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Submitted: 09 Aug 2019
Accepted: 30 Nov 2019
ePublished: 18 Dec 2019
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J Renal Inj Prev. 2020;9(1): e03.
doi: 10.15171/jrip.2020.03
  Abstract View: 252
  PDF Download: 128

Original

The discrimination of acute tubular necrosis and prerenal azotemia using two biomarkers simultaneously

Abbas Ali Zeraati 1 ORCID logo, Farnaz Sahihi 1, Zahra Lotfi 2 * ORCID logo, Freshteh Mamdouhi 1, Farzaneh Sharifipour 1, Tina Zeraati 1,2

1 Kidney Transplantation Complications Research Center, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
2 Research Committee, Mashhad University of Medical Science, Mashhad, Iran
*Corresponding author: Zahra Lotfi, Email: lotfiz@mums.ac.ir, Lotfi.farideh@gmail.com

Abstract

Introduction: The fractional excretion of sodium (FE Na) in urine has appeared as a helpful way to distinguish prerenal azotemia from acute tubular necrosis (ATN).

Objectives: The urinary index of sodium has some limits. Lithium can be an additional careful indicator. The goal of our study was to assess the standards fractional excretion of sodium and lithium, (FE Na and FE Li) in distinguishing pre-renal azotemia (PRA) from ATN.

Patients and Methods: Twenty-seven patients with prerenal azotemia, 25 patients with ATN and 20 healthy persons were included in this investigation. The plasma and urine sodium, creatinine and lithium levels were assessed. Additionally, FE Na and FE Li were calculated. To assess the diagnostic usefulness of FE Na and FE Li in discriminating prerenal azotemia from ATN, we created a receiver operating characteristic (ROC) curve.

Results: The area under the curves (AUCs) of fractional excretion of Li and Na were 0.84 and 0.83 for distinguishing prerenal azotemia from ATN, respectively. There was a significant direct association between FE Na and FE Li in patients with ATN (P=0.001). No significant association of FE Na and FE Li in patients with prerenal azotemia was detected (p=0.26). By a cutoff point of 2.96%, the sensitivity and specificity for FE Na, were 68% and 75%, respectively for distinguishing PRA from ATN. By a cutoff point of 4.17%, the sensitivity and specificity of FE Li were 80% and 79%, respectively, for distinguishing prerenal azotemia from ATN.

Conclusion: This investigation appeared a high AUC and accuracy of fractional excretion of sodium and lithium as a diagnostic method for distinguishing prerenal azotemia from ATN when used simultaneously. However, the discrimination of sensitivity and specificity of fractional excretion of lithium was greater than the fractional excretion of Na.

Keywords: Prerenal azotemia, Acute tubular necrosis, Lithium, Chronic kidney disease

Implication for health policy/practice/research/medical education:

In a study on 27 patients with prerenal azotemia, 25 patients with acute tubular necrosis and 20 healthy persons, we found accuracy of fractional excretion of sodium and lithium as a diagnostic method for distinguishing prerenal azotemia from acute tubular necrosis when used simultaneously. However, the discrimination of sensitivity and specificity of fractional excretion of lithium was greater than the fractional excretion of Na.

Please cite this paper as: Zeraati AA, Sahihi F, Lotfi Z, Sharifipour F, Zeraati T. The discrimination of acute tubular necrosis and prerenal azotemia using two biomarkers simultaneously. J Renal Inj Prev. 2020; 9(1): e03. DOI: 10.15171/jrip.2020.03. 

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