1/ #UncleBob presents #5goodminutes about the term AKI. For references I suggest - Acute Kidney Injury @AnnalsofIM acpjournals.org and Annals On Call - Care of Patients With Acute Kidney Injury acpjournals.org
2/ KDIGO definition of AKI includes a change in serum creatinine clearance (SCC) within 2–7 days & oliguria for 6 or more hours. The stage is defined by the peak rise in SCC compared w/ previous values & nadir in urine output & is related to risk for complications &prognosis
3/ Thus, when a patient comes to the hospital with an increased creatinine from previous creatinines, that does NOT constitute AKI. When a patient comes in with an increased creatinine, or develops an increase in the hospital you must first determine several things
4/ Is the patient volume contracted - if so, and the patient responds to volume expansion within 2 days - the patient does not have an AKI
Is the patient obstructed? Until we exclude acute obstruction, we should not label the patient with an AKI
Is the patient obstructed? Until we exclude acute obstruction, we should not label the patient with an AKI
5/ If the patient is not oliguric, then the patient does not truly have an AKI, rather perhaps a worsening of CKD. Today in the @CPSolvers #VMR - a patient had a marked creatinine increase from previous labs. Using the term AKI often can confuse evaluation
6/ AKi has become a "catch all" for any creatinine increase. But labeling patients as having an AKI may stall evaluation.
7/ I prefer labeling the patient as having an increased creatinine - and then proceeding with evaluation - volume assessment, obstruction assessment, U/A looking for proteinuria , infection or casts. Today's patient did not have an AKI, rather a new chronic kidney disease.
8/. I hope I'm not being too pedantic in making this distinction. I fear that the reflex use of the term AKI can lead to diagnostic delay and error.
@RosenelliEM @DxRxEdu @rabihmgeha @kidney_boy @hswapnil @Joe_Vassalotti
@RosenelliEM @DxRxEdu @rabihmgeha @kidney_boy @hswapnil @Joe_Vassalotti
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