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Kidney function
RIFLE2004, Acute Dialysis Quality Initiative groupRisk, Injury, Failure, Loss, and End-stage renal diseaseAKI was defined as
a rise in creatinine of 50% from its baseline value and/or a fall in the glomerular filtration rate (GFR) by 25%, and/or a decrease in urine output below 0.5 ml/kg/h for 6 h or
more known or presumed to have developed over 7 days
RIFLE
rise in creatinine of 0.3 mg/dl, (26 µmol/l), was independently associated with an approximately fourfold increase in hospital mortality!
AKIN 2007, the AKI Network (AKIN) the AKI classification for adults, an evolution of the
RIFLE criteria The Risk, Injury, and Failure stages became stage 1, 2
and 3 a 0.3 mg/dl rise in creatinine within 48 h was included
in stage 1 GFR criteria were removed as markers of adult AKI The Loss and End-stage categories of RIFLE were
dropped as they were felt to be outcomes, not stages
RIFLE vs AKIN
KDIGO
http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf
Back-calculation of creatinine
KDIGO
rises in creatinine 0.3 mg/dl in a chronic kidney disease (CKD) patient are classified as stage 3, whereas such a rise in a patient without CKD is classified as stage 1
CKDchronic kidney disease
AKD
The term ‘acute kidney disease’ (AKD) was proposed when kidney damage is present for 3 months
Non-AKI AKD
No-AKI AKI
AKD
Real-time GFR and creatinine values before and during anepisode of acute kidney injury (AKI)
Real-time GFR and creatinine values before and during anepisode of acute kidney injury (AKI)
3.0/1.4=2.14(3.0-1.4)/1.4=1.14 (114%)
Creatinine
Serum creatinine will then rise over hours to days, before a new steady state is reached
Estimated GFR (eGFR) will take days before it reflects the true GFR!!
The creatinine rise used to detect AKI may be measured as a percentage or an absolute rise% - takes more account of muscle massabsolute - may identify AKI earlier
Oliguria as an indicator of AKI
Oliguria is defined as a urine output of 400ml/day, equivalent to 0.24 ml/kg/h in a 70-kg patient