TY - JOUR
T1 - Prerenal acute kidney injury-still a relevant term in modern clinical practice?
AU - Bonavia, Anthony
AU - Vece, Gregory
AU - Karamchandani, Kunal
N1 - Publisher Copyright:
© 2020 The Author(s). Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.
PY - 2021/9/1
Y1 - 2021/9/1
N2 - 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.
AB - 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.
KW - Cardiorenal syndrome
KW - Hepatorenal syndrome
KW - Prerenal acute kidney injury
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U2 - 10.1093/ndt/gfaa061
DO - 10.1093/ndt/gfaa061
M3 - Review article
C2 - 32596733
AN - SCOPUS:85108052672
SN - 0931-0509
VL - 36
SP - 1570
EP - 1577
JO - Nephrology Dialysis Transplantation
JF - Nephrology Dialysis Transplantation
IS - 9
ER -