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Atypical AKI. A complementary problem to pseudo-AKI is the situation where a case of AKI fails to meet the definition. These cases should be distinguished from conditions in which data are simply missing (discussed above) and refer to situations in which existing data are unreliable. For example, a patient might receive very large quantities of intravascular fluids such that SCr is falsely lowered.65 Similarly, massive blood transfusions will result in the SCr more closely reflecting the kidney function of the blood donors than the patient. It is unusual for these cases not to result in oliguria and, thus, most patients will be diagnosed with AKI even if SCr is not increased. Nevertheless, the clinician should be cognizant of possibility that SCr may be falsely lowered by large-volume fluid resuscitation or transfusion; thus, a normal value may not rule out AKI. Changes in creatinine production are also well known in conditions such as muscle breakdown where production increases and in muscle wasting (including advanced liver disease) where production is decreased. Creatinine production may also be decreased in sepsis66 possibly due to decreased muscle perfusion.
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