급성신부전의 감별진단에 있어서 요산 및 요소 분획 배설율의 임상적 유용성 = (The) Usefullness of Fractional Excretion of Uric Acid and Urea Nitrogen in the Differential Diagnosis of Acute Renal Failure|RISS 상세보기

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Background: Acute renal failure is a common problem in clinical practice. An early recognition of prerenal azotemia allows to correct reversible factors and good prognosis can be anticipated. Fractional excretion of sodium(FENa) has been known to discriminate between prerenal azotemia(PR) and acute tubular necrosis(ATN). But the usefullness of FENa is limited in some conditions such as nephrotic syndrome, liver cirrhosis, burn, sepsis, and severe metabolic alkalosis. FENa is also significantly influenced by diuretics and saline infusion. Fractional excretion of uric acid(FEUa) and fractional excretion of urea nitrogen(FEUn) have been known to be more sensitive and specific index in patients received diuretics. Thus, we evaluated the efficacy of FEUa and FEUn in differentiating between prerenal azotemia and acute tubular necrosis.
Methods: Fifty five patients with acute renal failure who visited Chungbuk National University Hospital between January 1999 and April 2006 were enrolled. The urine and serum samples were serially collected initially, 24 hours and 48 hours later. It was reviewed whether they were managed with diuretics or saline replacement prior to visit. Acute renal failure was defined as serum creatinine above 1.5 mg/dl. The diagnosis of PR was established according to following criteria, 1) development of renal failure in the setting of extracellular volume depletion. and 2) normalization of serum creatinine within 5 days with correction of hemodynamic abnormality. ATN was defined as serum creatinine above 1.5 mg/dl persisted after correction of hemodynamic cause. Patch renal vasoconstriction was classified into ATN regardless of criteria. Subjects with glomerulonephritis or postrenal acute renal failure was excluded.
Results: FENa(PR group: 1.9±2, ATN group: 6.1±6.1, P=0.001) were lower in PR than in ATN patients. FEUa(PR group: 15.7±12.5, ATN group: 24.2±13.4, P=0.019) and FEUn(PR group: 29.9±22.5, ATN group: 43.9±19.5, P=0.016) were lower in PR than in ATN patients as well. Renal failure index(PR group: 2.6±2.7, ATN group: 8.1±8.2, P=0.001) and urinary to plasma creatinine ratio(PR group: 28.8±26.4, ATN group: 13.7±12.3, P=0.013) were significantly different between two groups. When FENa was less than 1%, sensitivity and specificity for the detection of PR patients was 48% and 97%. A FEUa less than 15% and a FEUn less than 35% had the best sensitivity and specificity for PR patients(FEUa: 65% and 71%, FEUn: 68% and 73%, respectively). When these three indices were combined, sensitivity and specificity were as follows. 1) If one of them is met, sensitivity and specificity is 84% and 53%. 2) If two of them are met, sensitivity and specificity is 52% and 86%. 3) If all of them are met, sensitivity and specificity is 33% and 96%. The prerenal azotemia group with FENa less than 1% showed significant change in FEUa(from 8.3±5 to 16.7±4.8, P=0.001) and FEUn(from 17.4±15 to 38.1±18, P=0.002) after restoration of volume depletion.
Conclusion: FEUa and FEUn were significantly lower in PR than in ATN patients. If two of three indices are met, sensitivity for PR increased from 48% to 52%. FEUa and FEUn were significantly influenced by saline infusion, so it is necessary to ascertain that saline infusion had been initiated previously.

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목차 (Table of Contents)

서론 1
연구 대상 및 방법 2
결과 5
고찰 17
결론 21

서론 1
연구 대상 및 방법 2
결과 5
고찰 17
결론 21
참고문헌 22

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급성신부전의 감별진단에 있어서 요산 및 요소 분획 배설율의 임상적 유용성 = (The) Usefullness of Fractional Excretion of Uric Acid and Urea Nitrogen in the Differential Diagnosis of Acute Renal Failure

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