Assessment of kidney failure (prerenal vs acute kidney injury)
Kinetic Ultraviolet Assay
BUN
Urine
A timed 24-hour urine collection is the preferred specimen for measuring and interpreting this urinary analyte. See URCR / Uric Acid, 24 Hour, Urine.
Random collections normalized to urinary creatinine may be of some clinical use in patients who cannot collect a 24-hour specimen, typically small children.
Supplies: Sarstedt 5 mL Aliquot Tube (T914)
Container/Tube: Plastic tube
Specimen Volume: 4 mL
Collection Instructions:
1. Collect a random urine specimen.
2. No preservative.
If not ordering electronically, complete, print, and send a Renal Diagnostics Test Request (T830) with the specimen.
1 mL
Specimen Type | Temperature | Time | Special Container |
---|---|---|---|
Urine | Refrigerated (preferred) | 14 days | |
Frozen | 30 days | ||
Ambient | 7 days |
Assessment of kidney failure (prerenal vs acute kidney injury)
Urea is a low molecular weight substance (60 Da) that is freely filtered by glomeruli, and the majority is excreted into the urine, although variable amounts are reabsorbed along the nephron. It is the major end-product of protein metabolism in humans and other mammals. Approximately 50% of urinary solute excretion and 90% to 95% of total nitrogen excretion is composed of urea under normal conditions. Factors that tend to increase urea excretion include increases in glomerular filtration rate, increased dietary protein intake, protein catabolic conditions, and water diuretic states. Factors that reduce urea excretion include low protein intake and conditions that result in low urine output (eg, dehydration). Urea excretion is a useful marker of protein metabolism.
In oliguric patients with a rising creatinine a fractional excretion of urea below 35% is consistent with a prerenal cause, while values above 35% are more consistent with acute kidney injury.(1) The fractional excretion of sodium is also used for this purpose but may be more affected by diuretics. Therefore, the fractional excretion of urea may be particularly useful for patients receiving diuretics.
No established reference values
Random urine urea may be interpreted in conjunction with serum urea, using both values to calculate fractional excretion of urea.
The calculation for fractional excretion (FE) of urea is
FE(U)= ([U(urine)XCreat(serum)]/[U(serum)XCreat(urine)]) X 100
Fractional excretion of urea under 35% is consistent with a prerenal cause.
No significant cautionary statements
1. 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):2223-2229
2. Lamb EJ, Jones GRD: Kidney function tests. In: Rifai N, Horvath AR, Wittwer CT, eds: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 6th ed. Elsevier; 2018:498-500
3. Bankir L, Trinh-Trang-Tan MM: Urea and the kidney. In: Brenner B, ed: The kidney. 6th ed. WB Saunders Company; 2000
Urea is hydrolyzed by urease to form ammonia and carbon dioxide. The ammonia formed then reacts with ketoglutarate and reduced nicotinamide adenine dinucleotide (NADH) in the presence of glutamate dehydrogenase to yield glutamate and NAD(+). The decrease in absorbance is due to consumption of NADH as measured kinetically at 340 nm.(Package insert: Roche Urea/BUN. Roche Diagnostics; V 8.0 02/2020)
Monday through Sunday
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.
84540
Test Id | Test Order Name | Order LOINC Value |
---|---|---|
URCON | Urea, Random, U | 3092-4 |
Result Id | Test Result Name |
Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
|
---|---|---|
URCON | Urea, Random, U | 3092-4 |