Early diagnosis of acute kidney injury in a critically ill patient using a combination of blood and urinary physicochemical parameters

Acute kidney injury (AKI) is common among critically ill patients. Because it is associated with high rates of morbidity and mortality, efforts are being made to identify AKI early to increase the likelihood of successful intervention. Serum creatinine, the primary parameter used to diagnose AKI, is universally considered a late marker. One of the major problems associated with AKI is acidbase disturbance. The physicochemical approach proposed by Stewart (1) is increasingly recognized as useful in managing complex acid-base disturbances. In this case, we demonstrate that, during the development of AKI, evolutive alterations in physicochemical serum and urinary variables are easily measured and may reliably precede increases in creatinine. These parameters may thus aid in the early diagnosis of AKI.