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[Correspondence] The definition of acute kidney injury – Authors’ reply

We thank John A Kellum and Norbert Lameire for their letter in response to our Comment.1 An acute increase in serum creatinine (sCr) is caused by direct injury to kidney cells (ie, pathophysiological processes resulting from ischaemia, sepsis, medications, metals, or enzymes) or a compromise in cardiovascular homoeostasis (ie, substantial volume depletion,2 congestive heart failure,3 or portal hypertension4). Hence, we appreciate that an acute rise in sCr can indicate several pathophysiological processes with worsened patient population outcomes.