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Definition and Classification of Acute Kidney Injury

  • Kelly V. Liang
  • Paul M. Palevsky
Chapter

Abstract

Acute kidney injury (AKI) is the sudden loss of kidney function, typically developing over hours to days. Although AKI is easy to define conceptually, consensus operational definitions were unavailable until the early portion of the last decade. Three consensus definitions have been developed since 2002: the RIFLE (Risk, Injury, Failure, Loss, and End-stage) definition, developed by the Acute Dialysis Quality Initiative (ADQI), the Acute Kidney Injury Network (AKIN) definition and staging system, and most recently the Kidney Disease: Improving Global Outcomes (KDIGO) definition and staging system. Each of these definitions and staging systems is based on changes in serum creatinine and urine output. In the most current KDIGO definition, AKI is defined based on an absolute increase in serum creatinine of ≥0.3 mg/dL occurring within 48 h, a relative increase of ≥50% occurring within 7 days, or a urine output of <0.5 mL/kg per hour for more than 6 h. Progressive stages of AKI severity are defined by larger increases in serum creatinine, longer durations of oliguria or anuria, or need for renal replacement therapy. Although these definitions are useful in epidemiologic studies and clinical trials, their utility in clinical practice is uncertain.

Keywords

Acute kidney injury Definition Staging Creatinine Oliguria 

References

  1. 1.
    Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet. 2005;365:417–30.CrossRefGoogle Scholar
  2. 2.
    Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network (AKIN): report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.CrossRefGoogle Scholar
  4. 4.
    Rosen S, Heyman SN. Difficulties in understanding human “acute tubular necrosis”: limited data and flawed animal models. Kidney Int. 2001;60:1220–4.CrossRefPubMedGoogle Scholar
  5. 5.
    Lameire N. The pathophysiology of acute renal failure. Crit Care Clin. 2005;21:197–210.CrossRefPubMedGoogle Scholar
  6. 6.
    Klahr S, Miller SB. Acute oliguria. N Engl J Med. 1998;338:671–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Morgan DJ, Ho KM. A comparison of nonoliguric and oliguric severe acute kidney injury according to the risk injury failure loss end-stage (RIFLE) criteria. Nephron Clin Pract. 2010;115:c59–65.CrossRefPubMedGoogle Scholar
  8. 8.
    Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, Tolwani AJ, Waikar SS, Weisbord SD. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013;61(5):649–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, The ADQI Workgroup. 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. 2004;8:R204–12.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: a systematic review. Kidney Int. 2008;73(5):538–46.CrossRefPubMedGoogle Scholar
  11. 11.
    Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol. 2005;16(11):3365–70.CrossRefGoogle Scholar
  12. 12.
    Akcan-Arikan A, Zappitelli M, Loftis LL, Washburn KK, Jefferson LS, Goldstein SL. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int. 2007;71(10):1028–35.CrossRefPubMedGoogle Scholar
  13. 13.
    Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, Metnitz PG. Acute kidney injury in critically ill patients classified by AKIN versus RIFLE using the SAPS 3 database. Intensive Care Med. 2009;35(10):1692–702.CrossRefPubMedGoogle Scholar
  14. 14.
    Lopes JA, Goncalves S, Jorge S, et al. Contemporary analysis of the influence of acute kidney injury after reduced intensity conditioning haematopoietic cell transplantation on long-term survival. Bone Marrow Transplant. 2008;42:619–26.CrossRefPubMedGoogle Scholar
  15. 15.
    Bihorac A, Yavas S, Subbiah S, et al. Long-term risk of mortality and acute kidney injury during hospitalization after major surgery. Ann Surg. 2009;249:851–8.CrossRefPubMedGoogle Scholar
  16. 16.
    Chen YC, Jenq CC, Tian YC, et al. Rifle classification for predicting in-hospital mortality in critically ill sepsis patients. Shock. 2009;31:139–45.CrossRefPubMedGoogle Scholar
  17. 17.
    Perez Valdivieso JR, Bes-Rastrollo M, Monedero P, et al. Evaluation of the prognostic value of the risk, injury, failure, loss and end-stage renal failure (RIFLE) criteria for acute kidney injury. Nephrology (Carlton). 2008;13:361–6.CrossRefGoogle Scholar
  18. 18.
    Bagshaw SM, George C, Gibney RT, et al. A multi-center evaluation of early acute kidney injury in critically ill trauma patients. Ren Fail. 2008;30:581–9.CrossRefPubMedGoogle Scholar
  19. 19.
    Daher EF, Marques CN, Lima RS, et al. Acute kidney injury in an infectious disease intensive care unit—an assessment of prognostic factors. Swiss Med Wkly. 2008;138:128–33.Google Scholar
  20. 20.
    Cruz DN, Bolgan I, Perazella MA, et al. North East Italian Prospective Hospital Renal Outcome Survey on Acute Kidney Injury (NEiPHROS-AKI): targeting the problem with the RIFLE Criteria. Clin J Am Soc Nephrol. 2007;2:418–25.CrossRefPubMedGoogle Scholar
  21. 21.
    Hoste EA, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, Edipidis K, Forni LG, Gomersall CD, Govil D, Honoré PM, Joannes-Boyau O, Joannidis M, Korhonen AM, Lavrentieva A, Mehta RL, Palevsky P, Roessler E, Ronco C, Uchino S, Vazquez JA, Vidal Andrade E, Webb S, Kellum JA. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study. Intensive Care Med. 2015;41(8):1411–23. Epub 2015 Jul 11.CrossRefGoogle Scholar
  22. 22.
    Doi K, Yuen PS, Eisner C, Hu X, Leelahavanichkul A, Schnermann J, Star RA. Reduced production of creatinine limits its use as marker of kidney injury in sepsis. J Am Soc Nephrol. 2009;20(6):1217–21.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Herget-Rosenthal S, Marggraf G, Hüsing J, Göring F, Pietruck F, Janssen O, Philipp T, Kribben A. Early detection of acute renal failure by serum cystatin C. Kidney Int. 2004;66(3):1115–22.CrossRefPubMedGoogle Scholar
  24. 24.
    Villa P, Jiménez M, Soriano MC, Manzanares J, Casasnovas P. Serum cystatin C concentration as a marker of acute renal dysfunction in critically ill patients. Crit Care. 2005;9(2):R139–43.CrossRefPubMedPubMedCentralGoogle Scholar
  25. 25.
    Wald R, Liangos O, Perianayagam MC, Kolyada A, Herget-Rosenthal S, Mazer CD, Jaber BL. Plasma cystatin C and acute kidney injury after cardiopulmonary bypass. Clin J Am Soc Nephrol. 2010;5(8):1373–9.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Ho J, Tangri N, Komenda P, Kaushal A, Sood M, Brar R, Gill K, Walker S, MacDonald K, Hiebert BM, Arora RC, Rigatto C. Urinary, plasma, and serum biomarkers’ utility for predicting acute kidney injury associated with cardiac surgery in adults: a meta-analysis. Am J Kidney Dis. 2015;66(6):993–1005.CrossRefGoogle Scholar
  27. 27.
    Siew ED, Matheny ME, Ikizler TA, Lewis JB, Miller RA, Waitman LR, Go AS, Parikh CR, Peterson JF. Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury. Kidney Int. 2010;77(6):536–42.CrossRefGoogle Scholar
  28. 28.
    Lin J, Fernandez H, Shashaty MG, Negoianu D, Testani JM, Berns JS, Parikh CR, Wilson FP. False-positive rate of AKI using consensus creatinine-based criteria. Clin J Am Soc Nephrol. 2015;10(10):1723–31.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Waikar SS, Bonventre JV. Creatinine kinetics and the definition of acute kidney injury. J Am Soc Nephrol. 2009;20:672–9.CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Coca SG, King JT Jr, Rosenthal RA, Perkal MF, Parikh CR. The duration of postoperative acute kidney injury is an additional parameter predicting long-term survival in diabetic veterans. Kidney Int. 2010;78(9):926–33.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Waikar SS, Wald R, Chertow GM, Curhan GC, Winkelmayer WC, Liangos O, Sosa MA, Jaber BL. Validity of international classification of diseases, ninth revision, clinical modification codes for acute renal failure. J Am Soc Nephrol. 2006;17(6):1688–94.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Renal-Electrolyte Division, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA
  2. 2.Renal Section, Medical ServiceVA Pittsburgh Healthcare SystemPittsburghUSA
  3. 3.Renal-Electrolyte Division, Department of MedicineUniversity of Pittsburgh School of MedicinePittsburghUSA

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