[Comment] Acute kidney injury: a problem of definition

Individuals with acute kidney impairment can have defects in the excretion of water, salts, and metabolic products, including creatinine. Classical nephrology taught that defective kidney excretion should be described on the basis of aetiology and anatomy. We learned to approach the patient with a pathophysiological focus: was the cause of defective excretion due to extrarenal volume deficiency, impaired blood perfusion, intrinsic kidney causes, or post-renal causes? If intrinsic damage was found, was the cause primarily related to sepsis, ischaemia, drugs or toxins, interstitial or glomerular causes, or a combination of the above? These categories were useful because they provided prospective insights into the clinical course and suggested appropriate therapeutic interventions.

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