Massive and disproportionate elevation of blood urea nitrogen in acute azotemia

  title={Massive and disproportionate elevation of blood urea nitrogen in acute azotemia},
  author={Donald A. Feinfeld and Hiba Bargouthi and Q Niaz and Christos P. Carvounis},
  journal={International Urology and Nephrology},
In renal failure, blood urea nitrogen and serumcreatinine usually rise in tandem; the normalBUN : Cr ratio is 10–15 : 1. Disproportionate risesin BUN : Cr (> 20 : 1) often imply pre-renalazotemia but may be caused by increased proteincatabolism or an excessive protein load. Inthis study we looked at intensive care patientswho acutely developed markedly increased BUN(≥ 100 mg/dL) with only modestelevation of Cr (≤ 5 mg/dL) forpossible causes of the disproportionateazotemia. There were 19 such… 

The meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury

Findings do not support BCR as a marker of PRA as approximately half of the patients with AKI have a BCR >20, the traditional threshold of diagnosing PRA.

A case of extreme azotaemia

A patient with remarkable biochemical derangement is presented, especially high BUN, which has not previously been seen in the department, nor described in the literature.

The fallacy of the BUN:creatinine ratio in critically ill patients.

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Clinicians should not use a BCR >20 to classify AKI in critically ill patients, and in those at risk for AKI, BUN correlated with age and severity of illness.

Usefulness of BUN/Albumin Ratio in Prediction of 28-day Mortality in Patients with Acute Cholangitis

The ratio of BUN to albumin on ED admission is a promising prognostic marker of 28-day mortality in patients with acute cholangitis.

Acute Kidney Injury Masked by Malnutrition: A Case Report and the Problem of Protein.

It is concluded that the available evidence suggests that significant restrictions in protein intake are not necessary for those critically ill patients with AKI, and further research is needed to systematically determine the optimal dose of protein for critically ill adults withAKI.

NT-ProBNP and cardiac troponin I in virulent canine babesiosis.

Influence of sub-chronic oral exposure to high monosodium glutamate on some serum markers of the renal functions in male Wistar rats

Exposure to MSG significantly altered the renal functions in rats by way of compromised urea and creatinine metabolism, and the nutritional and health implications of the results may be significant in animals and therefore warrant further and better controlled investigation in humans.



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In conclusion, infusion of therapeutic doses of amino acids can exacerbate early functional and histologic parameters of ischemic renal injury and thus, may sensitize the kidney to isChemic acute renal failure.

Optimal protein requirements during the first 2 weeks after the onset of critical illness.

Current recommended protein requirements in critically ill sepsis or trauma patients during the first 2 wks after admission to the intensive care unit are excessive if they are indexed to the body weight measured soon after the onset of critical illness.


The bedside formula appears superior to APACHE II in predicting ARF or death in MICU but not SICU, which suggests that these two ICU populations are different.

The vasopressin-regulated urea transporter in renal inner medullary collecting duct.

The terminal part of the inner medullary collecting duct (terminal IMCD) is unique among collecting duct segments in part because its permeability to urea is regulated by vasopressin. The urea

Pathophysiology of pre-renal azotemia.

The effect of arginine vasopressin on ureagenesis in isolated rat hepatocytes.

The effect of arginine vasopressin on ureagenesis was measured in isolated rat hepatocytes with ammonium chloride and L(+)-lactate as substrates and both the dose-response curve and the concentrations of NH+4 employed suggest that the effect observed could be of physiological significance.

Optimal protein intake in critical illness?

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