Renal failure

[Cknight]

What is the value of FENa for acute-on-chronic renal failure? Can that whole <1% for prerenal failure idea be relied upon when there is already pre-existing CRF?

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[KGUNNER1]

What is the value of FENa for acute-on-chronic renal failure? Can that whole <1% for prerenal failure idea be relied upon when there is already pre-existing CRF?

This is not an easy question to answer. A large group of intensivists, nephrologists, and critical care nephrologists have been trying to address this and many more renal-based questions in critical care. Their group is called ADQI (Acute Dialysis Quality Initiative). The ADQI II meeting addressed your question. I'll post the links.

http://ccforum.com/content/8/4/R204

http://www.ccm.upmc.edu/adqi/ADQI2/ADQI2g1.pdf

Hope this helps.

kg

 

[Cknight]

you're the man, kg! thanks a lot for your help

 

[Cknight]

I read through the texts on the links, there is actually no mentioning at all about FENa; all they say is that in the case of acute-on-chronic renal failure, you need to have some criteria to diagnose what is ARF, and they propose an increase in creatinine of at least 0.5 to a value over 4, in cases when baseline creatinine is abnormal.

 

[KGUNNER1]

I read through the texts on the links, there is actually no mentioning at all about FENa; all they say is that in the case of acute-on-chronic renal failure, you need to have some criteria to diagnose what is ARF, and they propose an increase in creatinine of at least 0.5 to a value over 4, in cases when baseline creatinine is abnormal.

Most nephrologists I've spoken to, and papers I've come across, place a very limited value on FENa. It is more of an historical calculation. If you do a pubmed search, I'm sure you'll also come across some of these same articles.