AM renal report pearls 5/13: AKI in the hospital!


A few take-home points from Chi:

  • Pre-renal AKI and ATN are probably on a spectrum!
    • Patients with pre-existing CKD or proteinuria are more likely to develop ATN
    • Patients without pre-existing CKD are more likely to recover (and recover quicker)
  • Cr (rise and fall) lags behind eGFR!
    • Given this lag in Cr, the question came up about new biomarkers. Per Chi, these are unlikely to be very clinically relevant. However, where there is a lot of interest is in novel drug development, as these can be early markers of drug toxicity.
      • Also, fun fact from Chi: renal toxicity is the 2nd most common reason drugs don’t make it into clinical practice! #1 is liver toxicity.


Our discussion around AKI allowed Chi to somehow magically pull up several key articles and helpful diagrams – the diagrams articles are attached!

Also, an article on ACEi use in advanced CKD – a review by Meyeon Park and Chi!


Figure 1: Himmelfarb paper: conceptual model for development and clinical course of AKI, including a narrow window when AKI is volume-responsive!


Figure 2: Moran paper: this shows how even as eGFR is improving, Cr may still be rising!

 AKI 2

Figure 3: Nejat – novel biomarkers – left side shows effect of duration of AKI on biomarker level; right side shows effect of pre-renal AKI on biomarker level




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