Urea-to-creatinine ratio

Medical laboratory value

In medicine, the urea to creatinine ratio (UCR), known in the United States as BUN to creatinine ratio, is the ratio of the blood levels of urea (BUN) (mmol/L) and creatinine (Cr) (μmol/L). BUN only reflects the nitrogen content of urea (MW 28) and urea measurement reflects the whole of the molecule (MW 60), urea is just over twice BUN (60/28 = 2.14). In the United States, both quantities are given in mg/dL The ratio may be used to determine the cause of acute kidney injury or dehydration. The principle behind this ratio is the fact that both urea (BUN) and creatinine are freely filtered by the glomerulus; however, urea reabsorbed by the renal tubules can be regulated (increased or decreased) whereas creatinine reabsorption remains the same (minimal reabsorption).

Urea and creatinine are nitrogenous end products of metabolism. Urea is the primary metabolite derived from dietary protein and tissue protein turnover. Creatinine is the product of muscle creatine catabolism. Both are relatively small molecules (60 and 113 daltons, respectively) that distribute throughout total body water. In Europe, the whole urea molecule is assayed, whereas in the United States only the nitrogen component of urea (the blood or serum urea nitrogen, i. e., BUN or SUN) is measured. The BUN, then, is roughly one half (7/15 or 0.466) of the blood urea. The normal range of urea nitrogen in blood or serum is 5 to 20 mg/dl, or 1.8 to 7.1 mmol urea per liter. The range is wide because of normal variations due to protein intake, endogenous protein catabolism, state of hydration, hepatic urea synthesis, and renal urea excretion. A BUN of 15 mg/dl would represent significantly impaired function for a woman in the thirtieth week of gestation. Her higher glomerular filtration rate (GFR), expanded extracellular fluid volume, and anabolism in the developing fetus contribute to her relatively low BUN of 5 to 7 mg/dl. In contrast, the rugged rancher who eats in excess of 125 g protein each day may have a normal BUN of 20 mg/dl. The normal serum creatinine (sCr) varies with the subject's body muscle mass and with the technique used to measure it. For the adult male, the normal range is 0.6 to 1.2 mg/dl, or 53 to 106 μmol/L by the kinetic or enzymatic method, and 0.8 to 1.5 mg/dl, or 70 to 133 μmol/L by the older manual Jaffé reaction. For the adult female, with her generally lower muscle mass, the normal range is 0.5 to 1.1 mg/dl, or 44 to 97 μmol/L by the enzymatic method.

The ratio is useful for the diagnosis of bleeding from the gastrointestinal (GI) tract in patients who do not present with overt vomiting of blood. In children, a BUN:Cr ratio of 30 or greater has a sensitivity of 68.8% and a specificity of 98% for upper gastrointestinal bleeding. A common assumption is that the ratio is elevated because of amino acid digestion, since blood (excluding water) consists largely of the protein hemoglobin and is broken down by digestive enzymes of the upper GI tract into amino acids, which are then reabsorbed in the GI tract and broken down into urea. However, elevated BUN:Cr ratios are not observed when other high protein loads (e. g., steak) are consumed. Renal hypoperfusion secondary to the blood lost from the GI bleed has been postulated to explain the elevated BUN:Cr ratio. However, other research has found that renal hypoperfusion cannot fully explain the elevation.

Because of decreased muscle mass, elderly patients may have an elevated BUN:Cr at baseline.

Hypercatabolic states, high dose glucocorticoids, and resorption of large hematomas have all been cited as causes of a disproportionate rise in BUN relative to the creatinine.