Urine biochemistry assessment in critically ill patients: controversies and future perspectives.

摘要: In the past, urine biochemistry was a major tool in acute kidney injury (AKI) management. Classic papers published some decades ago established values of indices which were thought to distinguish "pre-renal" (functional) AKI attributed low renal perfusion and "renal" (structural) tubular necrosis (ATN). However, there lot drawbacks limitations these studies recent articles have questioned utility measuring electrolytes especially because they do not seem adequately inform about nor duration (transient vs. persistent). At same time, paradigm has been consistently criticized hypoperfusion followed by ischemia ATN does explain most developing critically ill patients distinct durations be clearly related different pathophysiological mechanisms or histopathological findings. this new context, other possible roles for emerged. Some suggested standardized changes electrolyte composition preceding increases serum creatinine independently subsequent duration, might actually due intra-renal microcirculatory activation sodium-retaining even absence impaired global blood flow. present review, points controversy regarding assessment evaluated as well future perspectives its role monitoring. An alternative approach interpretation measured is proposed needs further larger validated incorporated daily ICU practice.