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BMC Anesthesiology
Published in: BMC Anesthesiology 1/2013

Open Access 01-12-2013 | Research article

Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study

Authors: Alexandre Toledo Maciel, Marcelo Park, Etienne Macedo

Published in: BMC Anesthesiology | Issue 1/2013

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Abstract

Background

Sequential physicochemical alterations in blood and urine in the course of acute kidney injury (AKI) development have not been previously described. We aimed to describe these alterations in parallel to traditional renal and acid–base parameters.

Methods

One hundred and sixty eight consecutive critically ill patients with no previous kidney disease, who had an indwelling urinary catheter at ICU admission and who remained with the catheter for at least two days without dialysis were included. A sample of blood and spot urine were collected simultaneously, once daily, until catheter removal or dialysis requirement. Traditional acid–base and renal parameters were sequentially evaluated in parallel to blood and urinary physicochemical parameters. Patients were classified during this period as having or not AKI and, for patients with AKI, duration (transient or persistent) and severity (creatinine-based AKIN stage) were evaluated.

Results

One hundred and thirteen patients (67.3%) had AKI: 92 at ICU admission and 21 during the observation period. AKI development was characterized in blood by increased values of phosphate and unmeasured anions (SIG), decreased albumin, and in urine by decreased values of sodium (NaU), chloride (ClU) as well as high urinary strong ion difference (SIDu). These alterations began to occur before AKI diagnosis, and they reverted in transient AKI but remained in persistent AKI. NaU, ClU and albumin decreased, and phosphate, SIG and SIDu increased with AKI severity progression. NaU and ClU values increased again when AKIN stage 3 was reached.

Conclusions

Simultaneous physicochemical analysis of blood and urine revealed standardized alterations that characterize AKI development in critically ill patients. These alterations paralleled AKI duration and severity. Future studies should consider including sequential evaluation of urine biochemistry as part of the armamentarium for AKI diagnosis and management.
Appendix
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Literature
1.
Kellum JA: Prerenal azotemia: still a useful concept?. Crit Care Med. 2007, 35: 1630-1631. 10.1097/01.CCM.0000266794.57111.01.CrossRefPubMed
2.
Bellomo R, Bagshaw S, Langenberg C, Ronco C: Pre-renal azotemia: a flawed paradigm in critically ill septic patients?. Contrib Nephrol. 2007, 156: 1-9.CrossRefPubMed
3.
Rachoin JS, Daher R, Moussallem C, Milcarek B, Hunter K, et al: The fallacy of the BUN:creatinine ratio in critically ill patients. Nephrol Dial Transplant. 2012, 27: 2248-2254. 10.1093/ndt/gfr705.CrossRefPubMed
4.
Rosen S, Heyman SN: Difficulties in understanding human "acute tubular necrosis": limited data and flawed animal models. Kidney Int. 2001, 60: 1220-1224. 10.1046/j.1523-1755.2001.00930.x.CrossRefPubMed
5.
Langenberg C, Bagshaw SM, May CN, Bellomo R: The histopathology of septic acute kidney injury: a systematic review. Crit Care. 2008, 12: R38-10.1186/cc6823.CrossRefPubMedPubMedCentral
6.
Bagshaw SM, Langenberg C, Wan L, May CN, Bellomo R: A systematic review of urinary findings in experimental septic acute renal failure. Crit Care Med. 2007, 35: 1592-1598. 10.1097/01.CCM.0000266684.17500.2F.CrossRefPubMed
7.
Carvounis CP, Nisar S, Guro-Razuman S: Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int. 2002, 62: 2223-2229. 10.1046/j.1523-1755.2002.00683.x.CrossRefPubMed
8.
Pepin MN, Bouchard J, Legault L, Ethier J: Diagnostic performance of fractional excretion of urea and fractional excretion of sodium in the evaluations of patients with acute kidney injury with or without diuretic treatment. Am J Kidney Dis. 2007, 50: 566-573. 10.1053/j.ajkd.2007.07.001.CrossRefPubMed
9.
Dewitte A, Biais M, Petit L, Cochard JF, Hilbert G, et al: Fractional excretion of urea as a diagnostic index in acute kidney injury in intensive care patients. J Crit Care. 2012, 27: 205-210.CrossRef
10.
Darmon M, Vincent F, Dellamonica J, Schortgen F, Gonzalez F, et al: Diagnostic performance of fractional excretion of urea in the evaluation of critically ill patients with acute kidney injury: a multicenter cohort study. Crit Care. 2011, 15: R178-10.1186/cc10327.CrossRefPubMedPubMedCentral
11.
Bagshaw SM, Langenberg C, Bellomo R: Urinary biochemistry and microscopy in septic acute renal failure: a systematic review. Am J Kidney Dis. 2006, 48: 695-705. 10.1053/j.ajkd.2006.07.017.CrossRefPubMed
12.
Bellomo R, Kellum JA, Ronco C: Acute kidney injury. Lancet. 2012, 380: 756-766. 10.1016/S0140-6736(11)61454-2.CrossRefPubMed
13.
Prowle J, Bagshaw SM, Bellomo R: Renal blood flow, fractional excretion of sodium and acute kidney injury: time for a new paradigm?. Curr Opin Crit Care. 2012, 18: 585-592. 10.1097/MCC.0b013e328358d480.CrossRefPubMed
14.
Maciel AT, Park M: Early diagnosis of acute kidney injury in a critically ill patient using a combination of blood and urinary physicochemical parameters. Clinics (Sao Paulo). 2012, 67: 525-526. 10.6061/clinics/2012(05)21.CrossRef
15.
Maciel AT, Park M, Macedo E: Urinary electrolyte monitoring in critically ill patients: a preliminary, observational study. Rev Bras Ter Intensiva. 2012, 24: 236-246. 10.1590/S0103-507X2012000300006.CrossRefPubMed
16.
Rocktaeschel J, Morimatsu H, Uchino S, Goldsmith D, Poustie S, et al: Acid–base status of critically ill patients with acute renal failure: analysis based on Stewart-Figge methodology. Crit Care. 2003, 7: R60-10.1186/cc2333.CrossRefPubMedPubMedCentral
17.
Masevicius FD, Tuhay G, Pein MC, Ventrice E, Dubin A: Alterations in urinary strong ion difference in critically ill patients with metabolic acidosis: a prospective observational study. Crit Care Resusc. 2010, 12: 248-254.PubMed
18.
Moviat M, Terpstra AM, van der Hoeven JG, Pickkers P: Impaired renal function is associated with greater urinary strong ion differences in critically ill patients with metabolic acidosis. J Crit Care. 2011, 27: 160-255.
19.
Moreno RP, Metnitz PG, Almeida E, Jordan B, Bauer P, et al: SAPS 3–From evaluation of the patient to evaluation of the intensive care unit. Part 2: Development of a prognostic model for hospital mortality at ICU admission. Intensive Care Med. 2005, 31: 1345-1355. 10.1007/s00134-005-2763-5.CrossRefPubMedPubMedCentral
20.
Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, et al: The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996, 22: 707-710. 10.1007/BF01709751.CrossRefPubMed
21.
Stewart PA: Modern quantitative acid–base chemistry. Can J Physiol Pharmacol. 1983, 61: 1444-1461. 10.1139/y83-207.CrossRefPubMed
22.
Figge J, Rossing TH, Fencl V: The role of serum proteins in acid–base equilibria. J Lab Clin Med. 1991, 117: 453-467.PubMed
23.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, et al: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007, 11: R31-10.1186/cc5713.CrossRefPubMedPubMedCentral
24.
Macedo E, Bouchard J, Soroko SH, Chertow GM, Himmelfarb J, et al: Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients. Crit Care. 2010, 14: R82-10.1186/cc9004.CrossRefPubMedPubMedCentral
25.
26.
27.
Diskin CJ, Stokes TJ, Dansby LM, Radcliff L, Carter TB: Toward the optimal clinical use of the fraction excretion of solutes in oliguric azotemia. Ren Fail. 2010, 32: 1245-1254. 10.3109/0886022X.2010.517353.CrossRefPubMed
28.
Fang LS, Sirota RA, Ebert TH, Lichtenstein NS: Low fractional excretion of sodium with contrast media-induced acute renal failure. Arch Intern Med. 1980, 140: 531-533. 10.1001/archinte.1980.00330160091033.CrossRefPubMed
29.
Arroyo V, Fernandez J, Gines P: Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis. 2008, 28: 81-95. 10.1055/s-2008-1040323.CrossRefPubMed
30.
Vaz AJ: Low fractional excretion of urine sodium in acute renal failure due to sepsis. Arch Intern Med. 1983, 143: 738-739. 10.1001/archinte.1983.00350040128017.CrossRefPubMed
31.
Corwin HL, Schreiber MJ, Fang LS: Low fractional excretion of sodium. Occurrence with hemoglobinuric- and myoglobinuric-induced acute renal failure. Arch Intern Med. 1984, 144: 981-982. 10.1001/archinte.1984.00350170131022.CrossRefPubMed
32.
Maciel AT: Breaking old and new paradigms regarding urinary sodium in acute kidney injury diagnosis and management. Crit Care. 2013, 17: 115-10.1186/cc11926.CrossRefPubMedPubMedCentral
33.
Nejat M, Pickering JW, Devarajan P, Bonventre JV, Edelstein CL, et al: Some biomarkers of acute kidney injury are increased in pre-renal acute injury. Kidney Int. 2012, 81: 1254-1262. 10.1038/ki.2012.23.CrossRefPubMedPubMedCentral
34.
Doi K, Katagiri D, Negishi K, Hasegawa S, Hamasaki Y, et al: Mild elevation of urinary biomarkers in prerenal acute kidney injury. Kidney Int. 2012, 82: 1114-1120. 10.1038/ki.2012.266.CrossRefPubMed
35.
Bagshaw SM, Haase M, Haase-Fielitz A, Bennett M, Devarajan P, et al: A prospective evaluation of urine microscopy in septic and non-septic acute kidney injury. Nephrol Dial Transplant. 2012, 27: 582-588. 10.1093/ndt/gfr331.CrossRefPubMed
36.
Schinstock CA, Semret MH, Wagner SJ, Borland TM, Bryant SC, et al: Urinalysis is more specific and urinary neutrophil gelatinase-associated lipocalin is more sensitive for early detection of acute kidney injury. Nephrol Dial Transplant. 2013, 28: 1175-1185. 10.1093/ndt/gfs127.CrossRefPubMed
37.
Wen X, Murugan R, Peng Z, Kellum JA: Pathophysiology of acute kidney injury: a new perspective. Contrib Nephrol. 2010, 165: 39-45.CrossRefPubMed
Metadata
Title
Physicochemical analysis of blood and urine in the course of acute kidney injury in critically ill patients: a prospective, observational study
Authors
Alexandre Toledo Maciel
Marcelo Park
Etienne Macedo
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2013
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/1471-2253-13-31

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