So welcome back to the Internet Book of Critical Care podcast. I'm here with Adam Thomas. We're going to talk to you about acute kidney injury and Algaria. And we've been giving you too many dessert podcasts lately. So here's some meat and potatoes for you. Acute kidney injury. Josh, today we're going to talk about that

definition and significance of A.K.I. We'll talk about that exploratory approach with how to

frame it in your mind and the management of each phenotype. So why don't you start us off with

that lovely definition? We got rifle, Akin, Kidogo. What are you going to go with, Josh?

So I looked through the literature and it seems Kadaigo is the latest and greatest definition.

But if you look carefully at all these definitions, they're really all the same thing.

You know, they're all based on creatinine and urine output.

And unfortunately, there's somewhat arbitrary.

I can't find that there's any specific evidence for these cutoffs, it seems like a bunch of people in the room broke down

creating cutoffs and urine output cutoffs. And you can correlate any creatine cutoff and any urine

output off with badness. So the nephrology gods didn't come down off the mountain and just say

less than 0.5 mils per kilogram? That is oliguria? Is that what you're trying to tell me?

I actually was interested in doing a block on this

0.5 cutoff a couple years ago, and I tracked back in the literature, and I tried to find where

this came from. And I tracked it all the way back to 1940s in some sort of OB journal. So I'm

pretty sure this is just like some sort of arbitrary thing. There was a publication in critical care a

couple years ago that was a bit more evidence-based

and seems to suggest the exact 0.5 cutoff is a little soft. It depends. 0.4.3 might be okay for short

periods of time. So bottom line, these cutoffs are somewhat arbitrary. But we used the cutoffs to help us

identify A. K.I. Why should I worry about acute kidney injury? Is it actually important for my patient, Josh? Yeah, it is. The literature shows over and over

again that folks with A.K.I. have increased mortality. And we haven't proven a causal relationship

because that would be impossible. But I do believe that this is really bad. And folks, you get kidney

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