Acute kidney injury diagnostic study of choice: Difference between revisions

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__NOTOC__
__NOTOC__
{{Acute kidney injury}}
{{Acute kidney injury}}
{{CMG}}; {{AE}}
{{CMG}}; {{AE}} {{F.K}}
== Overview ==
== Overview ==
Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output. In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical [[outcome]].


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
 
* Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output.
=== Study of choice ===
* In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical [[outcome]]. <ref name="doi10.1038/kisup.2011.34">{{cite journal|author=Kidney Disease Improving Global Outcomes Work Group| title=2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury| journal=Kidey Int Supp |year= 2012 | volume= 2 | pages= 69-88 |doi=10.1038/kisup.2011.34 | pmc=|url=http://www.nature.com/kisup/journal/v2/n1/full/kisup201134a.html }} </ref>  The rationale behind AKI staging is the needed to determine overall outcome as higher stags of AKI carry a greater risk of all cause and [[cardiovascular]] [[mortality]], renal replacement, as well as [[chronic kidney disease]] even after AKI resolution.<ref name="pmid16715038">{{cite journal| author=Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C| title=An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. | journal=Crit Care Med | year= 2006 | volume= 34 | issue= 7 | pages= 1913-7 | pmid=16715038 | doi=10.1097/01.CCM.0000224227.70642.4F | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16715038 }} </ref><ref name="pmid17962378">{{cite journal| author=Bagshaw SM, George C, Dinu I, Bellomo R| title=A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. | journal=Nephrol Dial Transplant | year= 2008 | volume= 23 | issue= 4 | pages= 1203-10 | pmid=17962378 | doi=10.1093/ndt/gfm744 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17962378 }} </ref><ref name="pmid18160961">{{cite journal| author=Ricci Z, Cruz D, Ronco C| title=The RIFLE criteria and mortality in acute kidney injury: A systematic review. | journal=Kidney Int | year= 2008 | volume= 73 | issue= 5 | pages= 538-46 | pmid=18160961 | doi=10.1038/sj.ki.5002743 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18160961 }} </ref><ref name="pmid17314324">{{cite journal| author=Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W et al.| title=Incidence and outcomes in acute kidney injury: a comprehensive population-based study. | journal=J Am Soc Nephrol | year= 2007 | volume= 18 | issue= 4 | pages= 1292-8 | pmid=17314324 | doi=10.1681/ASN.2006070756 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17314324 }} </ref>
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The following result of [gold standard test] is confirmatory of [disease name]:
* [Result 1]
* [Result 2]
 
OR
 
[Name of the investigation] must be performed when:
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.
 
OR
 
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
 
OR
 
The diagnostic study of choice for [disease name] is [name of the investigation].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
 
OR
 
[Disease name] is primarily diagnosed based on the clinical presentation.
 
OR
 
Investigations:
* Among patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
* Among patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
* Among patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
 
==== The comparison of various diagnostic studies for [disease name] ====
{|
{|
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |2012 KDIGO AKI Guidelines - Proposed staging criteria for AKI modified from AKIN
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Staging'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''GFR criteria'''
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background:#4479BA; color: #FFFFFF;" align="center" + |'''Urine output criteria'''
|-
| style="background:#DCDCDC;" align="center" + |'''Stage 1'''
| style="background:#F5F5F5;" + | 1.5 - 1.9 times baseline or  ≥ 0.3 mg/dl increase
| style="background:#F5F5F5;" + |<0.5 ml/kg/h for 6 - 12 hours
|-
| style="background:#DCDCDC;" align="center" + |'''Stage 2'''
| style="background:#F5F5F5;" + |2.0 - 2.9 times baseline
| style="background:#F5F5F5;" + |<0.5 ml/kg/h for ≥ 12 hours
|-
| style="background:#DCDCDC;" align="center" + |'''Stage 3'''
| style="background:#F5F5F5;" + |3.0 times baseline <br> '''or''' increase in serum creatinine to 4.0 mg/dL <br> '''or'''  initiation of renal replacement therapy <br> '''or''' decrease in eGFR to <35 ml/min per 1.73 m<sup>2</sup> (in patients <18 years)
| style="background:#F5F5F5;" + |<0.3 mL/kg/h for 24 hours <br> '''or''' <br> anuria for 12 hours
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
* The guidelines also advocated that in case of discordance between [[urine output]] and serum creatinine patients should be classified to the highest applicable AKI stage. Also, new emphasis on the differences seen in the [[pediatric]] population gave rise to revised definition of Stage 3 AKI in patients less than 18 years of age.<ref name="doi10.1038/kisup.2011.34">{{cite journal|author=Kidney Disease Improving Global Outcomes Work Group| title=2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury| journal=Kidey Int Supp |year= 2012 | volume= 2 | pages= 69-88 |doi=10.1038/kisup.2011.34 | pmc= |url=http://www.nature.com/kisup/journal/v2/n1/full/kisup201134a.html }} </ref>
 
===== Diagnostic results =====
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] should be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
=== Diagnostic Criteria ===
* Here you should describe the details of the diagnostic criteria.
*Always mention the name of the criteria/definition you are about to list (e.g. modified Duke criteria for the diagnosis of endocarditis / 3rd universal definition of MI) and cite the primary source of where this criteria/definition is found.
*Although not necessary, it is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.
*Be very clear as to the number of criteria (or threshold) that needs to be met out of the total number of criteria.
*Distinguish criteria based on their nature (e.g. clinical criteria / pathological criteria/ imaging criteria) before discussing them in details.
*To view an example (endocarditis diagnostic criteria), click [[Endocarditis diagnosis|here]]
*If relevant, add additional information that might help the reader distinguish various criteria or the evolution of criteria (e.g. original criteria vs. modified criteria).
*You may also add information about the sensitivity and specificity of the criteria, the pre-test probability, and other figures that may help the reader understand how valuable the criteria are clinically.
* [Disease name] is mainly diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
* There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
* The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
* The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
* [Disease name] may be diagnosed at any time if one or more of the following criteria are met:
** Criteria 1
** Criteria 2
** Criteria 3
 
IF there are clear, established diagnostic criteria:
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
*The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
*The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
IF there are no established diagnostic criteria: 
*There are no established criteria for the diagnosis of [disease name].


==References==
==References==

Latest revision as of 13:55, 24 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farima Kahe M.D. [2]

Overview

Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output. In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical outcome.

Diagnostic Study of Choice

  • Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output.
  • In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical outcome. [1] The rationale behind AKI staging is the needed to determine overall outcome as higher stags of AKI carry a greater risk of all cause and cardiovascular mortality, renal replacement, as well as chronic kidney disease even after AKI resolution.[2][3][4][5]
2012 KDIGO AKI Guidelines - Proposed staging criteria for AKI modified from AKIN
Staging GFR criteria Urine output criteria
Stage 1 1.5 - 1.9 times baseline or ≥ 0.3 mg/dl increase <0.5 ml/kg/h for 6 - 12 hours
Stage 2 2.0 - 2.9 times baseline <0.5 ml/kg/h for ≥ 12 hours
Stage 3 3.0 times baseline
or increase in serum creatinine to 4.0 mg/dL
or initiation of renal replacement therapy
or decrease in eGFR to <35 ml/min per 1.73 m2 (in patients <18 years) 		<0.3 mL/kg/h for 24 hours
or
anuria for 12 hours
  • The guidelines also advocated that in case of discordance between urine output and serum creatinine patients should be classified to the highest applicable AKI stage. Also, new emphasis on the differences seen in the pediatric population gave rise to revised definition of Stage 3 AKI in patients less than 18 years of age.[1]

References

  1. ↑ 1.0 1.1 Kidney Disease Improving Global Outcomes Work Group (2012). "2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury". Kidey Int Supp. 2: 69–88. doi:10.1038/kisup.2011.34.
  2. ↑ Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006). "An assessment of the RIFLE criteria for acute renal failure in hospitalized patients". Crit Care Med. 34 (7): 1913–7. doi:10.1097/01.CCM.0000224227.70642.4F. PMID 16715038.
  3. ↑ Bagshaw SM, George C, Dinu I, Bellomo R (2008). "A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients". Nephrol Dial Transplant. 23 (4): 1203–10. doi:10.1093/ndt/gfm744. PMID 17962378.
  4. ↑ Ricci Z, Cruz D, Ronco C (2008). "The RIFLE criteria and mortality in acute kidney injury: A systematic review". Kidney Int. 73 (5): 538–46. doi:10.1038/sj.ki.5002743. PMID 18160961.
  5. ↑ Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W; et al. (2007). "Incidence and outcomes in acute kidney injury: a comprehensive population-based study". J Am Soc Nephrol. 18 (4): 1292–8. doi:10.1681/ASN.2006070756. PMID 17314324.

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