Fractional Excretion of Sodium and Urea in Differentiating Acute Kidney Injury Phenotypes in Decompensated Cirrhosis

Gowda, Yashavanth H.S.; Jagtap, Nitin; Karyampudi, Arun; Rao, Nagaraja P.; Deepika, G.; Sharma, Mithun; Gupta, Rajesh; Tandan, Manu; Ramchandani, Mohan; John, Priyadarshini; Kulkarni, Anand V.; Kumar, Pramod; Bhaware, Bhushan; Turpati, Mohan V.; Reddy, Nageshwar

doi:10.1016/j.jceh.2021.09.019

Cited by 14 publications

(17 citation statements)

References 21 publications

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“…In addition, we obtained the necessary data to apply the 1% threshold in one study (22). All of the studies used the clinical responsiveness to fluids as a reference standard, and two of them included patients with HRS and AKI (19,24,25). Additionally, four studies (6,7,21,26) used histopathologic examination other than response to fluid expansion, whereas nine studies (4,9,20,22 –24,27 –30) supported their findings using microscopic urine analysis.…”

Section: Resultsmentioning

confidence: 99%

“…All studies included hospitalized patients or patients in the intensive care unit, except for one study that did not report patients' settings (6) and one study that enrolled patients in the emergency room (18). All but five studies (18,(21)(22)(23)(24) used the 1% threshold. In addition, we obtained the necessary data to apply the 1% threshold in one study (22).…”

Section: Study Selection and General Informationmentioning

confidence: 99%

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Diagnostic Performance of Fractional Excretion of Sodium for the Differential Diagnosis of Acute Kidney Injury

Abdelhafez

Nayfeh

Atieh

et al. 2022

CJASN

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Background and objectivesAKI is classified as prerenal, intrinsic, and postrenal. Prerenal AKI and intrinsic AKI represent the most common causes for AKI in hospitalized patients. This study aimed to examine the accuracy of the fractional excretion of sodium for distinguishing intrinsic from prerenal AKI.Design, setting, participants, & measurementsWe searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, the Cochrane Library, and Scopus for all available studies that met the criteria until December 31, 2021. We included studies that evaluated fractional excretion of sodium in differentiating AKI etiologies in adults, whereas studies that did not have sufficient data to extract a 2×2 table were excluded. We assessed the methodologic quality using the Quality Assessment of Diagnostic Accuracy Studies-2 tool and extracted the diagnostic accuracy data for all included studies. We conducted a meta-analysis using the bivariate random effects model. We performed subgroup analysis to investigate sources of heterogeneity and the effect of the relevant confounders on fractional excretion of sodium accuracy.ResultsWe included 19 studies with 1287 patients. In a subset of 15 studies (872 patients) that used a threshold of 1%, the pooled sensitivity and specificity for differentiating intrinsic from prerenal AKI were 90% (95% confidence interval, 81% to 95%) and 82% (95% confidence interval, 70% to 90%), respectively. In a subgroup of six studies (511 patients) that included CKD or patients on diuretics, the pooled sensitivity and specificity were 83% (95% confidence interval, 64% to 93%) and 66% (95% confidence interval, 51% to 78%), respectively. In five studies with 238 patients on diuretics, the pooled sensitivity and specificity were 80% (95% confidence interval, 69% to 87%) and 54% (95% confidence interval, 31% to 75%), respectively. In eight studies with 264 oliguric patients with no history of CKD or diuretic therapy, the pooled sensitivity and specificity were 95% (95% confidence interval, 82% to 99%) and 91% (95% confidence interval, 83% to 95%), respectively.ConclusionsFractional excretion of sodium has a limited role for AKI differentiation in patients with a history of CKD or those on diuretic therapy. It is most valuable when oliguria is present.

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Section: Resultsmentioning

confidence: 99%

Section: Study Selection and General Informationmentioning

confidence: 99%

Diagnostic Performance of Fractional Excretion of Sodium for the Differential Diagnosis of Acute Kidney Injury

Abdelhafez

Nayfeh

Atieh

et al. 2022

CJASN

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“…32 Recent studies also advocate the usage of FE urea as a simple tool for differential diagnosis of AKI in CLD. 33,34 However, the accuracy of low FE urea (<35%) to identify PRA is questionable. 35 Decreased serum protein concentration due to impaired liver synthetic function and/or poor nutritional status can undermine proteinuria in glomerular disorders in CLD and levels <0.5 g/day may indicate significant glomerular damage.…”

Section: F I G U R Ementioning

confidence: 99%

“…Few studies had reported that FENa was not independently associated with AKI progression and mortality 32 . Recent studies also advocate the usage of FE urea as a simple tool for differential diagnosis of AKI in CLD 33,34 . However, the accuracy of low FE urea (<35%) to identify PRA is questionable 35 .…”

Section: Introductionmentioning

confidence: 99%

Novel biomarkers of acute kidney injury in chronic liver disease: Where do we stand after a decade of research?

Yewale

Ramakrishna

2022

Hepatology Research

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Acute kidney injury (AKI) is a frequently encountered complication in decompensated chronic liver disease (CLD) with an estimated prevalence of 20%-50% among hospitalized patients. AKI often heralds the onset of a downhill course in the natural history of CLD. Serum creatinine has several limitations as a stand-alone marker of AKI in patients with decompensated CLD. The concept of hepatorenal syndrome, the prototype of AKI in decompensated CLD, has evolved tremendously over recent years. There is emerging evidence of an additional "structural" component in the pathophysiology of hepatorenal syndrome-AKI, which was previously identified as a purely "functional" form of renal impairment. Lacunae in the existent biochemical arsenal for diagnosis and prognosis of AKI have fueled enthusiastic research in the field of novel biomarkers of kidney injury in patients with cirrhosis. The advent of these biomarkers provides a crucial window of opportunity to improve the diagnosis and clinical outcomes of this vulnerable cohort of patients. This review summarizes the dynamic concept of renal dysfunction in CLD and the available literature on the role of novel biomarkers of AKI in assessing renal function, identifying AKI subtypes, and predicting prognosis. There is special emphasis on the renal tubular injury marker, neutrophil gelatinase-associated lipocalin, the most exhaustively studied biomarker of AKI in the CLD population.

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“…FENa correlates with survival among patients with cirrhosis and renal dysfunction [11] . FENa is a clinical tool that can differentiate structural AKI from prerenal AKI and HRS-AKI [12] . Therefore, this work aimed to investigate the spot Na/Kur ratio and FENa in patients admitted for decompensated cirrhosis, evaluating its relationship with AKI and short-term survival in southern India.…”

Section: Introductionmentioning

confidence: 99%

Spot Urine Sodium and Potassium Ratio as a Predictor of Acute Kidney Injury and Survival in Decompensated Cirrhosis

Bhuyan

Karunakaran

Muthukumaran

et al. 2022

ijirms

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Background: Acute kidney injury (AKI) is associated with high mortality in decompensated cirrhosis, so early prediction is vital. Urinary sodium excretion may have an association with mortality in decompensated cirrhosis. The study aims to investigate the spot urinary Na+/K+ ratio & fractional excretion of sodium in patients admitted with decompensated cirrhosis and evaluate its relationship with AKI and short-term survival. Method: It was a prospective analysis of 200 patients with decompensated cirrhosis over 6 months. Urinary sodium excretion was analyzed by spot urine Na+/K+ ratio & FENa. Receiver operator curve (ROC) analysis was done to find cut-off values of Na+/K+ in predicting AKI at admission, during the hospital stay, and survival probability. P-value <0.05 was considered significant. Result: AKI of admission was observed in 36.5% of patients and associated with low urine Na+/K+ and low urine Na+. 24.5% of patients who had no AKI at admission progressed to AKI during the hospital stay and were associated with low spot urine Na+/K+ and low FENa+. Area under curve (AUC) for urinary Na+/K+ (cutoff, sensitivity/specificity) at admission was 68.6% (≤1.36, 75.5/59.1), during hospital stay was 73.4% (≤ 1.64,77.6/67.5) and of short-term mortality was 73.4% (≤ 1.34, 93.3% /58.8). Conclusion: Spot urine Na+/K+ ratio at admission is a simple, predictable tool to predict AKI during the hospital stay and 30 days mortality in decompensated cirrhosis.

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Fractional Excretion of Sodium and Urea in Differentiating Acute Kidney Injury Phenotypes in Decompensated Cirrhosis

Cited by 14 publications

References 21 publications

Diagnostic Performance of Fractional Excretion of Sodium for the Differential Diagnosis of Acute Kidney Injury

Diagnostic Performance of Fractional Excretion of Sodium for the Differential Diagnosis of Acute Kidney Injury

Novel biomarkers of acute kidney injury in chronic liver disease: Where do we stand after a decade of research?

Spot Urine Sodium and Potassium Ratio as a Predictor of Acute Kidney Injury and Survival in Decompensated Cirrhosis

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