Changing serum creatinine in the detection of acute renal failure and recovery following radiocontrast studies among acutely ill inpatients: Reviewing insights regarding renal functional reserve gained by large-data analysis

A rise in serum creatinine (SCr) is widely used for the detection and definition of evolving acute kidney injury (AKI). Yet, it takes time for SCr to re-adjust in response to changes in glomerular filtration rate (GFR), and subtle transient changes in GFR may remain concealed. Additionally, it canno...

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Vydané v:Practical laboratory medicine Ročník 30; s. e00276
Hlavní autori: Gorelik, Yuri, Abassi, Zaid, Bloch-Isenberg, Natalie, Khamaisi, Mogher, Heyman, Samuel N.
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Netherlands Elsevier B.V 01.05.2022
Elsevier
Predmet:
Acute kidney functional recovery
Acute kidney injury
Chronic kidney disease
Contrast induced nephropathy
Glomerular filtration rate
Original
Renal functional reserve
Serum creatinine
eGFR
SCr
Renal functional reserve
Acute kidney injury
Serum creatinine
AKR
Contrast induced nephropathy
CIN
Chronic kidney disease
Acute kidney functional recovery
Glomerular filtration rate
GFR
CKD
AKI
RFR
CKD, Chronic kidney disease
SCr, Serum creatinine
GFR, glomerular filtration rate
RFR, Renal functional reserve
eGFR, estimated GFR
CIN, Contrast induced nephropathy
AKI, acute kidney injury (AKI)
AKR, Acute kidney functional reserve
ISSN:2352-5517, 2352-5517
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Shrnutí:A rise in serum creatinine (SCr) is widely used for the detection and definition of evolving acute kidney injury (AKI). Yet, it takes time for SCr to re-adjust in response to changes in glomerular filtration rate (GFR), and subtle transient changes in GFR may remain concealed. Additionally, it cannot differentiate altered glomerular hemodynamics and pre-renal failure from true renal tissue injury, necessitating additional clinical and laboratory diagnostic tools. While these features limit the usefulness of SCr and subsequently estimated GFR (eGFR) at a single time point for the individual patient, their overall pattern of changes along time in a large cohort of hospitalized patients may provide a powerful perspective regarding the detection and assessment of shifting kidney function in this population. Herein we review our experience running large data analyses, evaluating patterns of day-to-day changes in SCr among inpatients, occurring around the exposure to iodinated radiocontrast agents. These large data evaluations helped substantiating the existence of contrast-induced nephropathy in patients with advanced renal failure, underscoring the impact of predisposing and confounding factors. It also provides novel insights regarding a phenomenon of "acute kidney functional recovery” (AKR), and illustrate that the incidence of AKI and AKR along the scale of baseline kidney function co-associates and is inversely proportional to kidney function. This can be attributed to renal functional reserve, which serves as a buffer for up-and-down changes in GFR, forming the physiologic explanation for concealed subclinical AKI.
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both authors equally contributed to the manuscript.
ISSN:2352-5517
2352-5517
DOI:10.1016/j.plabm.2022.e00276