Impaired renal function is associated with greater urinary strong ion differences in critically ill patients with metabolic acidosis

Moviat, Miriam; Terpstra, Anniek M.; Hoeven, Johannes G. van der; Pickkers, Peter

doi:10.1016/j.jcrc.2011.05.028

Cited by 28 publications

(19 citation statements)

References 14 publications

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“…(14) In AKI patients with metabolic acidosis, there is an elevated urine SID (strong ion difference in the urine). (15) A study published in this edition of the RBTI (16) confirms this finding. It is an interesting possibility that daily monitoring of simple parameters, such as phosphorus levels, non-measurable anions and urine potassium, along with decreased urine sodium and chlorine and urine SID can facilitate the early diagnosis of AKI, even before the decrease in urinary output and creatinine.…”

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confidence: 69%

As novas fronteiras da lesão renal aguda

Batista¹,

Passos²

2012

Rev. bras. ter. intensiva

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Acute kidney injury (AKI) is a poorly understood syndrome. AKI has definitions and concepts that are changeable, and it can not rely on the possibility of histological examination for diagnosis, either because of the difficulty in performing a kidney biopsy in critical patients or for its focal nature and its preference for the external layer of the medulla that comprises most of the juxtamedullary glomeruli, which are not frequently obtained. (1) The pathophysiology of AKI has many aspects and depends on many mechanisms involving the endothelium, glycocalyx, cytoskeleton, integrins, lymphokines and chemokines among others. In the most studied experimental animal models of ischemia and reperfusion (1) and even in recent studies of human kidneys from organ donors whose glycocalyces were analyzed in vivo, AKI has inflammatory components and involves neutrophils and macrophages/monocytes. (2) Experimental studies have helped to clarify many aspects of AKI, but it is only possible to evaluate one etiological agent and a small number of mechanisms and outcomes in each study. This limitation is the exact opposite of what happens to patients in which multiple known factors (ischemic or toxic) act in synchrony or chaotically and in which multiple interactions between organs take place. (3) It is possible that the phases of AKI, which are described as prerenal, initiation, extension, maintenance and recovery, do not occur homogeneously in all nephrons. Over times, this syndrome has had multiple definitions (over 30 according to certain reviews) based on serum creatinine levels. (4) Recently, new AKI classification methods (5,6) have been proposed that also use the serum creatinine levels and diuresis but in a manner that is dynamic and standardized. Several drugs have been tested with the objective of preventing and treating AKI, but the promising results obtained in animal studies were not achieved in studies with humans. Is shall be asked if it is possible that the problem with those studies was the diagnosis and severity of disease instead of the treatment tested? It has only recently become understood that that very small increases in serum creatinine (0.3 mg/dL) have an impact on mortality (7) , that the cost associated with these increases is high (8) and that AKI patients can progress to stage 5 chronic kidney disease and become dialysis-dependent (9). However, the implications of the elevated costs implied in treating severe patients by dialysis have been known for a long time and are thoroughly characterized and quantified, suggesting that the quality of life of the survivors is reasonably acceptable, despite the high mortality and cost. (10)

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confidence: 69%

As novas fronteiras da lesão renal aguda

Batista¹,

Passos²

2012

Rev. bras. ter. intensiva

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“…We did not separate the patients with and without pure metabolic acidosis, which could also explain, at least in part, the differences between our results and theirs. Moviat et al (9) also proposed that impaired renal function is associated with a higher SIDu in patients with metabolic acidosis. Their findings were limited by a single measurement of a simplified SIDu (NaU -ClU) per patient and a simple definition of impaired renal function, as they used an isolated creatinine measurement.…”

Section: Icu Admissionsmentioning

confidence: 99%

“…(9,11) Masevicius et al (11) reported that most of the critically ill patients with metabolic acidosis showed inappropriate renal compensation because a minority of them presented a negative SIDu. However, we believe that decreases in SIDu below the level of plasma SID (i.e., still positive values of SIDu), as occurred in most of the survivors in our study ( Figure 5), is an appropriate renal response because the majority of survivors did not meet the AKIN creatinine criteria for AKI.…”

Section: Icu Admissionsmentioning

confidence: 99%

“…(8) However, its use has been generally restricted to plasma SID, and few studies have focused on SIDu and the relevant information it may provide. (9)(10)(11) Urinary electrolyte measurements are usually utilized in the intensive care unit (ICU) for the differential diagnosis of natremia disorders, the diagnosis of prerenal versus acute tubular necrosis, and determining the etiology of hyperchloremic metabolic acidosis. However, these urinary markers still need to be adequately studied and validated in the critical care setting.…”

Section: Introductionmentioning

confidence: 99%

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Monitorização de eletrólitos urinários em pacientes críticos: estudo preliminar observacional

Maciel¹,

Park²,

Macedo³

2012

Rev. bras. ter. intensiva

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Objective: Intensive care unit survivors and non-survivors have distinct acid-base profiles. The kidney's regulation of urinary electrolytes and the urinary strong ion difference plays a major role in acid-base homeostasis. The aim of this study was to evaluate the potential utility of daily spot urinary electrolyte measurement in acid-base and renal function monitoring. Methods:We prospectively recorded daily plasma acid-base parameters and traditional markers of renal function in parallel with spot urinary electrolyte measurements in patients with urinary catheters admitted to our intensive care unit. Patients who remained in the intensive care unit for at least 4 days with a urinary catheter were included in the study.Results: Of the 50 patients included in the study, 22% died during their intensive care unit stay. The incidence of acute kidney injury was significantly higher in nonsurvivors during the 4-day observation period (64% vs. 18% in survivors).Urinary chloride and sodium were lower and urinary strong ion difference was higher on day 1 in patients who developed acute kidney injury among both survivors and non-survivors. Both groups had similar urine output, although non-survivors had persistently higher urinary strong ion difference on all days. Survivors had a progressive improvement in metabolic acid-base profile due to increases in the plasma strong ion difference and decreases in weak acids. These changes were concomitant with decreases in urinary strong ion difference. In nonsurvivors, acid-base parameters did not significantly change during follow-up.Conclusions: Daily assessment of spot urinary electrolytes and strong ion difference are useful components of acid-base and renal function evaluations in critically ill patients, having distinct profiles between intensive care unit survivors and non-survivors.

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“…Impaired renal function is associated with greater urinary strong ion difference (SIDu) in patients with metabolic acidosis [1]. In critically ill patients, several factors, such as infused fluids and acid endogenous production, would lead to changes in plasma SID and acid-base homeostasis without renal regulation of urinary electrolytes and SIDu [2].…”

Section: Introductionmentioning

confidence: 99%

Urinary strong ion difference and acute kidney injury: an early marker of renal dysfunction?

et al. 2015

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Impaired renal function is associated with greater urinary strong ion differences in critically ill patients with metabolic acidosis

Abstract: In critically ill patients with metabolic acidosis, impaired renal function was associated with greater urinary SIDs. Subsequently, the higher urinary SIDs values were related to lower pH levels, illustrating the importance of renal chloride excretion to correct for acidosis.

Cited by 28 publications

References 14 publications

As novas fronteiras da lesão renal aguda

As novas fronteiras da lesão renal aguda

Monitorização de eletrólitos urinários em pacientes críticos: estudo preliminar observacional

Urinary strong ion difference and acute kidney injury: an early marker of renal dysfunction?

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