Urinary cyclic AMP and post-traumatic acute renal failure

Abstract

Consecutive daily urinary excretion of cyclic AMP has been investigated in 16 patients with severe trauma or illness, five of whom developed acute renal failure (ARF). Fluctuations in the nucleotide excretion exceeded the range found in 20 healthy volunteers (1.26–14.74, mean 7.13 ± 1.18 vs. 2.04–10.10, mean 5.07 ± 2.21 μmiol/24 h). This resulted in a 41% increase of cAMP excretion in the group with normal renal function ( P < 0.003) with the highest individual increase of 87%. The excretion usually reached its peak by 24 h after trauma and its lowest value by the third day, (first day vs. third day: 7.82 ± 4.23 vs. 3.96 ± 2.58 μmol/24 h, P < 0.05 for a group of 11 patients), while creatinine clearance remained normal. In four patients with severe ARF, the mean urine volume was above control value but the cAMP excretion was reduced to 3.9 to 14.4% and in one patient with a mild ARF to 60.6%. Creatinine excretion of the group was less reduced than that of cAMP (41.2% vs. 19.6%, resp.). cAMP excretion declined proportionally with diminishing creatinine clearance. In the category of 33–65 ml/min it decreased by 33.4% to 3.39 μmol ± 1.16 μmol/24 h. cAMP/creatinine ratio proved to be a less sensitive indicator thane AMP/24 h. Daily output of cAMP and creatinine correlated highly with diuresis in ARF patients, controls (always P < 0.001) and less in patients with normal renal function ( P < 0.02). Urinary cAMP appears to be a very sensitive and early indicator of the onset of ARF and subsequent recovery. This warrants its further study.