University of Colorado Denver, Division of Renal Diseases & Hypertension, Box C281, 12700 East 19th Avenue, Research 2, Aurora, CO 80045, USA.
J Am Soc Nephrol. 2011 Sep;22(9):1610-3. doi: 10.1681/ASN.2010121289. Epub 2011 Aug 18.
Up to 30% of hospitalized critically ill patients may have a rise in serum creatinine concentration. In addition to history and physical examination, there is diagnostic value in assessing urinary electrolytes, solute excretion, and urine flow in these patients. The correct interpretation of these urinary parameters can avoid unnecessary volume overload and mechanical ventilation, risk factors for increased mortality in patients with rising serum creatinine. The present article also discusses the role of arterial underfilling in causing prerenal azotemia in the presence of an increase in total body sodium and extracellular fluid expansion. As with extracellular fluid volume depletion, arterial underfilling secondary to impaired cardiac function or primary arterial vasodilation can delay or prevent recovery from ischemic or toxic acute tubular necrosis. The present brief review discusses the various aspects of the correct interpretation of urinary electrolytes, solute excretion, and urine flow in the setting of a rising serum creatinine concentration.
高达 30%的住院重症患者可能会出现血清肌酐浓度升高。除了病史和体格检查外，评估这些患者的尿电解质、溶质排泄和尿流也具有诊断价值。正确解读这些尿参数可以避免不必要的容量超负荷和机械通气，这是导致血清肌酐升高患者死亡率增加的危险因素。本文还讨论了在总钠和细胞外液扩张增加的情况下，动脉充盈不足引起肾前性氮质血症的作用。与细胞外液容量不足一样，继发于心功能障碍或原发性动脉血管扩张的动脉充盈不足可延迟或阻止从缺血或毒性急性肾小管坏死中恢复。本文简要回顾了在血清肌酐浓度升高的情况下正确解读尿电解质、溶质排泄和尿流的各个方面。
