Urea is a low molecular weight substance (Mol Wt=60) that is freely filtered by glomeruli and the majority is excreted into the urine, although variable amounts are reabsorbed along the nephron. It is the major end product of protein metabolism in humans and other mammals. Approximately 50% of urinary solute excretion and 90% to 95% of total nitrogen excretion is composed of urea under normal conditions. Factors that tend to increase urea excretion include increases in glomerular filtration rate, increased dietary protein intake, protein catabolic conditions, and water diuretic states. Factors that reduce urea excretion include low protein intake and conditions which result in low urine output (eg, dehydration). Urea excretion is a useful marker of protein metabolism.
In oliguric patients with a rising creatinine a fractional excretion of urea <35% is consistent with a prerenal cause, while values >35% are more consistent with acute kidney injury.(2) The fractional excretion of sodium is also used for this purpose, but may be more affected by diuretics. Therefore, the fractional excretion of urea may be particularly useful for patients receiving diuretics.