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We were interested to see the low fractional excretion of sodium and the high urine-to-plasma ratio of creatinine in the patient with acute renal failure after contrast studies described by D'Elia et al. We concur that these urinary indices can be deceiving and can lead to inappropriate and hazardous fluid volume challenges in patients with oliguria.
In the patients we described, there was no clinical evidence of dehydration on examination and, in two patients who required hemodynamic monitoring for their underlying disease processes, volume status and cardiac status were clearly adequate. Further volume expansion in these patients clearly would lead to further complications.
Fang LST. Inadequacy of Fractional Excretion of Sodium Test-Reply. Arch Intern Med. 1981;141(6):818. doi:10.1001/archinte.1981.00340060126039