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NDT Advance Access published online on September 23, 2006
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfl541
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© The Author [2006]. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org
Received May 17, 2006
Accepted August 10, 2006

Original Article

Urinary biochemistry in experimental septic acute renal failure

Christoph Langenberg 1, Li Wan 1, Sean M. Bagshaw 2, Moritoki Egi 2, Clive N. May 3, and Rinaldo Bellomo 2 *

1 Department of Intensive Care and Department of Medicine, Austin Hospital and University of Melbourne, Heidelberg, Melbourne, Australia; Howard Florey Institute, University of Melbourne, Parkville, Melbourne, Australia
2 Department of Intensive Care and Department of Medicine, Austin Hospital and University of Melbourne, Heidelberg, Melbourne, Australia
3 Howard Florey Institute, University of Melbourne, Parkville, Melbourne, Australia

* To whom correspondence should be addressed.
Rinaldo Bellomo, E-mail: rinaldo.bellomo{at}austin.org.au



  Abstract

Background. Several biochemical urine tests and derived indices are reported as useful in the diagnosis of acute renal failure (ARF) and its classification in prerenal (hypoperfusion) or intrarenal (acute tubular) necrosis. However, they have not been adequately studied in sepsis, the most frequent cause of ARF in ICU.

Methods. In 10 female Merino ewes, we implanted flow probes around the pulmonary and renal arteries to measure cardiac output and renal blood flow (RBF) continuously. Cardiovascular variables were monitored and urine samples collected during a 48 h control period and one week later during a 48 h period of hyperdynamic sepsis induced by an infusion of live Escherichia coli.

Results. Infusion of live E. coli induced systemic hyperdynamic sepsis with renal vasodilatation and increased RBF. Serum creatinine increased from 73.3 ± 15.1 to 276.9 ± 156.3 µmol/l (P < 0.05) and creatinine clearance decreased from 84.6 ± 21.4 to 27.5 ± 21.4 ml/min (P < 0.05). Urine sodium concentration (UNa) decreased significantly from 164.5 ± 50.4 to 14.6 ± 14.3 mmol/l, fractional excretion of sodium (FeNa) from 1.5 ± 0.17 to 0.12 ± 0.11%, fractional excretion of urea nitrogen (FeUn) from 62.7 ± 9.5 to 11.5 ± 15.4%, and urine osmolality from 724.8 ± 277.1 mosmol/l to 329.0 ± 52.1 mosmol/l. The u/p creatinine ratio did not change.

Conclusion. Sustained Gram-negative sepsis induced a hyperdynamic state and hyperaemic ARF. Despite increased renal perfusion, UNa, FeNa and FeUn decreased significantly. Our findings suggest that, in sepsis, these urinary biochemical changes are not reliable markers of renal hypoperfusion.

Keywords: acute renal failure; fractional excretion of sodium; fractional excretion of urea nitrogen; renal blood flow; sepsis; urinary marker.
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S. M. Bagshaw, S. Uchino, R. Bellomo, H. Morimatsu, S. Morgera, M. Schetz, I. Tan, C. Bouman, E. Macedo, N. Gibney, et al.
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