Urinalysis and pre-renal acute kidney injury: time to move on

Antoine Schneider, Rinaldo Bellomo

Research output: Contribution to journalLetterOther

28 Citations (Scopus)


Urinary indices are classically believed to allow differentiation of transient (or pre-renal) acute kidney injury (AKI) from persistent (or acute tubular necrosis) AKI. However, the data validating urinalysis in critically ill patients are weak. In the previous issue of Critical Care, Pons and colleagues demonstrate in a multicenter observational study that sodium and urea excretion fractions as well as urinary over plasma ratios performed poorly as diagnostic tests to separate such entities. This study confirms the limited diagnostic and prognostic ability of urine testing. Together with other studies, this study raises more fundamental questions about the value, meaning and pathophysiologic validity of the pre-renal AKI paradigm and suggests that AKI (like all other forms of organ injury) is a continuum of injury that cannot be neatly divided into functional (pre-renal or transient) or structural (acute tubular necrosis or persistent).
Original languageEnglish
Pages (from-to)1 - 2
Number of pages2
JournalCritical Care
Issue number3 (Art. No.: 141)
Publication statusPublished - 2013

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