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Kidney

Question
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Which differentiating prerenal azotemia with ATN features favouring pre-renal azotemia (select two options): (PGI Nov 11)



A Urine osmolality> 500 mosmol/kg

B Urinary Sodium <10 mmol/l

C Fractional excretion of sodium> 1%

D Plasma BUN/creatinine ratio < 20

Ans. A Urine osmolality> 500 mosmol/kg, B. Sodium <10 mmol/l

Table - Laboratory Findings in Acute Renal Failure (Ref. H-18th Edi, P- 337, Table 44-2)

Index

Prerenal Azotemia

Acute Renal Failure

BUN/PCr Ratio

>20:1

10–15:1

Urine sodium (UNa), meq/L

<20

>40

Urine osmolality, mosmol/L

>500

<350

Fractional excretion of sodium

<1%

>2%

Urine/plasma creatinine (UCr/PCr)

>40

<20

Renal failure index

< 1

>1

Extra Edge:

Extra Edge:

AKI from ATN due to ischemic injury, sepsis, or certain nephrotoxins has characteristic urine sediment findings: pigmented "muddy brown" granular casts and tubular epithelial cell casts.

Recent Advances : In pre renal failure, FENa is < 1% but the FENa may be >1.0% in some cases of prerenal ARF under following situations.

i. If patients are receiving diuretics ii. With preexisting chronic kidney disease

iii. Salt-wasting syndromes iv. Adrenal insufficiency

Phases of ARF a. Oliguria b. Polyuria

Kidney Flashcard List

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