Increased prevalence of acute interstitial nephritis: more disease or simply more detection?

significant amount of T-wave changes from the baseline. An understandable shortcoming of this paper was the lack of a baseline ECG in the absence of hyperkalemia which could be used for comparison. This left the authors unable to determine if the effects on the ECG were from hyperkalemia or from intrinsic heart disease. Immediate short-term reversibility of ‘tented’ T-wave or other signs of hyperkalemia (P–R interval, QRS duration, QTc interval, etc.) with intravenous infusion of calcium, in a patient with true hyperkalemia-related ECG changes, is used at our institution as a diagnostic tool to evaluate the effect of hyperkalemia on cardiac conduction. This physiological approach can be used to assess the risk of hyperkalemia for the patient in the acute clinical setting and also warrants systematic study. Importantly, this study emphasizes how essential it is for clinicians to be competent in the interpretation of an ECG using the clinical content rather than solely relying on a computer’s interpretation. While a formal curriculum on ECG interpretation is required in internal and emergent medicine programs, proof of competency is not assessed by the majority of them. Furthermore, this paper provides a framework for further study into the management of hyperkalemia. The authors have made a significant start to systematically study the predictive tools for adverse events in hyperkalemia. Clearly, this is an area that deserves further study and innovation.