Prerenal acute kidney injury—still a relevant term in modern clinical practice?
- 29 June 2020
- journal article
- research article
- Published by Oxford University Press (OUP) in Nephrology Dialysis Transplantation
- Vol. 36 (9), 1570-1577
- https://doi.org/10.1093/ndt/gfaa061
Abstract
The traditional taxonomy of acute kidney injury (AKI) has remained pervasive in clinical nephrology. While the terms ‘prerenal’, ‘intrarenal’ and ‘postrenal’ highlight the diverse pathophysiology underlying AKI, they also imply discrete disease pathways and de-emphasize the nature of AKI as an evolving clinical syndrome with multiple, often simultaneous and overlapping, causes. In a similar vein, prerenal AKI comprises a diverse spectrum of kidney disorders, albeit one that is often managed by using a standardized clinical algorithm. We contend that the term ‘prerenal’ is too vague to adequately convey our current understanding of hypoperfusion-related AKI and that it should thus be avoided in the clinical setting. Practice patterns among nephrologists indicate that AKI-related terminology plays a significant role in the approaches that clinicians take to patients that have this complex disease. Thus, it appears that precise terminology does impact the treatment that patients receive. We will outline differences in the diagnosis and management of clinical conditions lying on the so-called prerenal disease spectrum to advocate caution when administering intravenous fluids to these clinically decompensated patients. An understanding of the underlying pathophysiology may, thus, avert clinical missteps such as fluid and vasopressor mismanagement in tenuous or critically ill patients.This publication has 94 references indexed in Scilit:
- Some biomarkers of acute kidney injury are increased in pre-renal acute injuryKidney International, 2012
- Molecular Phenotypes of Acute Kidney Injury in Kidney TransplantsJournal of the American Society of Nephrology, 2012
- Hepatorenal syndrome: the 8th international consensus conference of the Acute Dialysis Quality Initiative (ADQI) groupCritical Care, 2012
- Cellular pathophysiology of ischemic acute kidney injuryJCI Insight, 2011
- Creatinine Kinetics and the Definition of Acute Kidney InjuryJournal of the American Society of Nephrology, 2009
- Importance of Venous Congestion for Worsening of Renal Function in Advanced Decompensated Heart FailureJournal of Invasive Cardiology, 2009
- Comparison of Clinical Features and Outcomes of Patients Hospitalized With Heart Failure and Normal Ejection Fraction (≥55%) Versus Those With Mildly Reduced (40% to 55%) and Moderately to Severely Reduced (<40%) FractionsThe American Journal of Cardiology, 2008
- The histopathology of septic acute kidney injury: a systematic reviewCritical Care, 2008
- Prerenal Failure: A Deleterious Shift from Renal Compensation to DecompensationThe New England Journal of Medicine, 1988
- Changes in Blood Viscosity, Hematocrit Value, and Fibrinogen Concentration in Subjects with Congestive Heart FailureCirculation, 1964