Urine Output and the Diagnosis of Acute Kidney Injury

  • J. R. Prowle
  • R. Bellomo
Part of the Annual Update in Intensive Care and Emergency Medicine book series (AUICEM, volume 2012)


Prevention and management of organ dysfunction are central to the practice of critical care medicine. To this end, physiological monitoring is used to assess organ function and the effects of treatment in real time. One of the foremost challenges for the intensive care specialist is to understand how to relate physiological variables, such as oxygenation, blood pressure and cardiac output, to underlying organ function. These relationships are complex and reflect interdependence of organ function, treatment, disease and comorbid conditions. Nevertheless, in search of patterns to guide clinical management, we commonly relate certain measurements to the function of particular organs, such as blood pressure and cardio-circulatory function. In the case of the kidneys, maintenance of urine output is a continuous manifestation of organ function and urine production is both monitored as an index of organ function and targeted as a therapeutic goal. However, in common with other continuously monitored physiological variables, the relationship between urine output and underlying kidney function is complex and there are many pitfalls to its interpretation in isolation.


Renal Replacement Therapy Acute Kidney Injury Urine Output Renal Blood Flow Renal Plasma Flow 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Sharfuddin AA, Molitoris BA (2011) Pathophysiology of ischemic acute kidney injury. Nat Rev Nephrol 7: 189–200PubMedCrossRefGoogle Scholar
  2. 2.
    Alejandro VS, Nelson WJ, Huie P, et al (1995) Postischemic injury, delayed function and Na+/K(+)-ATPase distribution in the transplanted kidney. Kidney Int 48: 1308–1315PubMedCrossRefGoogle Scholar
  3. 3.
    Saotome T, Ishikawa K, May CN, Birchall IE, Bellomo R (2010) The impact of experimental hypoperfusion on subsequent kidney function. Intensive Care Med 36: 533–540PubMedCrossRefGoogle Scholar
  4. 4.
    Ishikawa K, May CN, Gobe G, Langenberg C, Bellomo R (2010) Pathophysiology of septic acute kidney injury: A different view of tubular injury. Contrib Nephrol 165: 18–27PubMedCrossRefGoogle Scholar
  5. 5.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004) Acute renal failure — definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care 8: R204–212CrossRefGoogle Scholar
  6. 6.
    Mehta RL, Kellum JA, Shah SV, et al (2007) Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11: R31PubMedCrossRefGoogle Scholar
  7. 7.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW (2005) Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 16: 3365–3370PubMedCrossRefGoogle Scholar
  8. 8.
    Kidney Disease: Improving Global Outcomes (KDIGO) Available at: Accessed Nov 2011Google Scholar
  9. 9.
    Chesley LC (1938) Renal excretion at low urine volumes and the mechanism of oliguria. J Clin Invest 17: 591–597PubMedCrossRefGoogle Scholar
  10. 10.
    Gamble JL (1946) Physiological information gained from studies of the life raft ration. Harvey Lect 42: 247–278Google Scholar
  11. 11.
    Langenberg C, Wan L, Egi M, May CN, Bellomo R (2006) Renal blood flow in experimental septic acute renal failure. Kidney Int 69: 1996–2002PubMedCrossRefGoogle Scholar
  12. 12.
    Prowle JR, Echeverri JE, Ligabo EV, Ronco C, Bellomo R (2010) Fluid balance and acute kidney injury. Nat Rev Nephrol 6: 107–115PubMedCrossRefGoogle Scholar
  13. 13.
    Payen D, de Pont AC, Sakr Y, et al (2008) A positive fluid balance is associated with a worse outcome in patients with acute renal failure. Crit Care 12: R74PubMedCrossRefGoogle Scholar
  14. 14.
    Bouchard J, Soroko SB, Chertow GB, et al (2009) Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury. Kidney Int 76: 422–427PubMedCrossRefGoogle Scholar
  15. 15.
    Brandstrup B, Tønnesen H, Beier-Holgersen R, et al (2003) Effects of intravenous fluid restriction on postoperative complications: comparison of two perioperative fluid regimens: a randomized assessor-blinded multicenter trial. Ann Surg 238: 641–648PubMedCrossRefGoogle Scholar
  16. 16.
    Redfors B, Bragadottir G, Sellgren J, Swärd K, Ricksten SE (2010) Acute renal failure is NOT an “acute renal success”—a clinical study on the renal oxygen supply/demand relationship in acute kidney injury. Crit Care Med 38: 1695–1701PubMedCrossRefGoogle Scholar
  17. 17.
    Bagshaw SM, Langenberg C, Bellomo R (2006) Urinary biochemistry and microscopy in septic acute renal failure: a systematic review. Am J Kidney Dis 48: 695–705PubMedCrossRefGoogle Scholar
  18. 18.
    Bagshaw SM, Langenberg C, Wan L, May CN, Bellomo R (2007) A systematic review of urinary findings in experimental septic acute renal failure. Crit Care Med 35: 1592–1598PubMedCrossRefGoogle Scholar
  19. 19.
    Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM (2005) The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis 46: 1038–1048PubMedCrossRefGoogle Scholar
  20. 20.
    Hoste EAJ, Clermont G, Kersten A, et al (2006) RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 10: R73PubMedCrossRefGoogle Scholar
  21. 21.
    Kuitunen A, Vento A, Suojaranta-Ylinen R, Pettila V (2006) Acute renal failure after cardiac surgery: evaluation of the RIFLE classification. Ann Thorac Surg 81: 542–546PubMedCrossRefGoogle Scholar
  22. 22.
    Cruz DN, Bolgan I, Perazella MA, et al (2007) North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol 2: 418–425PubMedCrossRefGoogle Scholar
  23. 23.
    Ostermann M, Chang RW (2007) Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 35: 1837–1843PubMedCrossRefGoogle Scholar
  24. 24.
    Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe (2008) A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 23: 1569–1574PubMedCrossRefGoogle Scholar
  25. 25.
    Bagshaw SM, George C, Dinu I, Bellomo R (2008) A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 23: 1203–1210PubMedCrossRefGoogle Scholar
  26. 26.
    Barrantes F, Tian J, Vazquez R, Amoateng-Adjepong Y, Manthous CA (2008) Acute kidney injury criteria predict outcomes of critically ill patients. Crit Care Med 36: 1397–1403PubMedCrossRefGoogle Scholar
  27. 27.
    Lopes JA, Fernandes P, Jorge S, et al (2008). Acute kidney injury in intensive care unit patients: a comparison between the RIFLE and the Acute Kidney Injury Network classifications. Crit Care 12: R110PubMedCrossRefGoogle Scholar
  28. 28.
    Ostermann M, Chang R (2008) Correlation between the AKI classification and outcome. Crit Care 12: R144PubMedCrossRefGoogle Scholar
  29. 29.
    Haase M, Bellomo R, Matalanis G, Calzavacca P, Dragun D, Haase-Fielitz A (2009) A comparison of the RIFLE and Acute Kidney Injury Network classifications for cardiac surgery-associated acute kidney injury: a prospective cohort study. J Thorac Cardiovasc Surg 138: 1370–1376PubMedCrossRefGoogle Scholar
  30. 30.
    Joannidis M, Metnitz B, Bauer P, et al (2009) Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med 35: 1692–1702PubMedCrossRefGoogle Scholar
  31. 31.
    Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006) An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 34: 1913–1917PubMedCrossRefGoogle Scholar
  32. 32.
    Han SS, Kang KJ, Kwon SJ, et al (2012) Additional role of urine output criterion in defining acute kidney Injury. Nephrol Dial Transplant (in press)Google Scholar
  33. 33.
    Mandelbaum T, Scott DJ, Lee J, et al (2011) Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria. Crit Care Med 39: 2659–2664PubMedGoogle Scholar
  34. 34.
    Uchino S, Bellomo R, Bagshaw SM, Goldsmith D (2010) Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant 25: 1833–1839PubMedCrossRefGoogle Scholar
  35. 35.
    Morgan DJ, KM Ho (2010) A comparison of nonoliguric and oliguric severe acute kidney injury according to the risk injury failure loss end-stage (RIFLE) criteria. Nephron Clin Pract 115: c59–65PubMedCrossRefGoogle Scholar
  36. 36.
    Macedo E, Malhotra R, Claure-Del Granado R, Fedullo P, Mehta RL (2011) Defining urine output criterion for acute kidney injury in critically ill patients. Nephrol Dial Transplant 26: 509–515PubMedCrossRefGoogle Scholar
  37. 37.
    Macedo E, Malhotra R, Bouchard J, Wynn SK, Mehta RL (2011) Oliguria is an early predictor of higher mortality in critically ill patients. Kidney Int 80: 760–767PubMedCrossRefGoogle Scholar
  38. 38.
    Prowle JR, Liu YL, Licari E, et al (2011) Oliguria as predictive biomarker of acute kidney injury in critically ill patients. Crit Care 15: R172PubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • J. R. Prowle
  • R. Bellomo

There are no affiliations available

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