Blood Urea Nitrogen Creatinine Research Articles

Hemorrhagic fever with renal syndrome (HFRS, Korean hemorrhagic fever)

Sirs, Recently we experienced a case of hemorrhagic fever with renal syndrome (HFRS) and normal findings of kidney magnetic resonance imaging (MRI). A Korean girl aged 14 years 9 months was referred to Gyeongsang National University Children’s Hospital with symptoms of fever and hypotension. Three days prior to referral she had developed fever. These symptoms continued for 2 days and were then followed by abdominal pain, nausea, vomiting, diarrhoea and back pain. At this time, an abrupt decrease of blood pressure (80/40 mmHg) occurred. On presentation, she looked acutely ill. Her blood pressure was 120/ 90 mmHg and temperature 39°C. Except for diffuse tenderness and suspicious rebound tenderness on the abdomen, other findings on physical examination were normal. Initial laboratory values were: haemoglobin level 12.9 g/dl, white blood cell count (WBC) 18.1×10/l, platelet count 250×10/l blood urea nitrogen 17 mg/dl and serum creatinine 1.5 mg/dl. The blood urea nitrogen/ creatinine (BUN/Cr) slowly rose to 47/5.1 for 5 days without decrease of urine output. Fever declined slowly to 36.5°C for 5 days. On the sixth hospital day, urinary output was over 5,000 ml/day and MRI was checked, which was normal. At discharge on the 12th hospital day, serum Cr was 0.8 mg/dl and urinary output was normalised. The indirect immunofluorescent test for Hantaan virus performed on the second and 12th hospital days was at 1:2,560 and 1:1280 dilutions, respectively. Discrimination between Hantaan and Seoul viruses was done by plaque reduction neutralisation tests. She was diagnosed with HFRS caused by Hantaan virus [1]. Hemorrhagic fever by Hantaan virus accounts for 75% of Korean hemorrhagic fever, and compared with that caused by the Seoul virus has more severe clinical symptoms. It can cause complications, including hypopituitarism, and has a recorded death rate of up to 2∼7%. Infection by Seoul virus accounts for 10∼25% of all hemorrhagic fever and is mild in severity, often completely cured without complications and less than a 1% death rate. With Seoul virus infection, there is a tendency for the bleeding trait or the main symptom, kidney disorder, is milder than with Hantaan virus infection while liver function disorder is more severe. Haemoglobin counts suddenly increase in the hypotension stage, more than a half of which are above 50% in hematocrit [2]. Characteristic mucocutaneous manifestations and usual findings of hemoconcentration, thrombocytopenia, elevated liver enzymes and lactic acid dehydrogenase (LDH) of Korean hemorrhagic fever were not found in this patient. Kim et al. reported a low signal intensity along the outer renal medulla on the T2-weighted MRI image in all patients in oliguric or diuretic phase [3]. What is truly related with this form of Korean hemorrhagic fever due to Hantaan virus? I am not sure, but the economic growth, good health hygiene and strong host defence could be the answer. Patients with acute renal failure of unknown aetiology with ill-defined febrile or gastrointestinal disease need specific serological tests for Korean hemorrhagic fever. Pediatr Nephrol (2007) 22:156–157 DOI 10.1007/s00467-006-0234-z

Alteration in Renal Function for Patients with Ileal Conduit and Ileal Orthotopic Neobladder

Purpose: We performed this study to evaluate the alterations in renal function for patients with ileal conduit and ileal orthotopic neobladder Matrials and Methods: From January 1999 to June 2004, 48 patients who had undergone radical cystectomy with urinary diversion were included in our study. The patients were divided into two groups according to the types of urinary diversion. One group consisted of 29 patients with ileal conduit and the other group consisted of 19 patients with ileal W neobladder. The mean age of the ileal conduit group and the ileal W neobladder group were 65.6±9.9 years and 60.8±8.3 years, respectively. The preoperative and postoperative blood urea nitrogen/creatinine (BUN/Cr) levels, postoperative complications and postoperative GFR, as measured by Tc-DTPA scans, were compared between the two groups. Results: For the postoperative complications, stricture at the ureterovesical anastomosis site occurred in 1.7% (1/58 renal units) of the ileal conduit group and in 10.5% (4/38 renal units) of the ileal W neobladder group. Acute pyelonephritis occurred in 5.2% (3/58 renal units) of the ileal conduit group and in 5.3% (2/38 renal units) of the ileal W neobladder group. The preand postoperative serum BUN/Cr levels were 20.8/1.3 and 24.8/1.6, respectively, in the ileal conduit group, and 17.2/1.1 and 18.8/1.2, respectively, in the ileal W neobladder group. There were no statistical significant differences between the preand postoperative changes of the serum BUN/Cr levels for both groups. The GFR, as measured by Tc-DTPA scans, were 77.6 and 78.7ml/ min/1.73m in the ileal conduit group and the ileal W neobladder group, respectively. There were no statistical significant differences between the two groups. Conclusions: There were no significant differences in renal function between the ileal conduit and ileal W neobladder. (Korean J Urol 2006;47: 1065-1068) ꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏꠏ

Usefulness of the blood urea nitrogen/creatinine ratio in gastrointestinal bleeding

This study was conducted to evaluate the blood urea nitrogen/creatinine (BUN/Cr) ratio for distinguishing an upper versus lower source of gastrointestinal (Gl) bleeding. Charts of patients who presented to the emergency department (ED) with the diagnosis of Gl bleeding from August 1995 to August 1996 were retrospectively reviewed for source of bleeding, initial BUN, Cr, BUN/Cr ratio, hematocrit (Hct), and need for transfusion. A total of 124 patients were eligible for inclusion, 71 (57%) of whom were male. A total of 63 (51%) presented with blood in stool and 53 (43%) with bloody emesis; 8 (6%) had blood in both emesis and stool. A total of 31 (25%) patients had a lower Gl bleed, 88 (70%) had an upper, and 5 (4%) had both upper and lower bleeding sources. The mean BUN level was 24 mg/dL, the mean Cr level 1.03 mg/dL, and the mean BUN/Cr ratio was 24. The mean hemoglobin (Hb) level was 11.3 g/dL, the mean Hct was 32 g/dL, and 51% required transfusion. Upper Gl bleeding was significantly correlated with age younger than 50 ( P = .01) and male gender ( P = .01; odds ratio, 3.13). Taking into account age and gender, the BUN/Cr ratio correlated significantly with an upper Gl source of bleeding ( P = .03), with a ratio greater than 36 having a sensitivity of 90% and a specificity of 27%. The area under the receiver operating characteristic curve using age, gender, and BUN/Cr ratio was .73 (95% confidence interval, .62 to .84).

Hepatic and Renal Assessment of Acute Exposure to Inhaled Epichlorohydrin: Toxicological Evaluation and Exposure Modeling

To examine the hepatic and renal effects of acute exposure to inhaled epichlorohydrin (ECH), male F344 rats were exposed either to 0 or 100 ppm ECH by inhalation for 4 h. Hepatic and renal toxicity were assessed at the termination of exposure and on days 1, 2, and 3 postexposure. Exposure to inhaled ECH caused no histopathological evidence of hepatic or renal toxicity and had no effect on serum indicators of hepatic toxicity, or hepatic cytochrome P-450 and glutathione concentrations. Exposure to inhaled ECH resulted in an increase in relative kidney weight in rats that were either 65 ± 2 days old or 73 ± 2 days old on the day of inhalation exposure (young adult rats) but not in rats that were 96 ± 2 days old on the day of inhalation exposure (adult rats), and a decrease in absolute and relative liver weight in adult rats but not young adult rats. Blood urea nitrogen/creatinine (BUN/CREAT) was decreased in young adult rats on day 0, and BUN was slightly increased in adult rats on days I, 2 and 3. These observations indicate that acute exposure to 100 ppm ECH did not produce consistent alterations in indicators of hepatic and renal toxicity. Ambient impact assessment modeling (AIAM), a methodology for estimation of exposure over short time periods and comparison of these predicted ambient concentration levels to short-term toxicological threshold values, was conducted for three typical industrial sources of ECH pollution. The results of these analyses illustrated the interdependence of toxicological evaluation and exposure modeling in short-term non-cancer risk assessment and demonstrated the usefulness of AIAM in prioritizing chemicals for additional toxicological evaluation.

The BUN/creatinine ratio in localizing gastrointestinal bleeding in pediatric patients.

Localizing the bleeding site in pediatric patients with gastrointestinal hemorrhage may require invasive and costly diagnostic procedures. A simple index to discriminate upper and lower bleeding sources would be invaluable. We evaluated the reliability of the calculated blood urea nitrogen/creatinine (BUN/Cr) ratio in segregating upper from lower gastrointestinal bleeding sites in 40 children. For upper gastrointestinal hemorrhage, the calculated BUN/Cr ratios (mg/mg) ranged from 10 to 140, with a mean value of 34. For lower gastrointestinal bleeders, the BUN/Cr ratios ranged from 3.3 to 30, with a mean value of 16. All BUN/Cr ratios greater than 30 corresponded to patients with documented upper gastrointestinal bleeding sources. Calculation of the BUN/Cr ratio in the initial evaluation of gastrointestinal bleeding may prove useful in guiding the sequence of diagnostic procedures and examinations.

The BUN/Creatinine Ratio in Localizing Gastrointestinal Bleeding in Pediatric Patients

Summary: Localizing the bleeding site in pediatric patients with gastrointestinal hemorrhage may require invasive and costly diagnostic procedures. A simple index to discriminate upper and lower bleeding sources would be invaluable. We evaluated the reliability of the calculated blood urea nitrogen/creatinine (BUN/Cr) ratio in segregating upper from lower gastrointestinal bleeding sites in 40 children. For upper gastrointestinal hemorrhage, the calculated BUN/Cr ratios (mg/mg) ranged from 10 to 140, with a mean value of 34. For lower gastrointestinal bleeders, the BUN/Cr rations ranged from 3.3 to 30, with a mean value of 16. All BUN/Cr ratios > 30 corresponded to patients with documented upper gastrointestinal bleeding sources. Calculation of the BUN/Cr ratio in the initial evaluation of gastrointestinal bleeding may prove useful in guiding the sequence of diagnostic procedures and examinations.

Uremia with low serum creatinine-an entity produced by marked creatinine secretion

Two patients are presented who were uremic requiring dialysis despite steady state serum creatinine levels (Cr) of 4.0 and 4.4 mg percent. Their blood urea nitrogen/creatinine (BUN/Cr) ratios of 54 and 44 were shown to be due to excessive creatinine secretion and urea reabsorption. Evaluation of serum creatinine alone may occasionally give misleading information regarding the level of renal function. If clinical evidence of uremia is present while serum creatinine value is relatively low, measurement of glomerular filtration rate (GFR) by Na-iothalamate 125I (OIT) or inulin is essential.