Which of the following is suggestive of Acute renal failure?
Correct Answer: FENa<1
Description: Renal indices in AKI The FeNa is the fraction of the filtered sodium load that is reabsorbed by the tubules, and is a measure of both the kidney's ability to reabsorb sodium as well as endogenously and exogenously administered factors that affect tubular reabsorption. As such, it depends on sodium intake, effective intravascular volume, GFR, diuretic intake, and intact tubular reabsorptive mechanisms. With prerenal azotemia, the FeNa may be <1%, suggesting avid tubular sodium reabsorption. In patients with CKD, a FeNa significantly >1% can be present despite a superimposed prerenal state. The FeNa may also be >1% despite hypovolemia due to treatment with diuretics. Low FeNa is often seen early in glomerulonephritis and other disorders and, hence, should not be taken as prima facie evidence of prerenal azotemia. Low FeNa is therefore suggestive, but not synonymous, with effective intravascular volume depletion, and should not be used as the sole guide for volume management. The response of urine output to crystalloid or colloid fluid administration may be both diagnostic and therapeutic in prerenal azotemia. In ischemic AKI, the FeNa is frequently >1% because of tubular injury and resultant inability to reabsorb sodium. Several causes of ischemia-associated and nephrotoxin-associated AKI can present with FeNa <1%, however, including sepsis (often early in the course), rhabdomyolysis, and contrast nephropathy ref - Harrison's 20e pg 2107
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