Urine biochemistry assessment in critically ill patients: controversies and future perspectives
Correct interpretation of the urinary sodium concentration (NaU) and its relation to renal function in critically ill patients is lacking. Our aim was to evaluate the relationship between simultaneous NaU value and serum creatinine (sCr). The hypothesis is that a NaU value greater than 140 mmol/l (normal equivalent value in plasma) is only found in patients with normal sCr. We made a retrospective analysis of 1153 simultaneous samples of NaU and sCr, divided according to diuretic use in the previous 24 hours and grouped in five distinct NaU ranges (< 20, 20 to 39, 40 to 139, 140 to 169, ≥ 170 mmol/l). NaU values below 140 mmol/l were found simultaneously with both normal and increased sCr. NaU values above 140 mmol/l were almost always found in patients with normal sCr, even if diuretics were used. Median sCr values in the NaU ranges above 140 mmol/l were significantly lower than in the other NaU ranges. Estimated glomerular filtration rates were lower and intensive care unit and hospital mortalities were higher in patients with NaU values lower than 140 mmol/l compared to patients with a NaU higher than 140 mmol/l. We concluded that a high natriuretic capacity reflects significant residual renal function in the critically ill. NaU greater than normal plasma sodium is a possible biomarker of normal/improving renal function and also of better outcome. Sole NaU values below 140 mmol/l are difficult to interpret but it is possible that very low NaU values may signify some threat to normal kidney function and worse prognosis even in the presence of normal sCr. Our way to interpret NaU values in critically ill patients needs further careful evaluation.