Internal Medicine

Acute kidney injury

Questions discussed in this category

Would you recommend administering IV amino acids prior to cardiac surgery with cardiopulmonary bypass, given recent trial findings of improved AKI rates but no significant difference in kidney-replacement therapy with IV amino acids?

Landoni et al., PMID 38865168

1 Answer available

Do you use any urinary staining techniques when performing urine microscopy for patients with acute kidney injury?

1 Answer available

Have you considered priming CRRT machines with renal replacement solutions during the current crystalloid solution shortage?

2 Answers available

What are your top takeaways from ASN 2024?

1 Answer available

How do you determine the optimal time to restart a diuretic in a patient with cirrhosis, ascites, and lower extremity edema who presented with acute kidney injury that resolved with IV albumin and holding diuretics?

1 Answer available

What is your blood pressure or mean arterial pressure goal in a critically ill patient with acute kidney injury?

1 Answer available

Do you avoid performing urine microscopy in patients with AKI who have COVID-19 given concern for potential aerosolization?

2 Answers available

In which clinical scenarios do you use prolonged intermittent renal replacement therapy (PIRRT)?

2 Answers available

Do you avoid terlipressin for patients with hepatorenal syndrome who have a serum sodium level less than 125 mEq/L?

2 Answers available

Do you still consider hepatorenal syndrome in patients with renal impairment and liver disease who are found to have rare muddy brown casts on urine microscopy?

1 Answer available

Do you use terlipressin for patients with hepatorenal syndrome who also have elevated blood pressures?

1 Answer available

Would you recommend initially starting twice-weekly outpatient hemodialysis with close lab monitoring for nonoliguric AKI patients?

3 Answers available

Are there instances when you recommend performing a kidney biopsy in patients with presumed acute interstitial nephritis who are already on steroids and have improving renal function?

2 Answers available

How do you time 24 hour urine collections when calculating creatinine clearance for patients receiving thrice weekly hemodialysis?

2 Answers available

Do you use a phosphate binder to manage inpatient hyperphosphatemia in patients with AKI who have no history of CKD?

5 Answers available

Would you recommend a TIPS procedure in the management of hepatorenal syndrome for a patient with no history of hepatic encephalopathy?

1 Answer available

What is your approach to anticoagulation in a patient with AKI and cirrhosis who has frequent filter clotting on CRRT?

2 Answers available

Do you start patients on a B complex multivitamin if they are on CRRT and have not previous been on renal replacement therapy?

1 Answer available

Do you recommend automatically starting CRRT anticoagulation when initiating CRRT if there are no medical contraindications to anticoagulation?

1 Answer available

Would you recommend delaying left heart catheterization until development of ESKD in a patient with CKD Stage 5 and stable coronary artery disease given concern for contrast-induced nephropathy?

5 Answers available

For patients with suspected complement-mediated TMA, are there specific clinical or laboratory parameters that can help guide the decision for starting empirical treatment (e.g., eculizumab) while awaiting the results of complement testing?

1 Answer available

How do you approach the decision to use terlipressin in a patient with hepatorenal syndrome type 1, AKI, and a history of heart failure given its potential cardiovascular effects?

1 Answer available

For patients on CRRT with worsening hyperkalemia despite high replacement fluid rate using a 0 mEq/L potassium bath, do recommend using an additional CRRT machine with separate dialysis access for improved clearance?

3 Answers available

Do you use serum or urine biomarkers other than creatinine when evaluating patients with acute kidney injury?

3 Answers available

What is your approach to monitoring for recovery in a patient with non-oliguric AKI requiring dialysis?

4 Answers available

Is there benefit to performing CVVH instead of intermittent hemodialysis for a patient with AKI secondary to rhabdomyolysis who requires renal replacement therapy?

1 Answer available

In patients with intrinsic acute kidney injury of unknown etiology and with pending kidney biopsy results, are there instances when you would recommend a trial of glucocorticoids?

1 Answer available

What is your approach to achieving hypernatremia in a patient on CRRT for whom increasing the rate of a post-filter 3% sodium chloride infusion is insufficient?

2 Answers available

Do you recommend holding metformin in a patient with chronic kidney disease who has an upcoming CT contrast study?

3 Answers available

What is your preferred intravenous fluid type for matching volume loss in a patient with persistent surgical drain output and pre-renal acute kidney injury?

1 Answer available

Do you reduce the steroid regimen for patients with acute interstitial nephritis who have a high risk for developing side effects from glucocorticoid therapy?

1 Answer available

Are there instances when you do not perform urine microscopy and rely solely on laboratory performed urinalysis when evaluating a patient for acute kidney injury?

1 Answer available

Are there instances when you use erythropoietin stimulating agents in patients with acute kidney injury requiring dialysis?

2 Answers available

Would you perform dialysis on a patient with altered mental status in the setting of an elevated blood urea nitrogen level attributed to a tube feeding diet?

1 Answer available

Do you hold CRRT for a period of time before performing a diuretic challenge in a patient with whom you are assessing for the ability to wean off of continuous dialysis?

2 Answers available

How long would you wait before performing a kidney biopsy in a patient with possible AIN whose creatinine has plateaued, but not improved, after discontinuing the suspected offending agent?

1 Answer available

Would you recommend giving N-acetylcysteine in addition to holding diuretics in a patient with chronic kidney disease and mild hypervolemia who is planned to have a contrast study?

1 Answer available

Would you consider restarting a SGLT2i at a reduced dose in a patient who you previously discontinued the medication because of an associated significant decline in eGFR?

1 Answer available

When do you restart ACEi/ARB medications for patients whom these medications were previously discontinued due to acute kidney injury?

1 Answer available

Papers discussed in this category

Diabetes Metab, 2021 Dec 13

Acute renal injury events in diabetic patients treated with SGLT2 inhibitors: A comprehensive review with a special reference to RAAS blockers.

The New England journal of medicine, 2018-02-15

Outcomes after Angiography with Sodium Bicarbonate and Acetylcysteine.

The New England journal of medicine, 2013 Jul 10

Case records of the Massachusetts General Hospital. Case 23-2013. A 54-year-old woman with abdominal pain, vomiting, and confusion.

Critical care medicine, 2009-09

Discontinuation of continuous renal replacement therapy: a post hoc analysis of a prospective multicenter observational study.

Journal of critical care, 2019-08

The furosemide stress test for prediction of worsening acute kidney injury in critically ill patients: A multicenter, prospective, observational study.

BMC nephrology, 2022 Mar 13

Erythropoietin in Acute Kidney Injury (EAKI): a pragmatic randomized clinical trial.

Current opinion in critical care, 2021 Aug 01

Nutrients and micronutrients at risk during renal replacement therapy: a scoping review.

Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis, 2023 Jan-Dec

Regional Citrate Anticoagulation or Heparin Anticoagulation for Renal Replacement Therapy in Patients With Liver Failure: A Systematic Review and Meta-Analysis.

Kidney international, 2002-11

Microvascular endothelial injury and dysfunction during ischemic acute renal failure.

Medicine, 1979 Sep

The morphology of "acute tubular necrosis" in man: analysis of 57 renal biopsies and a comparison with the glycerol model.

The New England journal of medicine, 2021 Mar 04

Terlipressin plus Albumin for the Treatment of Type 1 Hepatorenal Syndrome.

American journal of infection control, 2020 Jun 02

Cautious handling of urine from moderate to severe COVID-19 patients.

Osong public health and research perspectives, 2020 Feb

Identification of Coronavirus Isolated from a Patient in Korea with COVID-19.

The New England journal of medicine, 2024 Oct 26

Bi- and Monoallelic Variants and Chronic Kidney Disease in West Africans.

Atencion primaria, 1997 Sep 30

[The existing differences between adolescent girls served on a first visit in a family planning center in 2 time periods].

The New England journal of medicine, 2024 Oct 25

Long-Term Effects of Empagliflozin in Patients with Chronic Kidney Disease.

The New England journal of medicine, 2024 Jun 12

A Randomized Trial of Intravenous Amino Acids for Kidney Protection.

The New England journal of medicine, 2003 Oct 02

The prevention of radiocontrast-agent-induced nephropathy by hemofiltration.

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