Prerenal azotemia

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Kidney anatomy

Kidney - blood and urine flow

Azotemia - prerenal; Uremia; Renal underperfusion

• Decreased or no urine produced
• Fatigue
• Decreased alertness
• Confusion
• Pale skin color
• Rapid pulse
• Dry mouth
• Thirst
• Swelling

• Excessive urination at night
• Abdominal pain

An examination may show signs of low heart function or signs of hypovolemia. Blood pressure may be low or may drop when the person stands up. The pulse pressure (difference between systolic blood pressure and diastolic blood pressure) may be reduced. The heart rate may be rapid.

Skin turgor may be poor, and mucous membranes may be dry. The neck veins may be collapsed. There may be little or no urine in the bladder even when drained by a catheter. If the condition is prolonged, other signs of acute kidney failure may be present.

A urinalysis may show decreased kidney function preserving the ability of the tubules. Nitrogen wastes and electrolytes continue to be excreted, but at abnormally low rates.

• Urine sodium may be low, with fractional excretion at less than 1%.
• Urine creatinine to serum creatinine ratio is high.
• Urine urea to serum urea (BUN) ratio is high.
• Fractional excretion of urea is low.
• Osmolality and specific gravity show concentrated urine.

• Increased BUN
• Increased creatine
• Increased BUN/creatinine ratio

Review Date: 05/03/2006
Reviewed By: Charles Silberberg, DO, Private Practice specializing in Nephrology, Affiliated with New York Medical College, Division of Nephrology, Valhalla, NY. Review provided by VeriMed Healthcare Network.