Acute renal failure definition
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Overview
Over 30 different definitions of AKI have been used in the literature since it was first described. The first consensus definition described and the most used definition is known as the RIFLE criteria. The acronym combines a classification of 3 levels of renal dysfunction (Risk, Injury, Failure) with 2 clinical outcomes (Loss, ESRD) to give the RIFLE stages of AKI.
Definition
Over 30 different definitions of AKI have been used in the literature since it was first described, which prompted the need for a uniform definition. In 2004, The Acute Dialysis Quality Initiative (ADQI) proposed the first consensus definition known as the RIFLE criteria. The acronym combines a classification of 3 levels of renal dysfunction (Risk, Injury, Failure) with 2 clinical outcomes (Loss, ESRD). This unified classification was proposed to enable a viable comparison in trials of prevention and therapy and to observe clinical outcomes of the defined stages of AKI. [1]
| CLASSIFICATION | GFR CRITERIA | URINE OUTPUT CRITERIA |
| Risk | 1.5x increase in SCr or GFR decrease >25% | <0.5 mL/kg/h for 6 hours |
| Injury | 2x increase in SCr or GFR decrease >50% | <0.5 mL/kg/h for 12 hours |
| Failure | 3x increase in SCr or GFR decrease >75% | <0.3 mL/kg/h for 24 hours or anuria for 12 hours |
| Loss | Complete loss of renal function >4 weeks | |
| End Stage Renal Disease | Complete loss of renal function >3 months | |
In 2007, the Acute Kidney Injury Network (AKIN) proposed modified diagnostic criteria based on the RIFLE criteria. AKI was defined as an acute increase in the serum creatinine of ≥0.3 mg/dL from baseline within 48 hours, a 50% increase in the serum creatinine concentration, or oliguria <0.5 mL/kg/h for 6 hours (following volume status optimization). The staging criteria retained the Risk, Injury, & Failure stages from the RIFLE criteria, with modifications related to serum creatinine increase. [2]
| CLASSIFICATION | SERUM CREATININE CRITERIA | URINE OUTPUT CRITERIA |
| Stage 1 | Increase in SCr ≥0.3 mg/dL or 1.5x to 2x increase from baseline | <0.5 mL/kg/h for 6 hours |
| Stage 2 | 2x to 3x increase in SCr from baseline | <0.5 mL/kg/h for 12 hours |
| Stage 3 | >3x increase in SCr or SCr≥ 4.0 mg/dL with acute increase >0.5 mg/dL | <0.3 mL/kg/h for 24 hours or anuria for 12 hours |
In March 2012, the Kidney Disease – Improving Global Outcomes (KDIGO) Clinical Practice Guidelines for Acute Kidney Injury retained the AKIN staging criteria while implementing modifications to the definition of AKI. AKI was defined as either an increase in serum creatinine by 50% in 7 days, an increase in serum creatinine by 0.3 mg/dL in 2 days, or anuria for more than 12 hours. [3]
References
- ↑ Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup (2004). "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. 8 (4): R204–12. doi:10.1186/cc2872. PMC 522841. PMID 15312219.
- ↑ Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG; et al. (2007). "Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury". Crit Care. 11 (2): R31. doi:10.1186/cc5713. PMC 2206446. PMID 17331245.
- ↑ Acute Kidney Injury Work Group (2012). "KDIGO Clinical Practice Guideline for Acute Kidney Injury". Kidney inter. 6 (2): 1–138. Text " doi:10.1038/kisup.2012.6 " ignored (help)