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High BUN indicates increased protein breakdown, which is associated with decreased immune function. A study shows that patients with elevated BUN (> 20 mg/dl) have an increased risk of infection (R). High BUN is associated with increased mortality in critically ill patients (R, R, R, R).
Reduced renal perfusion, e.g., congestive heart failure, or recent onset of urinary tract obstruction will result in an increase in BUN/Creatinine ratio. Increased urea formation also results in an increase in the ratio, e.g., gastrointestinal bleeding, trauma, etc. When there is decreased formation of urea as seen in liver disease, there is a decrease in the BUN/Creatinine ratio. In most cases of chronic renal disease the ratio remains relatively normal.