Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure
Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure
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DOI：
10.1046/j.1523-1755.2002.00683.x
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发表时间：
2002-12-01
影响因子：
19.6
通讯作者：
Guro-Razuman, S
中科院分区：
文献类型：
--
作者：
Carvounis, CP;Nisar, S;Guro-Razuman, S
背景钠排泄分数（FENa）已用于诊断急性肾功能衰竭（ARF），以区分ARF的两个主要原因，肾前状态和急性肾小管坏死（ATN）。然而，许多患有肾前性疾病的患者接受利尿剂，其减少钠重吸收，从而增加FENa。相反，尿素氮排泄分数（FEUN）主要依赖于被动力量，因此受利尿剂治疗的影响较小。为了验证这一假设，即FEUN可能是更有用的评估ARF，我们前瞻性地比较了FEUN与FENa在102次ARF事件由于无论是肾前性氮质血症或ATN.Results患者被分为三组：肾前性氮质血症（N = 50），肾前性氮质血症与利尿剂治疗（N = 27），与ATN（N = 25）。FENa仅在未经治疗的单纯肾前性氮质血症患者中较低，而在肾前性利尿剂组和ATN组中均较高。两个肾前组的FEUN基本相同（27.9 +/- 2.4% vs. 24.5 +/- 2.3%），与ATN的FEUN非常不同（58.6 +/-3.6%，P < 0.0001）。而92%的肾前性氮质血症患者有FENa
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