{
  "abstract": "Background Acute kidney injury (AKI) is a frequent condition among patients presenting to the emergency department (ED). Obstructive AKI constitutes a urological emergency requiring rapid diagnosis and intervention. The objective of this study was to derive and internally validate a predictive model of obstructive AKI in ED.Methods We conducted a retrospective derivation and internal validation cohort study. Adult patients presenting to the EDs of Toulouse University Hospital with AKI of any Kidney Disease: Improving Global Outcomes (KDIGO) stage between 1 July and 31 December 2019 were eligible. Included patients were randomly assigned in a 2:1 ratio to a derivation cohort (DC) and an internal validation cohort (VC). The primary outcome was obstructive AKI, defined as hydronephrosis identified on imaging and requiring either urological intervention or Foley catheter insertion. A risk stratification decision tree was developed (Kidney Injury Tree For Identification of obSTructive Origin (KIT-FISTO) model).Results The prevalence of obstructive AKI was 9% in the DC (64/727) and 7% in the VC (27/364). Patients presenting with lumbar, flank or hypogastric pain were classified as ‘high risk’ in each cohort, with a corresponding obstructive AKI risk of 55% (95% CI 45% to 64%) and 54% (95% CI 39% to 69%), respectively. Patients without pain but with a history of urinary tract surgery, abdominal cancer, a solitary functional kidney or prostatic hyperplasia were classified as ‘moderate risk’, with obstructive AKI risks of 4% (95% CI 1% to 10%) and 2% (95% CI 0% to 12%), respectively. All remaining patients (>70%) were classified as ‘low risk’, with an observed obstructive AKI risk of 0% (95% CI 0% to 1%). ‘Low risk’ classification had a sensitivity of 98% (95% CI 92% to 100%) and 96% (95% CI 81% to 100%), respectively.Conclusion The KIT-FISTO was derived and internally validated to predict obstructive AKI in ED, but requires external and prospective validation before implementation.",
  "authors": [
    {
      "affiliations": [
        "Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France",
        "The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada"
      ],
      "name": "Frederic Balen"
    },
    {
      "affiliations": [
        "Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France",
        "CERPOP, Toulouse, Occitanie, France"
      ],
      "name": "Xavier Dubucs"
    },
    {
      "affiliations": [
        "Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Coralie Roux"
    },
    {
      "affiliations": [
        "Département de Néphrologie et transplantation d’organes, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Pierre Guy"
    },
    {
      "affiliations": [
        "Urologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Florian Laclergerie"
    },
    {
      "affiliations": [
        "Urologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Xavier Game"
    },
    {
      "affiliations": [
        "Gériatrie, Centre Hospitalier Universitaire de Toulouse, Toulouse, Occitanie, France",
        "Institute on Aging, IHU HealthAge, Toulouse, France"
      ],
      "name": "Zara Steinmeyer"
    },
    {
      "affiliations": [
        "Service d’explorations physiologiques fonctionnelles, Centre Hospitalier Universitaire de Toulouse, Toulouse, France"
      ],
      "name": "Ivan Tack"
    },
    {
      "affiliations": [
        "Emergency Department, Centre Hospitalier Universitaire de Toulouse, Toulouse, France",
        "CERPOP, Toulouse, Occitanie, France"
      ],
      "name": "Sandrine Charpentier"
    },
    {
      "affiliations": [
        "The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada",
        "University of Ottawa Department of Emergency Medicine, Ottawa, Ontario, Canada"
      ],
      "name": "Venkatesh Thiruganasambandamoorthy"
    }
  ],
  "title": "Risk of obstructive acute kidney injury: derivation and internal validation of a risk stratification tree",
  "uid": "4fad9ff2-c247-5f37-9eb4-02d79b91dd14"
}