Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure.
BACKGROUND
Fractional excretion of sodium (FENa) has been used in the diagnosis of acute renal failure (ARF) to distinguish between the two main causes of ARF, prerenal state and acute tubular necrosis (ATN). However, many patients with prerenal disorders receive diuretics, which decrease sodium reabsorption and thus increase FENa. In contrast, the fractional excretion of urea nitrogen (FEUN) is primarily dependent on passive forces and is therefore less influenced by diuretic therapy.


METHODS
To test the hypothesis that FEUN might be more useful in evaluating ARF, we prospectively compared FEUN with FENa during 102 episodes of ARF due to either prerenal azotemia or ATN.


RESULTS
Patients were divided into three groups: those with prerenal azotemia (N = 50), those with prerenal azotemia treated with diuretics (N = 27), and those with ATN (N = 25). FENa was low only in the patients with untreated plain prerenal azotemia while it was high in both the prerenal with diuretics and the ATN groups. FEUN was essentially identical in the two pre-renal groups (27.9 +/- 2.4% vs. 24.5 +/- 2.3%), and very different from the FEUN found in ATN (58.6 +/- 3.6%, P < 0.0001). While 92% of the patients with prerenal azotemia had a FENa <1%, only 48% of those patients with prerenal and diuretic therapy had such a low FENa. By contrast 89% of this latter group had a FEUN <35%.


CONCLUSIONS
Low FEUN (</=35%) was found to be a more sensitive and specific index than FENa in differentiating between ARF due to prerenal azotemia and that due to ATN, especially if diuretics have been administered.
Carvounis
Christos P
CP
Department of Medicine, Division of Nephrology, Nassau University Medical Center and State University of New York atStony Brook, East Meadow, New York 11554, USA. christos@ncmc.edu
Nisar
Sabeeha
S
Guro-Razuman
Samerah
S
D058186:Acute Kidney Injury / Q000097:blood / Q000175:diagnosis* / Q000652:urine*; D000328:Adult; D001806:Blood Urea Nitrogen; D003404:Creatinine / Q000097:blood; D003937:Diagnosis, Differential; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014508:Urea / Q000652:urine*; D014511:Uremia / Q000175:diagnosis / Q000652:urine
D014508:Urea; D003404:Creatinine