A Valuable and Intuitive Diagnostic tool for Acute Kidney Injury in Liver Cirrhosis is the Fractional Excretion of Urea and Sodium

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Enas Ahmed Reda ALKareemy, Marwa M. Thabet, Ali Hamdy, Nermeen Mahmoud Mobarez, Essam M. Abdel Aziz

Abstract

Background: Prerenal and renal acute kidney injury (AKI) phenotypes could develop among patients with decompensated cirrhosis. Their prognosis and outcomes for therapy vary significantly. Each AKI type has a unique treatment approach; thus, it's critical to diagnose and initiate therapy for each immediately.


Aim of the study: We aimed to determine if fractional excretion of Urea and Sodium (FEUrea and FENa) may be valuable for distinguishing AKI phenotypes.


Methods: An observational study was conducted between May 2022–and May 2022. Enrolled in the trial were 50 cirrhotic patients without AKI and 100 cirrhotic patients with AKI. Every patient had a comprehensive clinical evaluation and history taking. Both groups' fractional excretion of urea and sodium was measured (Trial registration number Trial Register NCT0367563).


Results: Both studied groups had insignificant differences in terms of demographic data. FEUrea (%) was significantly higher in the AKI patients than in the non-AKI patients, owing to elevated urea levels in the AKI. However, plasma FENa (%) concentration in the non-AKI controls significantly increased compared to that in the AKI patients. Also, FEurea (%) and FENa (%) concentrations were significantly higher in the renal-AKI patients than in those with the pre-renal-AK. FEurea at a cut-off point > 36.6% had 90.9% sensitivity and 86.5% specificity, with the area under the curve (AUC) being 0.911 for the prediction of AKI. In comparison, FENa at a cut-off point > 0.88% had 90.6% sensitivity and 77.5% specificity, with an AUC of 0.986 for the prediction of AKI.


Conclusion Both FEurea and FENa can be utilized to predict AKI early. More verified research is needed.

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