153 Acute kidney injury in SAB 7 This is relevant, as falsely attributing AKI to beta-lactams may deter a patient from optimal antibiotic treatment. The current lack of non-invasive diagnostic tools to differentiate between the divergent etiologies of AKI in SAB leads to misdiagnoses that cannot be refuted. Insight in the etiology of AKI in SAB and the probability of different causal mechanisms has important diagnostic and therapeutic consequences and warrants prospective studies, focusing on etiology. Urine biomarkers could possibly be of additional value herein, but still need future research. An association between occurrence of AKI and 30-day mortality in patients with SAB was previously reported and confirmed in this study [22]. Although causality cannot be determined based on either study, AKI is likely to affect patient outcome on theoretical grounds. Patients with AKI— in general—are at increased future risk of chronic kidney disease and death [23]. The high burden of morbidity and mortality stresses the importance of further studies on AKI in SAB. An important limitation of our study is the fact that the cause of AKI was rarely proven histologically, limiting insights in the etiology of SAB in our population. The lack of biopsy-confirmed etiologic diagnoses in both our study and previously mentioned studies is a reflection of daily practice, as renal biopsies are rarely performed [10–14, 17, 18]. A second limitation of this study is the retrospective design. Variables that were not measured—such as aminoglycoside therapy— may be associated with the development of AKI in SAB. In conclusion, this study shows that AKI is common in patients with SAB. The risk factors found, and the swift reversibility in most patients, suggest that a major cause for AKI is hemodynamic in nature. This knowledge may provide insights that support diagnostic and therapeutic management of patients with SAB. Future prospective intervention studies are warranted to evaluate the underlying pathophysiology and potential interventions.
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