Measurement of urine electrolytes: clinical significance and methods

There are specific clinical settings in which each of the urine electrolytes may be diagnostically useful. The urine sodium alone is not efficient in differentiating prerenal azotemia from acute tubular necrosis, but if urine sodium is coupled with some measure of the renal concentrating ability, e.g., the urine:plasma creatinine ratio. discrimination between these two conditions is much improved. Usefulness of the urine sodium in other settings (evaluation of hyponatremia, prediction of acute rejection in renal transplant recipients, index of salt balance) is controversial. Urine potassium may be useful in the evaluation of hypokalemia of obscure etiology and, occasionally, in the form of the urinary Na/K ratio, as a guide to diuretic therapy. Urine chloride is assuming importance in the differential diagnosis of metabolic alkalosis, particularly when Bartter's syndrome is a consideration.