An interesting, short and sweet article in JAMA highlighting that serum creatinine increase in critically-ill patients may underestimate the degree of AKI.
They give following reasons for this underestimation:
1. Creatinine production decreases in sepsis, hence there is decreased release of creatinine and slow rise in serum creatinine
2. Critically-ill patients receive large-volume resuscitation and hence dilute serum creatinine. Of note, the volume of distribution of creatinine is about 65% of body weight.
Having said that, there does not appear to be any good alternatives for determining renal function ad GFR estimation in such population.
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