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    Patent Pending

    Fractional Excretion of Sodium (FENa)

    Determines if renal failure is due to pre-renal, intrinsic, or post-renal pathology.
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    BEFORE USE

    Do not use in patients taking diuretics or with known chronic kidney disease, urinary tract obstruction, or acute glomerular disease. Use FEUrea in patients on diuretics.

    When to Use
    Pearls/Pitfalls
    Why Use
    mEq/L
    mg/dL
    mEq/L
    mg/dL
    About the Creator
    Dr. Carlos Espinel
    Content Contributors
    • Devika Nair, MD

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    Evidence
    Creator Insights

    Advice

    • No FENa percentage will always accurately suggest “pre-renal” disease. Always consider history, clinical context, physical exam, and current medications.
    • Obtaining repeat FENa or urine studies throughout a patient’s hospital course can give more clinical clues.
    • Non-volume depleted states with low urine sodium (and consequently low FENa) include: acute glomerulonephritis, cardiorenal syndrome, hepatorenal syndrome, contrast-related nephropathy, and rarely, acute obstruction and early acute interstitial nephritis (AIN) or acute tubular necrosis (ATN).

    Management

    Some experts recommend placing a Foley catheter in all patients with acute renal failure to remove obstructive uropathy from the differential regardless of the FENa, especially in patients who are unable to provide information about their bladder and urination.

    Content Contributors
    • Devika Nair, MD