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Kidney Function Tests and Urinalysis

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Management of Acute Kidney Problems

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Abstract

The most common surrogates of kidney function are serum creatinine, urea, cystatin C; however, these all have limitations, most important of which is that they do not accurately reflecting real-time dynamic changes in glomerular filtration rate (GFR) that occur in acute kidney injury (AKI) The Cockcroft-Gault and Modification of Diet in Renal Disease (MDRD) Study Group equations are the most common methods used to estimate GFR; however, they have limited relevance to critically ill patients with AKI. Urine output can be a sensitive indicator for changes in renal hemodynamics, but it also has limited sensitivity and specificity Several tests of urinary biochemistry, derived indices and microscopy (i.e., FENa, UNa, FEU) have traditionally been used as aids for the detection and classification of AKI; however, their value in sick patients (i.e., after fluid resuscitation, diuretics, vasopressor infusions, radiocontrast media, and nephrotoxic drugs) remains uncertain Novel urinary biomarkers (i.e., NHE3, NGAL, KIM-1, IL-18) have recently been characterized that may provide added diagnostic value and prognostic information for critically ill patients in AKI.

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  1. Division of Critical Care Medicine, University of Alberta Hospital, University of Alberta, 3C1.12 Walter C. Mackenzie Centre, 8440–112 Street, Edmonton, Alberta, T6G 2B7, Canada

    Sean M. Bagshaw

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  1. Charité Campus Virchow, Universitätsklinikum Berlin, Augustenburger Platz 1, Berlin, 13353, Germany

    Achim Jörres

  2. Dipto. Nefrologia, Ospedale San Bortolo, Viale Rodolfi 16, Vicenza, 36100, Italy

    Claudio Ronco

  3. School of Medicine, University of Pittsburgh, Terrace Street 3550, Pittsburgh, 15261, U.S.A.

    John A. Kellum

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Bagshaw, S.M. (2010). Kidney Function Tests and Urinalysis. In: Jörres, A., Ronco, C., Kellum, J. (eds) Management of Acute Kidney Problems. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-540-69441-0_10

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