Thread by @medrants

1/ #UncleBob presents #5goodminutes about the term AKI. For references I suggest - Acute Kidney Injury @AnnalsofIM acpjournals.org/doi/10.7326/AI… and Annals On Call - Care of Patients With Acute Kidney Injury acpjournals.org/doi/10.7326/A1…

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

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