Urine biochemistry in septic and non-septic acute kidney injury: A prospective observational study

Sean M. Bagshaw, Michael Bennett, Prasad Devarajan, Rinaldo Bellomo

Research output: Contribution to journalArticleResearchpeer-review

41 Citations (Scopus)

Abstract

Purpose: 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. Materials and 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)371-378
Number of pages8
JournalJournal of Critical Care
Volume28
Issue number4
DOIs
Publication statusPublished - 1 Aug 2013
Externally publishedYes

Keywords

  • Acute kidney injury
  • Fractional excretion of sodium
  • Fractional excretion of urea
  • Neutrophil gelatinase-associated lipocalin
  • Renal replacement therapy
  • Sepsis

Cite this

Bagshaw, Sean M. ; Bennett, Michael ; Devarajan, Prasad ; Bellomo, Rinaldo. / Urine biochemistry in septic and non-septic acute kidney injury : A prospective observational study. In: Journal of Critical Care. 2013 ; Vol. 28, No. 4. pp. 371-378.
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abstract = "Purpose: 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. Materials and 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. Conclusion: 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.",
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Urine biochemistry in septic and non-septic acute kidney injury : A prospective observational study. / Bagshaw, Sean M.; Bennett, Michael; Devarajan, Prasad; Bellomo, Rinaldo.

In: Journal of Critical Care, Vol. 28, No. 4, 01.08.2013, p. 371-378.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Urine biochemistry in septic and non-septic acute kidney injury

T2 - A prospective observational study

AU - Bagshaw, Sean M.

AU - Bennett, Michael

AU - Devarajan, Prasad

AU - Bellomo, Rinaldo

PY - 2013/8/1

Y1 - 2013/8/1

N2 - Purpose: 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. Materials and 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. Conclusion: 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.

AB - Purpose: 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. Materials and 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. Conclusion: 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.

KW - Acute kidney injury

KW - Fractional excretion of sodium

KW - Fractional excretion of urea

KW - Neutrophil gelatinase-associated lipocalin

KW - Renal replacement therapy

KW - Sepsis

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