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