Kidney function. RIFLE AKIN RIFLE vs AKIN KDIGO

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Kidney function

Transcript of Kidney function. RIFLE AKIN RIFLE vs AKIN KDIGO

Page 1: Kidney function. RIFLE AKIN RIFLE vs AKIN KDIGO

Kidney function

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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

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RIFLE

rise in creatinine of 0.3 mg/dl, (26 µmol/l), was independently associated with an approximately fourfold increase in hospital mortality!

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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

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RIFLE vs AKIN

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KDIGO

http://www.kdigo.org/clinical_practice_guidelines/pdf/KDIGO%20AKI%20Guideline.pdf

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Back-calculation of creatinine

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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

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CKDchronic kidney disease

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AKD

The term ‘acute kidney disease’ (AKD) was proposed when kidney damage is present for 3 months

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Non-AKI AKD

No-AKI AKI

AKD

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Real-time GFR and creatinine values before and during anepisode of acute kidney injury (AKI)

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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%)

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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

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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