Prerenal acute kidney injury-still a relevant term in modern clinical practice?

Anthony Bonavia, Gregory Vece, Kunal Karamchandani

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)1570-1577
Number of pages8
JournalNephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
Volume36
Issue number9
DOIs
StatePublished - Aug 27 2021

Keywords

  • cardiorenal syndrome
  • hepatorenal syndrome
  • prerenal acute kidney injury

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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