A similar picture often arises following an acute hospital admission, when a patient becomes fluid loaded with renal function checked daily. If the only other renal function test was 10 months previously from primary care, and shows a similar value to the current one, the median is now lowered and an "inaccurate" alert will be generated.
OK, unlikely this will be anything other than AKI stage 1, but will be flagged as abnormal on GP systems, and they will then have to follow procedures put in place by local renal physicians to exclude renal disease.
Also often the case in the frail elderly with low muscle mass and minor dehydration following an illness which blips up the creatinine.
Whilst this is a move in the right direction, there is scope for more informed advise/comments in such cases where we can add value to the reports.
Kind regards,
Gary Mascall
Gary Mascall
Consultant in Clinical Biochemistry
Worcestershire Acute Hospitals NHS Trust
www.worcsacute.nhs.uk
Trust email: [log in to unmask]
NHS Net email: [log in to unmask]
Tel: 01905 760760 extn 30214
-----Original Message-----
From: ACB AKI-Detection-Algorithm [mailto:[log in to unmask]] On Behalf Of Robert Hill
Sent: 23 June 2015 23:18
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Subject: AKI warning stage test results in pregnancy
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Mike Cornes has raised an issue about the increased GFR during pregnancy leading to low baseline serum creatinines which can generate AKI warning stage test results if serum creatinine is measured during the year following pregnancy. The detection workstream of the "Think Kidneys"
has been aware of this potential problem for some time. We are discussing the scenario and an appropriate response with an expert in renal function during pregnancy. It is unlikely that there will be a simple fix because most LIMS do not contain reliable pregnancy status information regardless of whether a field exists for pregnancy within the LIMS database. One important piece of information we lack is how often serum creatinine is likely to be measured in the year following pregnancy. If anyone has any relevant information on this, please share it.
This is an issue which may only reveal itself when AKI messaging is switched on to primary care. Primary care messaging is the second phase of this project planned to run from June 2015 to June 2016. However I am aware that some colleagues had included primary care during the first phase for historical reasons. The result of our consultations will be posted here and, if necessary, added to existing best practice guidance.
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