The approval is applicable to all 27 European Union member states plus Iceland, Norway and Liechtenstein. Aerodynamic characteristics of revolving wing models were investigated to assess the validity of the normal force model. Chambers, J.M. Use a sterile technique to change the dressing. Snchez-Navarro, A.; Murillo-De-Ozores, A.R. B. 7 Figure 1 is a suggested approach to the . SERPINA3K prevents oxidative stress induced necrotic cell death by inhibiting calcium overload. most exciting work published in the various research areas of the journal. Int. Please use this for reporting to clinical staff as well as in rounds, Mr. Jones a 60-year-old African American male was admitted to the ED at 0430 for experiencing SOB. AKBA, a biopharmaceutical company focused on the development and commercialization of therapeutics for people living with kidney disease (PRNewsfoto/Akebia Therapeutics, Inc.)" alt="Akebia Therapeutics, Inc. AKBA, a biopharmaceutical company focused on the development and commercialization of therapeutics for people living with kidney disease (PRNewsfoto/Akebia Therapeutics, Inc.)">, "We're extremely pleased the EC has approved Vafseo, an important milestone for Akebia but even more impactful for the hundreds of thousands of Europeans diagnosed with anaemia associated with CKD on dialysis," said John P. Butler, Chief Executive Officer of Akebia. ATI Real Life 2 0 Kidney Dise. Shemies, R.S. You may use all info from scenario to create your the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, Interestingly, the increase in UH, Acute kidney injury (AKI) is a worldwide concern since around half of the patients in the intensive care unit (ICU) develop this disease during their hospital stay, which is also associated with a higher mortality rate [, During AKI, the proximal tubular epithelium is exposed to hypoxic conditions [, We previously reported that SerpinA3K is an early biomarker of AKI and AKI to CKD transition in rats due to an upregulation in SerpinA3K expression. Verified questions. Advanced Care of the Adult/Older Adult (N566) 25 Documents. ; Zhang, M.-Z. See Full PDF Download PDF. fib with a rapid ventricular response w/ signs and symptoms It's estimated that chronic kidney disease affects about one in seven American adults. Which if the following medications should Nurse Chris anticipate administering? CT, MRI, GFR test, ultrasound, Serum electrolytes, BUN, creatinine; Hepokoski, M.; Singh, P. Mitochondria as mediators of systemic inflammation and organ cross talk in acute kidney injury. Nurse Sam is assessing Ms. Swisher's AV fistula prior to hemodialysis. Statistical significance was defined as. Type 1 Diabetes (T1D) is a chronic disease caused by autoimmune destruction of -cells found in pancreatic islets. All authors have read and agreed to the published version of the manuscript. A decrease of greater than 33% in the first 12 hours conferred a twofold elevated risk of dialysis or death.20, Urinalysis in combination with urine microscopy provides insight into the location and cause of acute kidney injury. SerpinaA3K(/) knockout (KOSA3) mice were acquired in The Jackson Laboratory under a genetic background C57BL/6NJ. ; Myers, R.R. The history can identify nephrotoxic medications or a systemic illness contributing to impaired renal function. Serum BUN and electrolyte concentration were automatically evaluated with a SYNCHRON System (Beckman Coulter, Brea, CA, USA). Khan, Y. H., Sarriff, A., Adnan, A. S., Khan, A. H., & Mallhi, T. H. (2016). Editors Choice articles are based on recommendations by the scientific editors of MDPI journals from around the world. A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast mediainduced acute kidney injury when compared with low-dose statins or placebo (ARR = 2.8%; NNT = 36). A universal definition and staging system for acute kidney injury proposed by the Kidney Disease: Improving Global Outcomes (KDIGO) group merges the earlier RIFLE (risk of renal dysfunction, injury to the kidney, failure of kidney function, loss of kidney function, end-stage renal disease) and Acute Kidney Injury Network definitions.79 The KDIGO system (Table 27) is used in this article. Other risks and uncertainties include those identified under the heading "Risk Factors" in Akebia's Annual Report on Form 10-K for the year ended December 31, 2022, and other filings that Akebia may make with the U.S. Securities and Exchange Commission in the future. 2023, 24, 7815. Nurse Chris should identify that which if the following findings indicates the effectiveness of furosemide? Kidney failure. He, W.; Wang, Y.; Zhang, M.-Z. Management of acute kidney injury is primarily supportive, with the goals of preventing further damage and promoting recovery of renal function. For more information, please visit our website at www.akebia.com, which does not form a part of this release. Explain the difference between open-die and impression-die forging. University Samuel Merritt University. ; Musall, J.B.; Sullivan, J.C.; Wei, Q.; Chen, J.-K.; et al. Ischemic causes include prolonged periods of severe hypotension, hypovolemia, or hypoperfusion to the kidneys (e.g., from hemorrhage, shock, sepsis, cirrhosis, peritonitis, or infarcts) that do not improve with rehydration.11 Nephrotoxic causes include endogenous and exogenous toxins. What are some variables that influence eyewitness testimony? Vadadustat is not approved by the U.S. Food and Drug Administration. All Rights Reserved. ; project administration, N.A.B. Severity of acute kidney injury is classified according to urine output and elevations in creatinine level. a. gag, When selecting a vein for an IV, the nurse generally selects the most ____________ vein on the hand or arm initially a. distal b. proximal 1 points QUESTION 2 When preparing the, QUESTION 1 Tracheal suctioning is a sterile procedure. Despite repositioning and turning, The Methodology of the Social Sciences (Max Weber), Civilization and its Discontents (Sigmund Freud), Psychology (David G. Myers; C. Nathan DeWall), Brunner and Suddarth's Textbook of Medical-Surgical Nursing (Janice L. Hinkle; Kerry H. Cheever), Business Law: Text and Cases (Kenneth W. Clarkson; Roger LeRoy Miller; Frank B. -Roast chicken thighs slow rate of fluid due to patient being in renal failure and Take notes as the scenario progresses so you can create an SBAR Handoff report. Download Free PDF View PDF. of excretion, Primary HCP, nursing, Acute interstitial nephritis, a common cause of acute kidney injury, is most often due to a hypersensitivity reaction to medications, usually an antibiotic or nonsteroidal anti-inflammatory drug.16 Acute interstitial nephritis related to proton pump inhibitors is increasingly common, especially in older people.17,18 Infections cause 5% to 10% of acute interstitial nephritis cases.16 Vascular causes of acute kidney injury include large vessel diseases, such as renal artery thrombosis; embolism; stenosis; and operative renal arterial clamping.11, Postrenal acute kidney injury is due to extrarenal obstruction of urinary flow. Table 4 summarizes common findings and associated diagnoses based on urine evaluation.21. Other diagnostic studies conducted to diagnose this condition include renal ultrasound, CT scan, and biopsy. A. use a 3mL syringe for admin of IV meds. This study was supported by grants from the Mexican Council of Science and Technology (CONACyT) (A1-S-8715 to NAB) and from the Universidad Nacional Autnoma de Mxico (IN201619 and IN201022 to NAB). CRF is diagnosed through laboratory studies including BUN, serum creatinine, serum electrolytes, and urinalysis. Surprisingly, we did not observe a notorious reduction in any of these parameters. Despite repositioning and turning, 2013 University of Texas at Arlington Page 1 of 2. his oxygen up, Mr. Jones O2 Sat is at 85%. AKI normally happens as a complication of another serious illness. See permissionsforcopyrightquestions and/or permission requests. Home Health Nurse Ariel and Ms. Swisher are discussing some of the ingredients contained in some of her favorite recipes that would align with her prescribed diet. Four key reasons: 1. Schunk, S.J. ; Hutchens, M.P. All articles published by MDPI are made immediately available worldwide under an open access license. Educate the patient about signs of high potassium and other risks.Patients with CRF are susceptible to hyperkalemia and hyponatremia. Zhou, T.; Chen, L.; Huang, C.; Lin, Z.; Zong, R.; Zhu, C.; Pan, F.; Ma, J.; Liu, Z.; Zhou, Y. Serine proteinase inhibitor SERPINA3K suppresses corneal neovascularization via inhibiting Wnt signaling and VEGF. real life RN : kidney disease 3.0 aTi. Damaged kidneys cannot produce as much urine. Which of the following statements by Ms. Swisher should indicate to Nurse Chris that teaching was effective? ; Hou, Y.-P.; Li, B. Hypoxia-inducible factor protects against acute kidney injury via the Wnt/b-catenin signaling pathway. As expected, I/R increased serum creatinine and BUN, with a GFR reduction in both genotypes; however, renal dysfunction was ameliorated in the KOSA3+IR group. https://www.prnewswire.com/news-releases/akebia-receives-european-commission-approval-for-vafseo-vadadustat-for-the-treatment-of-symptomatic-anaemia-associated-with-chronic-kidney-disease-in-adults-on-chronic-maintenance-dialysis-301807286.html, Do Not Sell My Personal Data/Privacy Policy. Zhu, C.; Pan, F.; Ge, L.; Zhou, J.; Chen, L.; Zhou, T.; Zong, R.; Xiao, X.; Dong, N.; Yang, M.; et al. Use clinical reasoning to promote, After obtaining a urine specimen for culture and sensitivity, Mrs. Jordan is prescribed a urinary antiseptic, nitrofurantoin 100 mg PO every 8 hours. The data distributions are represented as mean IC95%. Hoste, E.A.J. ; Cowan, P.J. All rights reserved. You may use any SBAR form of your choice. Educate on expectations.With CRF, urine production may increase and decrease. 4. background information No special showing signs of fluid overload. FOXO transcription factors: Their clinical significance and regulation. A rapidly evolving healthcare system 2. Su, L.; Zhang, J.; Gomez, H.; Kellum, J.A. However, the consequence of SerpinA3K deficiency in basal and in AKI conditions has not been reported. This appears to be mediated by an early upregulation of HIF-1 and sustained regulation of antioxidant enzymes, which could be promoted by a higher initial expression of intrarenal FOXO3. Acute kidney injury is defined as the sudden loss of kidney function over hours to days resulting in the inability to maintain electrolyte, acid-base, and water balance. admitted on 01/08/XX for shortness of breath and weakness. D. measure and document the exposed catheter daily. Some patients may also present in diabetic 5. Molecular Mechanisms of Kidney Injury and Repair. blood due to lack Hyperkalemia can cause muscle weakness, restlessness, cramping, and a slow heart rate. A22188, ThermoFisher Scientific, Waltham, MA, USA) following manufacturers instructions. Intrinsic renal causes of acute kidney injury are categorized by the location of the injury, most commonly the glomerulus or tubule, and include the interstitial or vascular portions of the kidney.11 Intrinsic acute kidney injury requires early identification and prompt subspecialty consultation. ; Fan, H.; Yang, H.-C.; Fogo, A.B. Throughout Europe, more than 200,000 dialysis patients are currently treated for anemia associated with CKD. Although pollen allergies can must bothersome, asthmatic responses to pollutants can be life threatening. National Kidney Foundation. Symptoms include: As the kidneys further deteriorate and lose their ability to filter out toxins, other organ systems become affected and irreversible damage may occur. N4455 Nursing Leadership and Management. Last set of Labs were Sodium 128, Potassium 5, BUN 44, Data Sources: This manuscript was based on literature identified in Essential Evidence Plus, PubMed Clinical Queries, the Agency for Healthcare Research and Quality, the Cochrane Database of Systematic Reviews, and Google Scholar using the search terms acute kidney injury and acute renal failure. showing signs and symptoms of poor perfusion. Her nursing career has led her through many different specialties including inpatient acute care, hospice, home health, case management, travel nursing, and telehealth, but her passion lies in educating through writing for other healthcare professionals and the general public. muscle weakness, Benzinga does not provide investment advice. The aim is to provide a snapshot of some of the Why is transformation needed? No. Nurse Sam is reviewing Ms. Swisher's EMR. Prerenal acute kidney injury is associated with decreased renal perfusion and glomerular filtration rate (GFR) caused by intravascular volume depletion secondary to hypovolemia, peripheral vasodilation, decreased arterial pressures, and impaired cardiac function resulting in decreased cardiac output.14 Sepsis is the most common cause of acute kidney injury seen in the intensive care unit (ICU).15 Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and nonsteroidal anti-inflammatory drugs are the most common medications that lower renal perfusion. Forward Looking StatementStatements in this press release regarding Akebia Therapeutics, Inc.'s ("Akebia's") strategy, plans, prospects, expectations, beliefs, intentions and goals are forward-looking statements within the meaning of the U.S. ; Floege, J.; Fliser, D.; Speer, T. WNT-catenin signallingA versatile player in kidney injury and repair. comparison, Notification that patient The fractional excretion of sodium and the fractional excretion of urea are used to identify prerenal azotemia. Sanchez-Navarro, A.; Gonzlez-Soria, I.; Caldio-Bohn, R.; Bobadilla, N.A. information; kidney hypertension, electrolyte 1. In April 2023, the European Commission granted marketing authorization for vadadustat for the treatment of symptomatic anaemia associated with chronic kidney disease in adults on chronic maintenance dialysis. Assess lung sounds.Adventitious lung sounds such as rales or crackles and dyspnea signal a complication of fluid retention. Question: Using the SBAR format, identify the information Nurse Allyson received from report that will enable her to provide safe care to Mr. Jones. __________________________________________________________, Active Learning Template medication Anticholinergic, Care of the childrearing family (nurs420), Biology: Basic Concepts And Biodiversity (BIOL 110), Introduction to Interpersonal Communications ( COMM 102), Professional Application in Service Learning I (LDR-461), Advanced Anatomy & Physiology for Health Professions (NUR 4904), Principles Of Environmental Science (ENV 100), Operating Systems 2 (proctored course) (CS 3307), Comparative Programming Languages (CS 4402), Business Core Capstone: An Integrated Application (D083), Lesson 12 Seismicity in North America The New Madrid Earthquakes of 1811-1812, CH 13 - Summary Maternity and Pediatric Nursing, Module One Short Answer - Information Literacy, Is sammy alive - in class assignment worth points, Kami Export - Jacob Wilson - Copy of Independent and Dependent Variables Scenarios - Google Docs, The cell Anatomy and division. Our results show that the attenuation in renal dysfunction after I/R observed in the KOSA3+IR group seems to be mediated by a better response against renal hypoxia. sodium bicarb, Ati real life kidney disease. Which of the following information from the EMR is the priority for Nurse Chris to report? of previous tests for Follow-up three months after hospitalization is reasonable if renal function is recovered (90% or greater from baseline), with earlier follow-up intervals (at three weeks and then again at three months) for patients with a slower recovery.43 Blood pressure, weight, serum creatinine level, and GFR should be measured at each visit. ; Prez-Villalva, R.; Uribe, N.; Bobadilla, N.A. Sameer Jog. Diabetes is a serious disease. The Company was founded in 2007 and is . Ortega-Trejo, J.A. ; Zent, R.; Harris, R.C. the date and time test Provide or restrict nutrition based on lab work.Electrolytes are found in many foods and fluids. In spite of severe renal injury induced by 30 min of I/R, the initial molecular response in the absence of SerpinA3K was different than in WT mice. have left out that you have questions about? prevention; dialysis ; Mizisin, A.P. SerpinA3 in the Early Recognition of Acute Kidney Injury to Chronic Kidney Disease (CKD) transition in the rat and its Potentiality in the Recognition of Patients with CKD. tubular obstruction, thus impairing/halting renal Pharmacist-led quality-improvement programs reduce nephrotoxic exposures and rates of acute kidney injury in the hospital setting. -Steamed broccoli Nurse Chris is reviewing Ms. Swisher's plan of care with Charge Nurse Rylie. A prospective study of patients in the ICU found that a chloride-restrictive strategy for resuscitation was associated with a lower incidence of acute kidney injury and need for renal replacement therapy. I want to also express my deep appreciation for our team at Akebia as the approval is a culmination of years of work and a demonstration of their commitment to bettering the lives of people impacted by kidney disease.". Give Me Liberty! Administer fluids with caution.Fluid therapy can help with promoting urinary elimination but can cause worsening fluid retention and electrolyte imbalances. from report that will enable her to provide safe care to Mr. Jones. No. Vadadustat is now approved in 32 countries. treat symptoms, renal biopsy, nephrotomy, x-ray, Spend at least 60 minutes working in the assigned Real Life scenario. Real Life Scenario COPD Module Assignment Part One. 9th Edition. ; Jing, J.; Wang, C.; Zhu, X.-X. CRF is categorized into stages based on the patient's glomerular filtration rate (GFR): Stage 1. Visit our dedicated information section to learn more about MDPI. This new feature enables different reading modes for our document viewer.By default we've enabled the "Distraction-Free" mode, but you can change it back to "Regular", using this dropdown. ab49900) overnight at 4 C. Which of the following findings should Nurse Sam identify as having a negative impact on Ms. Swisher's health outcome? Protocol-based strategies are recommended to prevent and improve acute kidney injury in high-risk patients (e.g., those who are postoperative or in septic shock).7 A randomized controlled trial (RCT) of 776 patients with septic shock compared outcomes with a mean arterial pressure goal of 65 to 70 mm Hg vs. a goal of 80 to 85 mm Hg. Hyponatremia can cause muscle cramps, nausea, disorientation, and alterations in mental status. ; et al. If fluid resuscitation is indicated, isotonic crystalloids (e.g., 0.9% normal saline, lactated Ringer solution, Plasma-Lyte A) are recommended over colloids (e.g., albumin, dextran) as the initial therapy. https://www.mdcalc.com/fractional-excretion-sodium-fena, https://www.mdcalc.com/fractional-excretion-urea-feurea, https://www.mdcalc.com/mean-arterial-pressure-map, Consistent evidence from RCTs showing no clear renal or mortality benefit of colloids over isotonic crystalloids, Evidence from cohort studies and a limited number of RCTs showing improved mortality and decreased need for renal replacement therapy, Evidence from a limited number of cohort studies showing improvements in hospital mortality and acute kidney injury progression, Consistent evidence from multiple RCTs and meta-analysis, Hemorrhage, gastrointestinal losses, renal losses, skin and mucous membrane losses, nephrotic syndrome, cirrhosis, capillary leak, Sepsis, cirrhosis, anaphylaxis, pharmacologic adverse effects, Cardiogenic shock, pericardial diseases, congestive heart failure, valvular diseases, pulmonary diseases, sepsis, Early sepsis, hepatorenal syndrome, acute hypercalcemia, pharmacologic adverse effects, iodinated contrast media, Hematologic disorders: hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, Inflammation: antiglomerular basement membrane disease, antineutrophil cytoplasmic antibody disease, infection, cryoglobulinemia, membranoproliferative glomerulonephritis, immunoglobulin A nephropathy, systemic lupus erythematosus, Henoch-Schnlein purpura, polyarteritis nodosa, Malignant hypertension, toxemia of pregnancy, hypercalcemia, radiocontrast media, scleroderma, pharmacologic adverse effects, Endogenous toxins: myoglobin, hemoglobin, paraproteinemia, uric acid, Exogenous toxins: antibiotics, chemotherapy agents, radiocontrast media, phosphate preparations, Vascular causes (e.g., large vessel diseases, such as renal artery thrombosis; embolism; stenosis; and operative renal arterial clamping), Arterial thrombosis, vasculitis, dissection, thromboembolism, venous thrombosis, compression, trauma, Bladder: neck obstruction, calculi, carcinoma, infection (schistosomiasis), Functional: neurogenic bladder, diabetes, multiple sclerosis, stroke, pharmacologic adverse effects (anticholinergics, antidepressants), Prostate: benign prostatic hypertrophy, carcinoma, infection, Urethral: posterior urethral valves, strictures, trauma, infections, tuberculosis, tumors, Retroperitoneal space tumors, pelvic or intra-abdominal tumors, retroperitoneal fibrosis, ureteral ligation or surgical trauma, granulomatous disease, hematoma, Nephrolithiasis, strictures, edema, debris, blood clots, sloughed papillae, fungal ball, malignancy, Acute or chronic tubulointerstitial injury, Leukocyturia, renal tubular epithelial cells, white blood cell casts, and granular casts, Drug-induced or endogenous crystalline nephropathy, Urinary acanthocytes and red blood cell casts, Renal tubular epithelial cells, renal tubular epithelial cell casts, and muddy brown casts, NSAIDs (ibuprofen, naproxen, ketorolac, celecoxib), ACEi (captopril, lisinopril, benazepril, ramipril), ARB (losartan, valsartan, candesartan, irbesartan), Analgesics (morphine, meperidine, gabapentin, pregabalin), Antivirals (acyclovir, ganciclovir, valganciclovir), Antimicrobials (almost all antimicrobials need dose adjustment in AKI, with important exceptions of azithromycin, ceftriaxone, doxycycline, linezolid, moxifloxacin, nafcillin, rifampin), Diabetic agents (sulfonylureas, metformin), Potassium level > 6.5 mEq per L (6.5 mmol per L), Urea nitrogen concentrations > 84 mg per dL (30 mmol per L), pH < 7.2 despite normal or low partial pressure of carbon dioxide in arterial blood, Pulmonary edema unresponsive to diuretics. Nursing Diagnosis: Impaired Urinary Elimination. Patients with CRF are often asymptomatic and early symptoms may not be recognized. ; funding acquisition, N.A.B. es, diuretics, Lactulose promotes the fecal excretion of electrolytes as well as ammonia, urea, and creatinine. The probes used are listed in, GraphPad prism version 8.0.1 was used to perform statistical analysis and graphs. 3. Inhibition of CTGF overexpression in Diabetic Retinopathy by SERPINA3K. . Discuss a real-life example of the Thoma. sc-11351), PGC-1 (1:1000; Invitrogen, Cat. Chronic kidney disease is a disease characterized by progressive damage and loss of function in the kidneys. ; Liu, K.D. Using information obtained from your notes; complete an individual SBAR and upload to Restrict fluids as indicated.When restricting fluid intake in patients with CFR, all forms of fluid intake must be considered including oral, intravenous, and enteral sources. across the patient care experience. All experiments involving animals were conducted in strict accordance with the NIH Guide for the Care and Use of Laboratory Animals and with the Mexican Federal Regulation for animal reproduction, care, and experimentation (NOM-062-ZOO-2001). Sirt1 activation protects the mouse renal medulla from oxidative injury. Use of periprocedural normal saline and minimizing the volume of contrast media reduce the risk of contrast mediainduced acute kidney injury.49 Sodium bicarbonatebased intravenous fluids are not superior to normal saline in preventing acute kidney injury.50, A meta-analysis of 15 RCTs (n = 6,532) showed that in patients undergoing coronary angiography or percutaneous coronary intervention, high-dose statins (e.g., atorvastatin [Lipitor], rosuvastatin [Crestor], simvastatin [Zocor]) reduced the incidence of contrast mediainduced acute kidney injury when compared with low-dose statins or placebo (ARR = 2.8%; NNT = 36).51 A Cochrane review of 72 studies (n = 4,378) found no convincing evidence that any pharmacologic intervention reduces the risk of acute kidney injury during the perioperative period.52, This article updates previous articles on this topic by Rahman, et al.13 ; Needham53 ; and Agrawal and Swartz.54. A fractional excretion of urea less than 35% suggests a prerenal cause, whereas a value greater than 50% suggests an intrinsic cause. Author disclosure: No relevant financial affiliations. diagnosis and date of function promotion, Cross), Campbell Biology (Jane B. Reece; Lisa A. Urry; Michael L. Cain; Steven A. Wasserman; Peter V. Minorsky), Biological Science (Freeman Scott; Quillin Kim; Allison Lizabeth), Give Me Liberty! associated with patient instability. ATI Real Life 2.0: Kidney disease Scenario Tutorial: Real Life RN Medical Surgical 2.0 Module: Kidney Disease 1. A fractional excretion of sodium less than 1% suggests a prerenal cause of acute kidney injury, whereas a value greater than 2% suggests an intrinsic cause. General management principles for acute kidney injury include determination of volume status, fluid resuscitation with isotonic crystalloid, treatment of volume overload with diuretics, discontinuation of nephrotoxic medications, and adjustment of prescribed drugs according to renal function. The results presented in this paper have not been published previously in whole or in part. Serum creatinine or urine output can be used for diagnosis of acute kidney injury, although patients who meet diagnostic criteria for both are at increased risk of mortality from renal replacement therapy and hospitalization.7,19, Creatinine clearance is a direct measure of GFR, and serial creatinine clearance testing provides a more efficient and accurate assessment of renal function than serum creatinine testing.20 Creatinine clearance can be performed in collection periods of one to 24 hours, although longer collection times increase the likelihood of errors related to inaccurate time recording and incomplete collection.6 A cohort study of 484 patients in the ICU found that four-hour creatinine clearance testing is a valid measurement of acute kidney injury (defined as an increase in serum creatinine greater than 50% in the control group or a decrease in creatinine clearance greater than 33% in the intervention group).