Rule AD, Larson TS, Bergstralh EJ, Slezak JM, Jacobsen SJ, Cosio FG. Using serum creatinine to estimate glomerular filtration rate: accuracy in good health and in chronic kidney disease. Ann Intern Med. 2004 Dec 21. 141 (12):929-37. [QxMD MEDLINE Link].
eGFR Calculator. National Kidney Foundation. Available at https://www.kidney.org/professionals/kdoqi/gfr_calculator. Accessed: March 8, 2023.
Inker LA, Eneanya ND, Coresh J, Tighiouart H, Wang D, Sang Y, et al. New Creatinine- and Cystatin C-Based Equations to Estimate GFR without Race. N Engl J Med . 2021 Nov 4. 385:1737-1749. [Full Text].
Eklof H, Bergqvist D, Hagg A, et al. Outcome after endovascular revascularization of atherosclerotic renal artery stenosis. Acta Radiol. 2009 Apr. 50(3):256-64. [QxMD MEDLINE Link].
Mindikoglu AL, Weir MR. Current concepts in the diagnosis and classification of renal dysfunction in cirrhosis. Am J Nephrol. 2013. 38(4):345-54. [QxMD MEDLINE Link]. [Full Text].
Xue JL, Daniels F, Star RA, Kimmel PL, Eggers PW, Molitoris BA, et al. Incidence and mortality of acute renal failure in Medicare beneficiaries, 1992 to 2001. J Am Soc Nephrol. 2006 Apr. 17 (4):1135-42. [QxMD MEDLINE Link]. [Full Text].
Liaño F, Pascual J. Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int. 1996 Sep. 50 (3):811-8. [QxMD MEDLINE Link]. [Full Text].
Prakash J, Singh TB, Ghosh B, Malhotra V, Rathore SS, Vohra R, et al. Changing epidemiology of community-acquired acute kidney injury in developing countries: analysis of 2405 cases in 26 years from eastern India. Clin Kidney J. 2013 Apr. 6 (2):150-5. [QxMD MEDLINE Link]. [Full Text].
US Renal Data System. 2022 Annual Data Report. USRDS. Available at https://usrds-adr.niddk.nih.gov/2022. Accessed: March 8, 2023.
Carvounis CP, Nisar S, Guro-Razuman S. Significance of the fractional excretion of urea in the differential diagnosis of acute renal failure. Kidney Int. 2002 Dec. 62(6):2223-9. [QxMD MEDLINE Link]. [Full Text].
Faubel S, Patel NU, Lockhart ME, Cadnapaphornchai MA. Renal relevant radiology: use of ultrasonography in patients with AKI. Clin J Am Soc Nephrol. 2014 Feb. 9(2):382-94. [QxMD MEDLINE Link]. [Full Text].
Holmquist F, Hansson K, Pasquariello F, et al. Minimizing contrast medium doses to diagnose pulmonary embolism with 80-kVp multidetector computed tomography in azotemic patients. Acta Radiol. 2009 Mar. 50(2):181-93. [QxMD MEDLINE Link].
Knipp D, Lane BF, Mitchell JW, Daly BD. Computed Tomographic Angiography of the Abdomen and Pelvis in Azotemic Patients Utilizing 80-kV(p) Technique and Reduced Dose Iodinated Contrast: Comparison With Routine 120-kV(p) Technique. J Comput Assist Tomogr. 2017 Jan. 41 (1):141-147. [QxMD MEDLINE Link].
Sofocleous CT, Bahramipour P, Mele C, et al. Transvenous transjugular renal core biopsy with a redesigned biopsy set including a blunt-tipped needle. Cardiovasc Intervent Radiol. 2002 Mar-Apr. 25(2):155-7. [QxMD MEDLINE Link].
Fenske W, Stork S, Koschker AC, et al. Value of fractional uric acid excretion in differential diagnosis of hyponatremic patients on diuretics. J Clin Endocrinol Metab. 2008 Aug. 93(8):2991-7. [QxMD MEDLINE Link].
Liu KD, Matthay MA, Chertow GM. Evolving practices in critical care and potential implications for management of acute kidney injury. Clin J Am Soc Nephrol. 2006 Jul. 1(4):869-73. [QxMD MEDLINE Link]. [Full Text].
McMahon BA, Chawla LS. The furosemide stress test: current use and future potential. Ren Fail. 2021 Dec. 43 (1):830-839. [QxMD MEDLINE Link]. [Full Text].
Zahorec R, Setvak D, Cintula D, Belovicova C, Blaskova A. Renal rescue therapy in early stage of severe sepsis: a case study approach. Bratisl Lek Listy. 2004. 105 (10-11):345-52. [QxMD MEDLINE Link].
Duffy M, Jain S, Harrell N, Kothari N, Reddi AS. Albumin and Furosemide Combination for Management of Edema in Nephrotic Syndrome: A Review of Clinical Studies. Cells. 2015 Oct 7. 4 (4):622-30. [QxMD MEDLINE Link]. [Full Text].
Marenzi G, Assanelli E, Marana I, et al. N-acetylcysteine and contrast-induced nephropathy in primary angioplasty. N Engl J Med. 2006 Jun 29. 354(26):2773-82. [QxMD MEDLINE Link]. [Full Text].
Recio-Mayoral A, Chaparro M, Prado B, et al. The reno-protective effect of hydration with sodium bicarbonate plus N-acetylcysteine in patients undergoing emergency percutaneous coronary intervention: the RENO Study. J Am Coll Cardiol. 2007 Mar 27. 49(12):1283-8. [QxMD MEDLINE Link].
Tepel M, van der Giet M, Schwarzfeld C, Laufer U, Liermann D, Zidek W. Prevention of radiographic-contrast-agent-induced reductions in renal function by acetylcysteine. N Engl J Med. 2000 Jul 20. 343(3):180-4. [QxMD MEDLINE Link].
Subramaniam RM, Suarez-Cuervo C, Wilson RF, Turban S, Zhang A, Sherrod C, et al. Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy: A Systematic Review and Meta-analysis. Ann Intern Med. 2016 Feb 2. [QxMD MEDLINE Link].
Weisbord SD, et al; PRESERVE Trial Group. Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine. N Engl J Med. 2018 Feb 15. 378 (7):603-614. [QxMD MEDLINE Link]. [Full Text].

Media Gallery

Graph shows relation of glomerular filtration rate (GFR) to steady-state serum creatinine and blood urea nitrogen (BUN) levels. In early renal disease, substantial decline in GFR may lead to only slight elevation in serum creatinine. Elevation in serum creatinine is apparent only when GFR falls to about 70 mL/min.
Diagnostic indices in azotemia. Although such indices are helpful, it is not necessary to perform all these tests on every patient. Comparison should always be made with patients' baseline values to identify trends consistent with increase or decrease in effective circulating volume. Use of some of these indices may be limited in certain clinical conditions, such as anemia (hematocrit), hypocalcemia (serum calcium), decreased muscle mass (serum creatinine), liver disease (blood urea nitrogen [BUN], total protein, and albumin), poor nutritional state (BUN, total protein, and albumin), and use of diuretics (urine sodium). Fractional excretion of urea and fractional excretion of trace lithium appear to be superior for assessing prerenal status in patients on diuretics.

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Author

Moro O Salifu, MD, MPH, MBA, MACP Associate Professor, Department of Internal Medicine, Chief, Division of Nephrology, Director of Nephrology Fellowship Program and Transplant Nephrology, State University of New York Downstate Medical Center

Moro O Salifu, MD, MPH, MBA, MACP is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Artificial Internal Organs, American Society of Diagnostic and Interventional Nephrology, American Society of Nephrology, American Society of Transplantation, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Subodh J Saggi, MD, MPH, FACP, FASN Professor of Medicine (with Tenure), Fellowship Program Director (Nephrology and Nephrology-Critical Care), Medical Director, Pancreas Transplant Program, State University of New York Downstate College of Medicine

Subodh J Saggi, MD, MPH, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Nephrology, American Society of Transplantation

Disclosure: Nothing to disclose.

Sonalika Agarwal, MBBS Attending Physician, Department of Internal Medicine (Nephrology/Transplant Nephrology), Kings County Hospital

Sonalika Agarwal, MBBS is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, American Society of Transplantation, Delhi Nephrology Society, National Kidney Foundation

Disclosure: Nothing to disclose.

Chief Editor

Vecihi Batuman, MD, FASN Professor of Medicine, Section of Nephrology-Hypertension, Deming Department of Medicine, Tulane University School of Medicine

Vecihi Batuman, MD, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Additional Contributors

Onyekachi Ifudu, MD, MBBS Director of Inpatient Dialysis Services, Associate Professor, Department of Internal Medicine, State University of New York Health Science Center at Brooklyn

Disclosure: Nothing to disclose.

Acknowledgements

George R Aronoff, MD Director, Professor, Departments of Internal Medicine and Pharmacology, Section of Nephrology, Kidney Disease Program, University of Louisville School of Medicine

George R Aronoff, MD is a member of the following medical societies: American Federation for Medical Research, American Society of Nephrology, Kentucky Medical Association, and National Kidney Foundation

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Reference Salary Employment

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