Urine: an overlooked biomedium in heart failure?

Taken together, these observations support the notion that UNa+ should be considered a useful metric to monitor diuretic efficacy and eventually guide the intensity of depletive treatment. [...]lower UNa+ and the inability to increase with diuretic therapy (tubular stress test) may identify a subgro...

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Bibliographic Details
Published in:Biomarkers in medicine 2020-02, Vol.14 (3), p.165-168
Main Authors: la Espriella, Rafael de, Bayés-Genís, Antoni, Núñez, Eduardo, Núñez, Julio
Format: Article
Language:English
Subjects:
albuminuria
Aldosterone
Angiotensin
Biomarkers
Cardiology
Congestive heart failure
Creatinine
Diuretics
Dosage
Epidermal growth factor receptors
Heart failure
kidney injury molecule-1 (KIM-1)
Kidneys
Nephrology
neutrophil gelatinase-associated lipocalin (NGAL)
Pathophysiology
Patients
Peptides
Renin
urinary kidney injury biomarkers
urinary measurement of N-terminal B type natriuretic peptide
urinary sodium
Urine
urine biomarkers
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Summary:Taken together, these observations support the notion that UNa+ should be considered a useful metric to monitor diuretic efficacy and eventually guide the intensity of depletive treatment. [...]lower UNa+ and the inability to increase with diuretic therapy (tubular stress test) may identify a subgroup of patients prone to diuretic resistance, in whom close monitoring and timely interventions may be required. [...]a recent position statement from the Heart Failure Association of the European Society of Cardiology recommended measuring a spot UNa+ 2 h after the starting dose of loop diuretics as a part of a stepped pharmacological care algorithm, aimed at early intensification of loop diuretic dosing and/or using a strategy of sequential nephron blockade in patients with a poor diuretic response (8). [...]several studies have demonstrated that, in patients receiving diuretic therapy, mild elevation in sCr is more related to hemoconcentration and optimal diuretic response rather than AKI (9). [...]the changes in sCr or eGFR that occurred during decongestion and linked to the renin-angiotensin-aldosterone system inhibition should be interpreted within the realm of clinical response, diuretic efficiency and perhaps UNa+ concentration. According to a recent report from the Reasons for Geographic and Racial Differences in stroke study, urinary albumin-to-creatinine ratio (UACR) >300mg/g was associated with a four to fivefold increased risk of incident HF hospitalization compared with individuals with a UACR
ISSN:1752-0363
1752-0371
DOI:10.2217/bmm-2019-0433