title: Urine biochemistry in septic and non-septic acute kidney injury: a prospective observational study.
abstract: OBJECTIVE
  Determine whether there are unique patterns to the urine biochemistry profile in septic compared with non-septic acute kidney injury (AKI) and whether urinary biochemistry predicts worsening AKI, need for renal replacement therapy and mortality.
  
  
  METHODS
  Prospective cohort study of critically ill patients with septic and non-septic AKI, defined by the RIFLE (Risk, Injury, Failure, Loss, End-Stage) criteria. Urine biochemistry parameters were compared between septic and non-septic AKI and were correlated with neutrophil gelatinase-associated lipocalin (NGAL), worsening AKI, renal replacement therapy (RRT), and mortality.
  
  
  RESULTS
  Eighty-three patients were enrolled, 43 (51.8%) with sepsis. RIFLE class was not different between groups (P = .43). Urine sodium (UNa) <20 mmol/L, fractional excretion of sodium (FeNa) <1%, and fractional excretion of urea (FeU) <35% were observed in 25.3%, 57.8%, and 33.7%, respectively. Septic AKI had lower UNa compared with non-septic AKI (P = .04). There were no differences in FeNa or FeU between groups. Urine NGAL was higher for FeNa ≥ 1% compared to FeNa<1% (177.4 ng/mL [31.9-956.5] vs 48.0 ng/mL [21.1-232.4], P = .04). FeNa showed low correlation with urine NGAL (P = .05) and plasma NGAL (P = .14). There was poor correlation between FeU and urine NGAL (P = .70) or plasma NGAL (P = .41). UNa, FeNa, and FeU showed poor discrimination for worsening AKI, RRT and mortality.
  
  
  CONCLUSIONS
  Urine biochemical profiles do not discriminate septic and non-septic AKI. UNa, FeNa, and FeU do not reliably predict biomarker release, worsening AKI, RRT or mortality. These data imply limited utility for these measures in clinical practice in critically ill patients with AKI.
authors.affiliation: Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 3C1.12 Walter C Mackenzie Center, 8440-112 ST NW, Edmonton, Alberta, T6G 2B7, Canada. bagshaw@ualberta.ca
authors.forename: Sean M
authors.initials: SM
authors.lastname: Bagshaw
authors.forename: Michael
authors.initials: M
authors.lastname: Bennett
authors.forename: Prasad
authors.initials: P
authors.lastname: Devarajan
authors.forename: Rinaldo
authors.initials: R
authors.lastname: Bellomo
mesh_terms: D018806:APACHE; D058186:Acute Kidney Injury / Q000401:mortality / Q000652:urine*; D000209:Acute-Phase Proteins / Q000652:urine; D000368:Aged; D019540:Area Under Curve; D015415:Biomarkers / Q000652:urine; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D000071068:Lipocalin-2; D054834:Lipocalins / Q000097:blood / Q000652:urine; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019370:Observation; D011446:Prospective Studies; D011518:Proto-Oncogene Proteins / Q000097:blood / Q000652:urine; D018805:Sepsis / Q000401:mortality / Q000652:urine*; D012964:Sodium / Q000652:urine; D014508:Urea / Q000652:urine; D016482:Urinalysis
chemical_list: D000209:Acute-Phase Proteins; D015415:Biomarkers; C489506:LCN2 protein, human; D000071068:Lipocalin-2; D054834:Lipocalins; D011518:Proto-Oncogene Proteins; D014508:Urea; D012964:Sodium