Very simplistic explanation and it's MUCH more complicated than this, but a nice way to think about creatinine dilution with decompensated heart failure and convince people that a creatinine rise with decongestion is not actual kidney injury #nephsky #cardsksy - ThreadSky

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captainchloride.bsky.social • 106 days ago

Very simplistic explanation and it's MUCH more complicated than this, but a nice way to think about creatinine dilution with decompensated heart failure and convince people that a creatinine rise with decongestion is not actual kidney injury
#nephsky #cardsksy

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amyaimei.bsky.social•105 days ago

I have a talk about this… how creatinine is such an imperfect marker for such a #perfectorgan

peeingredagain.bsky.social•106 days ago

I feel like this has a be a good use case for a "renal troponin" like NGAL to sus out actual ischemia vs dilution or hemodynamic changes?

hswapnil.medsky.social•106 days ago

in real life clinical practice you mean? wonder why NGAL fell by the wayside despite data like https://pubmed.ncbi.nlm.nih.gov/29352071/. i don;’t think NephroCheck is as useful in this setting - or is it?

(we don’t have anything like that up here…urea, creatinine, and now cystatin C)

swissnephro.bsky.social•105 days ago

This might look simple, but is really not correct:

Increase in crea signifies true decrease in clearance/GFR.

Even if you could excrete relatively more H2O than crea in urine (and you cannot), crea concentration in steady state would be unchanged. It’s independent of distribution volume.

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