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Acute Kidney Injury

SOURCE

Source: Halilovic J, Dager W. Acute kidney injury. In: DiPiro, JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861&sectionid=134127206. Accessed December 6, 2016.

DEFINITION

  • Wide continuum of abrupt damage to kidneys, ranging from mild renal dysfunction to need for renal replacement therapies (RRTs), such as hemodialysis and peritoneal dialysis.

  • Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Renal Disease (RIFLE) and Acute Kidney Injury Network (AKIN) criteria and Kidney Disease: Improving Global Outcomes (KDIGO) are classification systems based on separate criteria for serum creatinine (Scr) and urine output used to stage severity of AKI (Table 1).

    • AKIN criteria require a time constraint of 48 hours for diagnosis.

TABLE 1.abcRIFLE and AKIN Classification Schemes for Acute Kidney Injurya
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TABLE 1. RIFLE and AKIN Classification Schemes for Acute Kidney Injurya
RIFLE category Scr or GFRb criteria Urine output criteria
Risk Scr increase to 1.5-fold or GFR decrease >25% from baseline <0.5 mL/kg/h for ≥6 h
Injury Scr increase to 2-fold or GFR decrease >50% from baseline <0.5 mL/kg/h for ≥12 h
Failure Scr increase to 3-fold or GFR decrease >75% from baseline, or Scr ≥4 mg/dL (≥354 μmol/L) with acute increase of at least 0.5 mg/dL (44 μmol/L) Anuria for ≥12 h
Loss Persistent acute renal failure = complete loss of function (RRT) for >4 weeks
ESKD RRT >3 months
AKIN criteria Scr criteria Urine output criteria
Stage 1 Scr increase ≥0.3 mg/dL (≥27 μmol/L) or 1.5- to 2-fold from baseline <0.5 mL/kg/h for ≥6 h
Stage 2 Scr increase >2- to 3-fold from baseline <0.5 mL/kg/h for ≥12 h
Stage 3 Scr increase >3-fold from baseline or Scr ≥4 mg/dL (≥354 μmol/L), with acute increase of at least 0.5 mg/dL (44 μmol/L) or need for RRT <0.3 mL/kg/h for ≥24 h or anuria for ≥12 h
KDIGO criteria Scr criteria Urine output criteria
Stage 1 Scr increase ≥0.3 mg/dL (≥27 μmol/L) or 1.5- to 1.9 times from baseline <0.5 mL/kg/h for 6–12 h
Stage 2 Scr increase 2–2.9 times from baseline <0.5 mL/kg/h for ≥12 h
Stage 3 Scr increase >3 times from baseline or Scr ≥4 mg/dL (≥354 μmol/L), or need for RRR, or eGFRc <35 mL/min/1.73 m2 (<0.34 mL/min/1.73 m2) in patients <18 years Anuria for ≥12 h

AKI, acute kidney injury; AKIN, Acute Kidney Injury Network; eGFR, estimated glomerular filtration rate; ESKD, end-stage kidney disease; h, hours; KDIGO, Kidney Disease: Improving Global Outcomes; RIFLE, Risk, Injury, Failure, Loss of Kidney Function, and End-Stage Kidney Disease; RRT, renal replacement therapy; Scr, serum ...

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