QUESTION
🤔How quickly does PTH increase in acute kidney injury (AKI)?
I learned (and have taught) that PTH can be used to suggest chronic kidney disease. At today's Clinical Reasoning Conference, our discussion (Jeff Williams) cautioned me not to just come to this conclusion.
🤔How quickly does PTH increase in acute kidney injury (AKI)?
I learned (and have taught) that PTH can be used to suggest chronic kidney disease. At today's Clinical Reasoning Conference, our discussion (Jeff Williams) cautioned me not to just come to this conclusion.
Comments
💡PTH can increase as early as days after an AKI.
A 1978 study performed serial measurements of PTH in patients with AKI. They found that PTH was elevated within days of injury and returned to normal when renal function recovered.
https://buff.ly/3YKpgxx
The acute rise in PTH is probably multifactorial:
☞ Increased secretion of PTH
☞ Decreased renal clearance of PTH
There could also be a change in the hormone's metabolism.
https://buff.ly/3YKpgxx
And if PTH isn't as reliable as I previously thought, what are the best ways to differentiate between AKI and CKD on day one?
IMO kidney US is still the best way, ie small and/or echogenic kidneys
But not sensitive or specific enough on its own!