Liaño F, Gámez C, Pascual J, Teruel J L, Villafruela J J, Orte L, Ortuño J
Servicio de Nefrología, Hospital Ramón y Cajal, Madrid, Spain.
Nephron. 1994;66(2):170-5. doi: 10.1159/000187797.
Limited attention has been paid to the composition of the small amounts of urine that are frequently produced by patients with acute renal failure (ARF) of vascular origin. We have investigated the value of basic urinary parameters in the early diagnosis of total or partial acute renal artery occlusion (ARAO). We have reviewed the records of 30 patients with ARF: group 1 (n = 10) had total ARAO; group 2 (n = 10) had unilateral ARAO with a contralateral functioning kidney, and group 3 (n = 10) had hemodynamically mediated ARF subsequent to a major vascular abdominal surgical procedure, without arterial thrombosis. Serum sodium, potassium, urea, creatinine and osmolality, as well as urinary sodium, potassium, urea, creatinine and osmolality, were determined by standard techniques, and the fractional excretion of sodium (FENa) was calculated. Serum parameters were similar in all groups. Urinary sodium and FENa were higher in group 1 than in the other groups (p < 0.01), while urinary potassium was lower (p < 0.05). Urinary urea (p < 0.01) and osmolality (p < 0.05) were higher in group 2 than in the other groups, revealing a prerenal pattern in some cases. Serum and urinary concentrations of sodium, urea and creatinine and osmolality were similar in group 1, while respective serum and urinary concentrations and osmolality were different from each other in the other groups. Analysis of urine provides a useful diagnostic tool in ARF of vascular origin. When urinary concentrations of sodium, urea and creatinine are similar to those in serum and FENa approaches 100%, the strong likelihood of total ARAO should be acknowledged, and renal arteriography is mandatory.
血管源性急性肾衰竭（ARF）患者经常产生少量尿液，人们对这些少量尿液的成分关注有限。我们研究了基本尿液参数在完全或部分急性肾动脉闭塞（ARAO）早期诊断中的价值。我们回顾了30例ARF患者的记录：第1组（n = 10）为完全性ARAO；第2组（n = 10）为单侧ARAO且对侧肾脏功能正常，第3组（n = 10）为腹部大血管手术后出现血流动力学介导的ARF，无动脉血栓形成。采用标准技术测定血清钠、钾、尿素、肌酐和渗透压，以及尿钠、钾尿素、肌酐和渗透压，并计算钠排泄分数（FENa）。所有组的血清参数相似。第1组的尿钠和FENa高于其他组（p < 0.01），而尿钾较低（p < 0.05）。第2组的尿尿素（p < 0.01）和渗透压（p < 0.05）高于其他组，在某些情况下显示为肾前性模式。第1组的血清和尿液中钠、尿素和肌酐的浓度及渗透压相似，而其他组各自的血清和尿液浓度及渗透压互不相同。尿液分析为血管源性ARF提供了一种有用的诊断工具。当尿钠、尿素和肌酐浓度与血清相似且FENa接近100%时，应认识到完全性ARAO的可能性很大，必须进行肾动脉造影。
