicenter study in 11 French ICUs. Patients presenting septic shock, with the development of AKI within the first 6 h, were included. Urine [TIMP-2]*[IGFBP7] was determined at inclusion (0 h), 6 h, 12 h, and 24 h. AKI was considered transient if it resolved within 3 days. Discriminative power was evaluated by receiver operating characteristic (ROC) curve analysis. Results We included 184 patients, within a median [IQR] time of 1.0 [0.0–3.0] h after norepinephrine (NE) initiation; 100 (54%) patients presented transient and 84 (46%) presented persistent AKI. Median [IQR] baseline urine [TIMP-2]*[IGFBP7] was higher in the persistent AKI group (2.21 [0.81–4.90] (ng/ml)2/1000) than in the transient AKI group (0.75 [0.20–2.12] (ng/ml)2/1000; p < 0.001). Baseline urine [TIMP-2]*[IGFBP7] was poorly discriminant, with an AUROC [95% CI] of 0.67 [0.59–0.73]. The clinical prediction model combining baseline serum creatinine concentration, baseline urine output, baseline NE dose, and baseline extrarenal SOFA performed well for the prediction of persistent AKI, with an AUROC [95% CI] of 0.81 [0.74–0.86]. The addition of urine [TIMP-2]*[IGFBP7] to this model did not improve the predictive performance. Conclusions Urine [TIMP-2]*[IGFBP7] measurements in the early phase of septic shock discriminate poorly between transient and persistent AKI and do not improve clinical prediction over that achieved with the usual variables. Trial registration NCT02812784

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“…In critically ill patients, the use of FeU has also been questioned. In a multicenter study carried by Wlodzimirow et al [ 41 ], 150 critically ill patients evaluated the performance of FeU to differentiating transient T-AKI in 51 patients from P-AKI in 41 patients. The use of FeU had a reduced ability to discriminate T-AKI from P-AKI on the day of diagnosis of AKI (AUC 0.61) and on the first (AUC 0.61) and second (AUC 0.58) days prior AKI.…”

Section: Fractional Excretion Of Urea (Feu)mentioning

confidence: 99%

Urinary Biochemistry in the Diagnosis of Acute Kidney Injury

Lima

Macedo

2018

Disease Markers

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Acute kidney injury (AKI) is a common complication, impacting short- and long-term patient outcomes. Although the application of the classification systems for AKI has improved diagnosis, early clinical recognition of AKI is still challenging, as increments in serum creatinine may be late and low urine output is not always present. The role of urinary biochemistry has remained unclear, especially in critically ill patients. Differentiating between a transient and persistent acute kidney injury is of great need in clinical practice, and despite studies questioning their application in clinical practice, biochemistry indices continue to be used while we wait for a novel early injury biomarker. An ideal marker would provide more detailed information about the type, intensity, and location of the injury. In this review, we will discuss factors affecting the fractional excretion of sodium (FeNa) and fractional excretion of urea (FeU). We believe that the frequent assessment of urinary biochemistry and microscopy can be useful in evaluating the likelihood of AKI reversibility. The availability of early injury biomarkers could help guide clinical interventions.

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Transient versus Persistent Acute Kidney Injury and the Diagnostic Performance of Fractional Excretion of Urea in Critically Ill Patients

Cited by 18 publications

References 42 publications

Urinary fractional excretion indices in the evaluation of acute kidney injury

Urinary fractional excretion indices in the evaluation of acute kidney injury

Urine cell cycle arrest biomarkers distinguish poorly between transient and persistent AKI in early septic shock: a prospective, multicenter study

Urinary Biochemistry in the Diagnosis of Acute Kidney Injury

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