Overview of pseudo-acute kidney injury

Acute kidney injury (AKI), a common complication among hospitalized patients, is associated with significant morbidity and mortality. Pseudo-AKI, a condition in which serum creatinine levels meet AKI diagnostic criteria despite a preserved glomerular filtration rate, presents diagnostic challenges. It is frequently misdiagnosed or overlooked in clinical practice, potentially leading to unnecessary interventions or diagnostic delays. Pseudo-AKI is caused by the derangement in pathways of creatinine metabolism and handling, including increased creatinine production, reduced tubular creatinine secretion, sampling or assay interference, and urine extravasation. In this review, we provide an overview of the definition, epidemiology, pathophysiology, mechanisms, diagnosis, and management of pseudo-AKI, with the aim of raising important scientific questions that warrant further exploration.