What should you call that elevated Creatinine?
That's the easy question.
But what is their baseline?! That's tougher.
A thread π§΅
That's the easy question.
But what is their baseline?! That's tougher.
A thread π§΅
The problem?
πΆ People don't know criteria for AKI
πΆ Determining baseline Cr is unclear
πΆ ATN is underdiagnosed
πΆ Poor documentation sabotages your AKI diagnosis
Let's dig in ‡οΈ
πΆ People don't know criteria for AKI
πΆ Determining baseline Cr is unclear
πΆ ATN is underdiagnosed
πΆ Poor documentation sabotages your AKI diagnosis
Let's dig in ‡οΈ
1 / What is Acute Kidney Injury?
πΆ Cr increase at least 1.5 times baseline OR
πΆ β₯ 0.3 mg/dl increase within 48 hours
(A Cr decrease of 0.3 cannot be used to diagnose AKI)
πΆ Urine volume < 0.5 ml/kg/h for 6 hrsπ
That's easy. But what is baseline? THIS gets complicated...
πΆ Cr increase at least 1.5 times baseline OR
πΆ β₯ 0.3 mg/dl increase within 48 hours
(A Cr decrease of 0.3 cannot be used to diagnose AKI)
πΆ Urine volume < 0.5 ml/kg/h for 6 hrsπ
That's easy. But what is baseline? THIS gets complicated...
2 / Cr baseline
The baseline must be "known or presumed" to have occurred within the prior 7 days.
(7 days = the *acute* in Acute Kidney Injury)
This does not mean you HAVE to have a documented Cr the 7 days prior to an admission.
So, what is considered baseline?
The baseline must be "known or presumed" to have occurred within the prior 7 days.
(7 days = the *acute* in Acute Kidney Injury)
This does not mean you HAVE to have a documented Cr the 7 days prior to an admission.
So, what is considered baseline?
Baseline is determined by review of prior record. But:
πΆ KDIGO does not clearly define how.
πΆ Is it the lowest Cr within the past year?
πΆ Or the most recent outpatient Cr?
πΆ Or an average of their Cr within the last year?
A recent study in Denmark looked at this...
πΆ KDIGO does not clearly define how.
πΆ Is it the lowest Cr within the past year?
πΆ Or the most recent outpatient Cr?
πΆ Or an average of their Cr within the last year?
A recent study in Denmark looked at this...
The take-home points:
πΆ All definitions of baseline result in similar morbidities
πΆ NOT defining a baseline = higher morbidity.
If a baseline Cr cannot be defined, then use:
πΆ Lowest Cr during hospital stay
πΆ Estimated Cr based on MDMR study (w/o CKD, more in my newsletter)
πΆ All definitions of baseline result in similar morbidities
πΆ NOT defining a baseline = higher morbidity.
If a baseline Cr cannot be defined, then use:
πΆ Lowest Cr during hospital stay
πΆ Estimated Cr based on MDMR study (w/o CKD, more in my newsletter)
3 / What about Acute Tubular Necrosis?
This is underdiagnosed.
Why? It is often a retrospective diagnosis. ATN can be diagnosed if AKI persists > 3 days after fluid resuscitation.
But there's other criteria (do not need all):
This is underdiagnosed.
Why? It is often a retrospective diagnosis. ATN can be diagnosed if AKI persists > 3 days after fluid resuscitation.
But there's other criteria (do not need all):
πΆ Associated hypotension, sepsis, or nephrotoxins (contrast, rhabdomyolysis, medications)
πΆ UA with muddy brown casts, proteinuria, or epithelial casts
πΆ FENA > 2% π
πYouπdoπnotπNEED muddy brown casts for ATN. You can document "possible", suspected, etc.
πΆ UA with muddy brown casts, proteinuria, or epithelial casts
πΆ FENA > 2% π
πYouπdoπnotπNEED muddy brown casts for ATN. You can document "possible", suspected, etc.
Documentation Tips:
πΆ Do not give a RANGE for baseline. Pick a number.
πΆ Don't use "acute renal insufficiency"
πΆ If someone has AKI on CKD, specify as such + stage of CKD
πΆ AKI is a CC; ATN is an MCC (Don't understand this? More in my newsletter)
πΆ Do not give a RANGE for baseline. Pick a number.
πΆ Don't use "acute renal insufficiency"
πΆ If someone has AKI on CKD, specify as such + stage of CKD
πΆ AKI is a CC; ATN is an MCC (Don't understand this? More in my newsletter)
In summary:
1οΈβ£ AKI is:
πΆ β¬οΈ of Cr to β₯1.5x the baseline Cr
πΆ β₯ 0.3 mg/dl increase within 48 hours
2οΈβ£ Don't use a range for baseline
3οΈβ£ Consider "suspected ATN" if Cr still not at baseline > 3 days s/p IVF resuscitation
Criteria are based on @goKDIGO
1οΈβ£ AKI is:
πΆ β¬οΈ of Cr to β₯1.5x the baseline Cr
πΆ β₯ 0.3 mg/dl increase within 48 hours
2οΈβ£ Don't use a range for baseline
3οΈβ£ Consider "suspected ATN" if Cr still not at baseline > 3 days s/p IVF resuscitation
Criteria are based on @goKDIGO
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The algorithm limits me to threads with less than 12 tweets (and only 280 characters of course).
I go into more detail in my free newsletter. Link in bio.
Won't spam you. Easy to unsubscribe.
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