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  • Oliguric period of ≥6h (<0.5mL/kg/h) or SCr ↑ of either 50–100% or ≥0.3mg/dL ≤48h (Crit Care Med 2007;11:R31; Crit Care Med 2004;8:R204)
  • Abrupt ↓ in renal function with inability to excrete metabolic waste & maintain fluid & electrolyte balance (JAMA 2003;289:747)

Epidemiology: occurs in 7% of all hospitalized patients & 36–67% of critically ill; 5–6% of ICU patients with AKI require renal replacement therapy (RRT) (Crit Care Med 2010;38:261; Crit Care Med 2010;38:S169)

Prognosis: associated with ↑ mortality, length of hospital stay, hospital costs, end-stage renal disease (Clin J Am Soc Nephrol 2009;4:891); mortality as high as 50–70% in patients with severe AKI requiring RRT (Crit Care 2010;38:261)

(JAMA 2003;289:747)

  • Prerenal: any condition leading to ↓ renal perfusion (e.g., ↓ cardiac output, hypotension, dehydration, hemorrhage)
  • Intrinsic: affects renal structures such as glomeruli, tubules, vessels, or interstitium; acute tubular necrosis (ATN) = most common condition
  • Postrenal: obstruction of urinary flow (5% of cases)
  • 5 most common causes in ICU: sepsis (most common), major surgery, ↓ cardiac output, hypovolemia, drug-induced (including toxins such as radiocontrast media)
  • Drug-induced AKI: 20% of AKI cases in ICU related to medications (JAMA 2005;294:813)

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Clinical Pearl 15-1

Prerenal azotemia & ATN account for 75% of all AKI cases.

Table 15-1 Drug-Induced AKI
Table 15-2 Classification & Laboratory Findings in AKI

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