Furosemide Stress Test and Biomarkers for the Prediction of AKI Severity

Acute kidney injury (AKI) is widely prevalent in the intensive care unit and is associated with significant morbidity and mortality. However, no accurate prediction model exists to determine which AKI cases will progress and, if so, to what severity. Chawla et al developed and standardized a furosemide stress test (FST), and Koyner et al assessed the utility of the FST plus biomarkers for prediction of AKI severity. The development of the FST and utility of the FST plus biomarkers were studied in the same two cohorts. Ultimately, the studies proposed, respectively, that (1) the FST in early AKI identifies those with severe and progressive AKI, and (2) the addition of biomarker levels to the FST improves the risk stratification of these patients.

In the end, the FST showed that, at the two-hour time point, urine output of 200 mL or less had the best sensitivity and specificity to predict progression to Acute Kidney Injury Network (AKIN) stage 3. The studies also showed that the FST was superior to the panel of biochemical biomarkers for all end points.

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