Abstract
OBJECTIVE: In experimental septic acute renal failure, urinary analysis is used to help diagnose and classify renal injury. However, the scientific basis for such use has not been systematically evaluated. Thus, we appraised the value of common urinary findings for the diagnosis and classification of experimental septic acute renal failure. DESIGN: Systematic review. SETTING: Academic medical center and university-based research laboratory. SUBJECTS: Experimental studies describing urinary biochemistry, derived indexes, and microscopy in septic acute renal failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven articles fulfilled all inclusion criteria. Due to heterogeneity, no formal quantitative analysis was possible. The methods for induction of sepsis and models were variable. The urinary sodium, fractional excretion of sodium, and urine osmolality were reported in only four (15%), 21 (78%), and seven (26%) studies, respectively. The fractional excretion of sodium exhibited a decrease, no change, or an increase from baseline in 11 (52%), five (24%), and five (24%) studies, respectively. The urine osmolality decreased from baseline in all endotoxin-induced models but showed an early transient increase in six (22%) studies of cecal-ligation perforation. Proteinuria or urinary enzymuria was reported in only seven (26%) studies. Urinary microscopy was described in one study. Only ten studies (37%) simultaneously reported on histopathology. In all these studies, histology either was normal or showed minor ultrastructural changes on electron microscopy. CONCLUSIONS: No conclusions are possible on how several urinary tests perform in diagnosing or classifying acute renal failure or in predicting the presence of acute tubular necrosis in experimental sepsis. Additional research is necessary to define the diagnostic and prognostic value of urinalysis in experimental sepsis.
| Original language | English |
|---|---|
| Pages (from-to) | 1592-1598 |
| Number of pages | 7 |
| Journal | Critical Care Medicine |
| Volume | 35 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - 1 Jan 2007 |
| Externally published | Yes |
Keywords
- Acute renal failure
- Acute tubular necrosis
- Experimental
- Fractional excretion of sodium
- Histopathology
- Microscopy
- Sepsis
- Urinary markers
Cite this
}
A systematic review of urinary findings in experimental septic acute renal failure. / Bagshaw, Sean M.; Langenberg, Christoph; Wan, Li; May, Clive N.; Bellomo, Rinaldo.
In: Critical Care Medicine, Vol. 35, No. 6, 01.01.2007, p. 1592-1598.Research output: Contribution to journal › Review Article › Research › peer-review
TY - JOUR
T1 - A systematic review of urinary findings in experimental septic acute renal failure
AU - Bagshaw, Sean M.
AU - Langenberg, Christoph
AU - Wan, Li
AU - May, Clive N.
AU - Bellomo, Rinaldo
PY - 2007/1/1
Y1 - 2007/1/1
N2 - OBJECTIVE: In experimental septic acute renal failure, urinary analysis is used to help diagnose and classify renal injury. However, the scientific basis for such use has not been systematically evaluated. Thus, we appraised the value of common urinary findings for the diagnosis and classification of experimental septic acute renal failure. DESIGN: Systematic review. SETTING: Academic medical center and university-based research laboratory. SUBJECTS: Experimental studies describing urinary biochemistry, derived indexes, and microscopy in septic acute renal failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven articles fulfilled all inclusion criteria. Due to heterogeneity, no formal quantitative analysis was possible. The methods for induction of sepsis and models were variable. The urinary sodium, fractional excretion of sodium, and urine osmolality were reported in only four (15%), 21 (78%), and seven (26%) studies, respectively. The fractional excretion of sodium exhibited a decrease, no change, or an increase from baseline in 11 (52%), five (24%), and five (24%) studies, respectively. The urine osmolality decreased from baseline in all endotoxin-induced models but showed an early transient increase in six (22%) studies of cecal-ligation perforation. Proteinuria or urinary enzymuria was reported in only seven (26%) studies. Urinary microscopy was described in one study. Only ten studies (37%) simultaneously reported on histopathology. In all these studies, histology either was normal or showed minor ultrastructural changes on electron microscopy. CONCLUSIONS: No conclusions are possible on how several urinary tests perform in diagnosing or classifying acute renal failure or in predicting the presence of acute tubular necrosis in experimental sepsis. Additional research is necessary to define the diagnostic and prognostic value of urinalysis in experimental sepsis.
AB - OBJECTIVE: In experimental septic acute renal failure, urinary analysis is used to help diagnose and classify renal injury. However, the scientific basis for such use has not been systematically evaluated. Thus, we appraised the value of common urinary findings for the diagnosis and classification of experimental septic acute renal failure. DESIGN: Systematic review. SETTING: Academic medical center and university-based research laboratory. SUBJECTS: Experimental studies describing urinary biochemistry, derived indexes, and microscopy in septic acute renal failure. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Twenty-seven articles fulfilled all inclusion criteria. Due to heterogeneity, no formal quantitative analysis was possible. The methods for induction of sepsis and models were variable. The urinary sodium, fractional excretion of sodium, and urine osmolality were reported in only four (15%), 21 (78%), and seven (26%) studies, respectively. The fractional excretion of sodium exhibited a decrease, no change, or an increase from baseline in 11 (52%), five (24%), and five (24%) studies, respectively. The urine osmolality decreased from baseline in all endotoxin-induced models but showed an early transient increase in six (22%) studies of cecal-ligation perforation. Proteinuria or urinary enzymuria was reported in only seven (26%) studies. Urinary microscopy was described in one study. Only ten studies (37%) simultaneously reported on histopathology. In all these studies, histology either was normal or showed minor ultrastructural changes on electron microscopy. CONCLUSIONS: No conclusions are possible on how several urinary tests perform in diagnosing or classifying acute renal failure or in predicting the presence of acute tubular necrosis in experimental sepsis. Additional research is necessary to define the diagnostic and prognostic value of urinalysis in experimental sepsis.
KW - Acute renal failure
KW - Acute tubular necrosis
KW - Experimental
KW - Fractional excretion of sodium
KW - Histopathology
KW - Microscopy
KW - Sepsis
KW - Urinary markers
UR - http://www.scopus.com/inward/record.url?scp=34249308862&partnerID=8YFLogxK
U2 - 10.1097/01.CCM.0000266684.17500.2F
DO - 10.1097/01.CCM.0000266684.17500.2F
M3 - Review Article
C2 - 17452939
AN - SCOPUS:34249308862
VL - 35
SP - 1592
EP - 1598
JO - Critical Care Medicine
JF - Critical Care Medicine
SN - 0090-3493
IS - 6
ER -