الفهرس 
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Abstract
The incidence of acute renal injury (AKI) in ICU is 5%. The mortality rate increases up to 50% if AKI is a part of multiple organ dysfunction syndromes.
Prerenal acute renal injury is responsible for 30–40% of cases of oliguria in ICU; a situation which can be usually reverted by correcting the underlying disorder, but prolonged or severe prerenal acute renal injury may proceed to oliguric renal acute renal injury.
Many laboratory tools have been used for differentiating renal from prerenal acute renal injury. The fractional excretion of sodium (FENa) and fractional excretion of urea (FEUrea) are beneficial laboratory tools to differentiate prerenal from renal AKI. The purpose of this study was to compare FENa and FEurea in differentiating renal from prerenal acute renal injury, and to detect the effect of diuretics on their handling.
This retrospective study was conducted on 45 Egyptian patients with AKI complicating circulatory shock admitted to the ICUs of AIN SHAMS University Hospital, from August 2018 to February 2019.Both FENa and FEurea, as well as regular laboratory tests, were measured in all patients. The patients were divided into 30 patients with prerenal (group-1) and 15 patients with renal acute kidney injury (group-2). Group-1 will be subdivided into 15 patients who did not receive diuretics 24 h before the sampling process (group-1a) and 15 patients who received diuretics (group-1b).
Compared to FENa, on using FEurea as a predictor in differentiating renal from prerenal azotemia in all patients, higher sensitivity (80.2%), specificity (90.3%) and overall accuracy (87.1%) could be detected, than FENa; sensitivity (72.8%), specificity (70.8%) and overall accuracy (68.9%). For patients who received diuretics, FEurea as a predictor also could differentiate renal from prerenal azotemia (group-1b) with higher sensitivity (79.2%), specificity (93%) and overall accuracy (86.6%), than FENa; sensitivity (64.9%), specificity (59%) and overall accuracy (60%).As a predictor of differentiation, the cutoff value of FEurea was 35.2% (P < 0.001) and the cutoff value of FENa was 1.08% (P < 0.05).
Both FENa and FEUrea are easy laboratory tests which can be used to differentiate renal from prerenal Acute Kidney Injury (AKI), but FEUrea has higher sensitivity and specificity than FENa in that concern and its value is not affected by using diuretics.