English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Plus monthly

Global: Zendy Tools annual

Global: Zendy Tools monthly

Global: Zendy Free Plan

We read with interest the article by Pons and colleagues [1] in a recent issue of Critical Care and we would like to ask them a few questions. They excluded patients ‘for whom urine could not be collected according to the study protocol’ [1]. What were the reasons for this - anuria, renal replacement therapy (RRT), ICU discharge or death? The authors said that there was no patient receiving RRT at the time of the study, but then they mentioned 14 patients requiring RRT in the first 24 hours. How many patients were excluded due to less than 72 hours of follow-up? Since acute kidney injury (AKI) diagnosis was mandatorily done on admission in order to define AKI reversal in the first 3 ICU days, what about patients who were ‘no-AKI’ on admission but developed AKI in these 3 days?  The authors evaluated urinary indices which are actually calculated variables, dependent on multiple measured parameters. In a pilot study [2], we demonstrated that urinary sodium (NaU) was lower on admission in patients who developed AKI in the first 4 ICU days. We believe that sequential NaU measurement is useful, especially in the absence of diuretics, and that early AKI development is characterized by decreases in NaU which may precede increases in creatinine, in both transient and persistent AKI (unpublished data). These findings suggest that transient and persistent AKI are different magnitudes of the same pathophysiological process and not synonyms of functional/structural AKI [3]. This may partially explain the absence of discernment ability of the urinary indices. What was the time course of NaU in your three groups in the absence of diuretics? We believe that there is a role for urine biochemistry in AKI assessment and to exclude it from daily practice is the wrong direction.

Urine biochemistry in acute kidney injury: are we moving in the right direction?