Acute kidney injury

Kidney Disease: Improving Global Outcomes (KDIGO) - definition criteria[1]Kidney disease: improving global outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012 Mar;2(1):1-138. https://kdigo.org/guidelines/acute-kidney-injury/

Any of the following:

• Increase in serum creatinine by ≥26 micromol/L (≥0.3 mg/dL) within 48 hours; or

• Increase in serum creatinine to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or

• Urine volume <0.5 mL/kg/hour for 6 hours.

Kidney Disease: Improving Global Outcomes (KDIGO) - severity criteria[1]Kidney disease: improving global outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012 Mar;2(1):1-138. https://kdigo.org/guidelines/acute-kidney-injury/

• Stage 1

  • Serum creatinine 1.5 to 1.9 times baseline; or

  • ≥26 micromol/L (≥0.3 mg/dL) increase in serum creatinine; or

  • Urine output <0.5 mL/kg/hour body weight for 6 to 12 hours

• Stage 2

  • Creatinine increased 2.0 to 2.9 times; or

  • Urine output <0.5 mL/kg/hour for 12 hours or longer

• Stage 3

  • Creatinine increased ≥3.0 times; or

  • Increase in creatinine to ≥354 micromol/L (≥4.0 mg/dL); or

  • Initiation of renal replacement therapy; or

  • Urine output <0.3 mL/kg/hour for 24 hours OR anuria for 12 hours.

RIFLE (Risk, Injury, Failure, Loss of kidney function, and Endstage kidney disease) consensus criteria[69]Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004 Aug;8(4):R204-12. https://ccforum.biomedcentral.com/articles/10.1186/cc2872 http://www.ncbi.nlm.nih.gov/pubmed/15312219?tool=bestpractice.com

Laboratory test indicates reduced kidney clearance.

Severity groups are as follows.

• Indicates risk:

  • Serum creatinine increased 1.5 times; or

  • Urine production of <0.5 mL/kg body weight for 6 hours.

• Indicates injury:

  • Creatinine increased 2.0 times; or

  • Urine production of <0.5 mL/kg for 12 hours.

• Indicates failure:

  • Creatinine increased 3.0 times; or

  • Urine output <0.3 mL/kg for 24 hours or anuria for 12 hours.

• Indicates loss:

  • Persistent AKI for more than 4 weeks; complete loss of kidney function.

• Indicates ESRD:

  • ESRD (loss >3 months).

National Institute for Health and Care Excellence: detecting acute kidney injury[3]National Institute for Health and Care Excellence. Acute kidney injury: prevention, detection and management. December 2019 [internet publication]. https://www.nice.org.uk/guidance/ng148

Detect AKI, in line with the RIFLE, Acute Kidney Injury Network (AKIN), or KDIGO definitions, by using any of the following criteria:

• A rise in serum creatinine of 26 micromol/L (0.3 mg/dL) or greater within 48 hours; or

• A 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days; or

• A fall in urine output to <0.5 mL/kg/hour for more than 6 hours in adults and more than 8 hours in children and young people; or

• A 25% or greater fall in estimated GFR in children and young people within the past 7 days.