![]() ![]() ![]() It can be challenging to differentiate prerenal from intrinsic acute kidney injury in this setting. ĪKI is common in Emergency Departments (ED). These studies consisted of small series of patients, essentially from intensive care units, the largest of which included only 103 patients and this study was not specifically aimed at investigating BCR. Since then, very few studies (human or animal) have addressed the question and their results are conflicting. However, as soon as 1947, other investigators found no such relationship. One of the first to put forward this tool was Fishberg in 1939 when he observed that “ an increase in urea content of the blood may be considerable before the creatinine value rises in prerenal azotemia”. In states of renal hypoperfusion with intact tubular function, blood urea nitrogen (BUN) is considered to rise out of proportion to plasma creatinine concentration, due to avid urea reabsorption by the proximal tubule, the BCR typically becoming >100. Under normal conditions, BCR is less than 100 (with urea and creatinine concentrations expressed in mmol/L). Indeed many textbooks of internal medicine, nephrology and critical care continue to advocate the use of BCR even though its usefulness in the diagnosis and clinical management of AKI remains unclear. This ratio is simple to use and is often put forward as a reliable diagnostic tool. The blood urea nitrogen to creatinine ratio (BCR) has been used since the early 1940s to help clinicians differentiate between prerenal acute kidney injury (PR AKI) and intrinsic AKI (I AKI). BCR is not a reliable parameter for distinguishing prerenal AKI from intrinsic AKI. Our study is the largest to investigate the diagnostic performance of BCR. The area under the ROC curve was 0.5 indicating that BCR had no capacity to discriminate between PR AKI and I AKI. There was no statistical difference between mean BCR of the PR AKI and I AKI groups, p = 0.758. 2756 patients had plasma creatinine levels in excess of 133 μmol/L, 1653 were excluded, leaving 1103 patients for definitive inclusion. Sixty thousand one hundred sixty patients were consecutively admitted to the ED. Eligible for inclusion were all adult patients consecutively admitted to the ED with a creatinine >133 μmol/L (1.5 mg/dL). We conducted a retrospective observational study over a 13 months period, in the Emergency Department (ED) of Nantes University Hospital. The aim of this study was to determine whether BCR is a reliable tool for distinguishing PR AKI from I AKI. This ratio is simple to use and often put forward as a reliable diagnostic tool even though little scientific evidence supports this. ![]()
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