尿素排泄分数在急性肾损伤鉴别诊断中的应用  

Significance of the fractional excretion of urea in the differential diagnosis of acute kidney injury

作　　者：付水[1] 陈君飞[1] 张苗苗[1] 袁远[1] 褚邦勇[1] 

机构地区：[1]浙江省台州医院,浙江台州317000

出　　处：《中国卫生检验杂志》2012年第8期1900-1902,1904,共4页Chinese Journal of Health Laboratory Technology

摘　　要：目的:探讨尿素排泄分数在急性肾损伤鉴别诊断中的意义。方法:收集2008年1月-2012年2月间73例急性肾损伤(肾前性:无利尿剂治疗的肾前性肾损伤26例;肾前性-D:利尿剂治疗的肾前性肾损伤23例;ATN:急性肾小管损伤24例)的尿液和血液。检测其钠、肌酐和尿素的浓度,计算Purea/Pcr、FENa和FEurea的值并对其进行统计分析。结果:FENa仅在肾前性AKI低于1%,而在其它两组均高于1%。FEurea在两组肾前性AKI中均低于35%且基本一致。92.3%的肾前性AKI患者FENa<1%,39.1%肾前性-D AKI患者FENa<1%。78.2%肾前性-D AKI患者FEurea<35%。结论:FEurea在AKI鉴别诊断时具有较高的敏感性和特异性,尤其在应用利尿剂的肾前性AKI患者中FEurea比FENa更适合于AKI的病因诊断。Objective：To evaluate the value of FE in the diagnosis and differential diagnosis of acute kidney injury. Methods ： Fresh urine and blood samples were obtained from 26 patients with pre - renal AKI（ pre - renal） , 23 patients with pre - renal AKI with diuretics and 24 patients with acute tubular necrosis （ATN） during January 2008 to February 2012. Blood and urine chemistries and electrolytes were determined. The value of Pur^a/Pc~, FENa and FE were calculated, and the data were statistical analyzed. Results： FENa was lower than 1% only in the patients with untreated plain prerenal kidney injury while it was higher than 1% in both the prerenal with diuretics and ATN groups. FE was essentially identical in the two prerenal groups. While 92.3 % of the patients with prerenal acute kidney injury had a FENa 〈 1% , only 39.1% of patients with prerenal and diuretic therapy had such a low FEN. By contrast, 78.2% of this latter group had a FEu^a 〈 35%. Conclusion： FEur^a was found to be more sensi- tive and specific in the diagnosis and differential diagnosis of acute kidney injury, especially more suitable for differentiating AKI due to prerenal azotemia and that due to ATN than FENa when diuretics have been administered.

关 键 词：急性肾损伤 尿素排泄分数 钠排泄分数 利尿剂 

分 类 号：R692[医药卫生—泌尿科学]