2026/03/26 by Ran Jiang, Yafeng Huang, Lingling Deng +3 · 1 voice
Medicine · #Acute Kidney Injury Research #Chronic Kidney Disease and Diabetes #Kidney Stones and Urolithiasis Treatments
paper · pdf · doi:10.1016/j.ekir.2026.106512
openalex publication_date 2026/03/26 · openalex created_date 2026/03/27 · openalex updated_date 2026/07/23
Introduction We conducted a proof-of-concept study to evaluate the diagnostic performance of the serum creatinine/cystatin C ratio (CrCyR) in distinguishing pseudo-acute kidney injury (AKI) from true AKI. Methods This study included patients with confirmed AKI (excluding rhabdomyolysis) at the First Affiliated Hospital of Nanjing Medical University (May 2023–August 2024) and pseudo-AKI cases identified through a literature review (1994–2025). CrCyR values (unit: L/dL) measured before (CrCyR pre ) and during AKI onset (CrCyR post ) were collected. Diagnostic performance of CrCyR post was assessed using the area under the receiver-operating-characteristic curve (AUC). Results Of 239 patients, 197 had true AKI and 42 had pseudo-AKI (mechanisms: reduced creatinine excretion [n=18], assay interference [n=14], urine leakage [n=7], and increased creatinine production [n=3]). Median CrCyR post was significantly higher in the pseudo-AKI group than in the true AKI group (1.89 [IQR, 1.32–3.28] vs. 0.78 [0.64–0.94] L/dL; P<0.001). CrCyR post showed a preliminary AUC of 0.97 (95% CI, 0.95–1.00); an exploratory threshold of >1.11 L/dL yielded 95% sensitivity and 91% specificity for diagnosing pseudo-AKI. After adjustment for age and sex, the covariate-adjusted AUC remained high at 0.98 (0.96–1.00). Diagnostic utility was consistently high across pseudo-AKI subtypes (AUCs: 1.00 for assay interference, urine leakage, and increased creatinine production; 0.94 for reduced creatinine excretion). A cross-center robustness assessment using true AKI patients from the Salzburg Intensive Care database suggested consistent diagnostic utility (AUC 0.94 [0.90–0.98]) in Europeans. Conclusion CrCyR post preliminarily demonstrates promising diagnostic accuracy for distinguishing pseudo-AKI from true AKI. Further validation in prospective studies is warranted.