Always hated calling prerenal failure as "renal failure"...anyone annoyed by it?

[sscheinfe]

In other words....if you are severely dehydrated, you will go into "renal failure"...but of course we know this is due to a pre-renal cause. But I am very annoyed by the misnomer. Renal failure implies that...the kidneys are failing, i.e. not working. In dehydration, the kidneys are working just fine! They just have no fluid to filter. It's almost like saying "my entire car broke down" when it's actually "I ran out of gas." There is a big difference, no?

 

Random, I know, but I have few other thoughts to keep me up at night.

[Teasip]

Just look at all the CKD now being noted as a result of the GFR being abnormally low (somewhat recent value that labs now auto calculate). I've even seen it addressed somewhere recently in an article as I recall that if we're finding so many cases of it is it actually abnormal? I find stage II and III's all the time on wellness examinations and have to refer them to their PCP (my role is not to serve as their PCP in my current position) even though there are no risk factors or other signs of renal disease.

[andersenpa]

I remember reading as a student that prerenal failure is actually "renal success"....the kidneys are doing what they are supposed to do- retain Na/water/blood volume, etc.

The fact is whatever the cause is, glomerular filtration declines, and the renal FUNCTION deteriorates.

[andersenpa]

Just look at all the CKD now being noted as a result of the GFR being abnormally low (somewhat recent value that labs now auto calculate). I've even seen it addressed somewhere recently in an article as I recall that if we're finding so many cases of it is it actually abnormal? I find stage II and III's all the time on wellness examinations and have to refer them to their PCP (my role is not to serve as their PCP in my current position) even though there are no risk factors or other signs of renal disease.

 

A newly increased incidence reflects the testing, but the higher numbers doesn't necessarily mean the test is flawed.

It all depends on your definition of abnormal. Early risk factors that show before clinical evidence of disease are still risk factors if they show correlation/causation in the literature. Look at CRP or homocysteine levels in heart disease.

The best screening tool indicates a disease before there ae signs of the disease.

[MythicalBearNole]

I believe the renal experts have started referring to it as "acute kidney injury" now instead of acute renal failure, possibly to clear up this exact confusion.

[Teasip]

Ah, a good point about the differences between association and causation. I don't believe that the evidence, with regard to CVD, shows causation, only an association. Thus, HS CRP and homocysteine levels are not routinely encouraged ("evidence insufficient" as of 2009) as per current USPSTF guidelines (nor are Ca+ index scoring studies for that matter). We all need to remember that when we specifically go looking for something we tend to find it more often. It doesn't necessarily mean that it is a direct indicator of underlying pathology which needs to be addressed, just as we need to take into consideration what the additional risk to the patient is by further assessing the original finding. Gosh, I'm starting to sound like Jerome Hoffman, M.D. more and more..... Getting back on point, if GFR AND CrCl are both low then I would agree that more specific assessment and nephrology follow up are indicated. What I have personally observed is something related to what the OP was commenting on which is if the test is repeated a couple of weeks or so later values have returned to normal.

 

Just as an FYI, for those who may be new and don't fully comprehend the difference between association and causation, here's how I explain it to my patients. If you walk in a room and see a dead mouse in one corner, and in another corner you see a cat licking it's paws, many would draw the conclusion that the cat killed the mouse. That's an association because you didn't see it take place. If you walk in the room and the cat is going to town on the mouse (direct cause and effect) that is causation. Many decisions today in medicine are made based on association, not causation. Perfect example was before the advent of CT scanners, lumbar HNP's were always felt to warrant surgical intervention because they would be commonly found at the time of surgery. When CT studies were performed with asx. control groups what they found disproved this association. Many asx. individuals had HNP's. They just weren't in a location to impact nerve roots, thus no need for surgical intervention.

[Joelseff]

I believe the renal experts have started referring to it as "acute kidney injury" now instead of acute renal failure, possibly to clear up this exact confusion.

 

This. "renal failure" at least on my practice is reserved for chronic disease or CKD. I am seeing a flurry of CKD 3s lately though my pt population has all the major risk fxs and then some. Some of it is iatrogenic since the ubiquitous tx for HIV nowadays is Truvada which contains tenofovir, but even in my non HIV pts there is an increase in new cases.....

 

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[Teasip]

I concur with Joelseff. I've seen the same reference as to "AKI".

[ventana]

new terms with CKD

 

IIIA 60- 45

IIIB 44-30

 

FYI

[EMEDPA]

I frequently see prerenal/dehydration written as "renal insufficiency".

[True Anomaly]

Use "prerenal azotemia" instead- signifies the location of the problem, and specifically identifies the problem- an increase of nitrogen-containing compounds, aka BUN and Cr. It doesn't say there's anything wrong with the kidneys...just that there's something causing the blood level increase.

 

That being said, Like y'all, I never see anyone tagged with "azotemia" much at all either.