Acute Renal Insufficiency (Failure)

  • Chang-I Wu
  • Vasiliy Sim
  • S. Rob Todd


One of the primary roles of the kidneys is to filter waste material from the blood. The inability of the kidneys to do this leads to renal failure. Acute renal insufficiency (ARI) is defined as the sudden onset (<48 h) of impaired kidney function. This is represented by a rise in the serum creatinine or a decrease in the urine output. The serum creatinine serves as a useful biomarker for measuring the flow rate of fluids through the kidneys, termed the glomerular filtration rate (GFR). As the clearance of creatinine and GFR decrease, the serum creatinine correspondingly increases signifying impaired renal function. The most common formula used to estimate GFR is the Cockcroft–Gault formula:
$$ \mathrm{GF}{{\mathrm{R}}_{\mathrm{CG}}}=\frac{{\left( {140-\mathrm{Age}} \right)\times \mathrm{Weight}\ \left( {\mathrm{kg}} \right)}}{{72\times \mathrm{Serum}\ \mathrm{creatinine}\ \left( {\mathrm{mg}/\mathrm{dL}} \right)}}\times [0.85\ \mathrm{if}\ \mathrm{Female}] $$
$$ \frac{{\left[ {\left( {140-\mathrm{Age}} \right) \times \mathrm{Mass}\left( {\mathrm{in}\ \mathrm{kg}} \right)} \right]}}{{\left[ {72 \times \mathrm{Serum}\ \mathrm{creatinine}\left( {\mathrm{in}\ \mathrm{mg}/\mathrm{dL}} \right)} \right]}} $$


Renal Replacement Therapy Continuous Renal Replacement Therapy Hepatorenal Syndrome Rifle Criterion Acute Renal Insufficiency 
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  1. 1.
    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(1):c59–65 [Comparative Study].PubMedCrossRefGoogle Scholar
  2. 2.
    Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. 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(4):R204–12 [Consensus Development Conference Guideline Practice Guideline Review].PubMedCrossRefGoogle Scholar
  3. 3.
    Joannidis M, Metnitz B, Bauer P, Schusterschitz N, Moreno R, Druml W, et al. 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 [Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  4. 4.
    Bagshaw SM, George C, Bellomo R. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant. 2008;23(5):1569–74 [Comparative Study Multicenter Study Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  5. 5.
    Hou SH, Bushinsky DA, Wish JB, Cohen JJ, Harrington JT. Hospital-acquired renal insufficiency: a prospective study. Am J Med. 1983;74(2):243–8 [Research Support, U.S. Gov’t, P.H.S.].PubMedCrossRefGoogle Scholar
  6. 6.
    Liano F, Junco E, Pascual J, Madero R, Verde E. The spectrum of acute renal failure in the intensive care unit compared with that seen in other settings. The Madrid Acute Renal Failure Study Group. Kidney Int Suppl. 1998;66:S16–24 [Comparative Study Research Support, Non-U.S. Gov’t].PubMedGoogle Scholar
  7. 7.
    Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294(7):813–8 [Multicenter Study Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  8. 8.
    Brochard L, Abroug F, Brenner M, Broccard AF, Danner RL, Ferrer M, et al. An official ATS/ERS/ESICM/SCCM/SRLF statement: prevention and management of acute renal failure in the ICU patient: an international consensus conference in intensive care medicine. Am J Respir Crit Care Med. 2010;181(10):1128–55 [Consensus Development Conference].PubMedCrossRefGoogle Scholar
  9. 9.
    Chen YC, Jenq CC, Tian YC, Chang MY, Lin CY, Chang CC, et al. Rifle classification for predicting in-hospital mortality in critically ill sepsis patients. Shock. 2009;31(2):139–45 [Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  10. 10.
    Nolan CR, Anderson RJ. Hospital-acquired acute renal failure. J Am Soc Nephrol. 1998;9(4):710–8 [Review].PubMedGoogle Scholar
  11. 11.
    Wiedermann CJ, Dunzendorfer S, Gaioni LU, Zaraca F, Joannidis M. Hyperoncotic colloids and acute kidney injury: a meta-analysis of randomized trials. Crit Care. 2010;14(5):R191 [Meta-Analysis].PubMedCrossRefGoogle Scholar
  12. 12.
    Brunkhorst FM, Engel C, Bloos F, Meier-Hellmann A, Ragaller M, Weiler N, et al. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med. 2008;358(2):125–39 [Comparative Study Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  13. 13.
    Celik I. Renal dysfunction after hydroxyethyl starch. Anesth Analg. 2004;99(1):309–10. Author reply 10 [Comment Letter].PubMedCrossRefGoogle Scholar
  14. 14.
    Lauschke A, Teichgraber UK, Frei U, Eckardt KU. ‘Low-dose’ dopamine worsens renal perfusion in patients with acute renal failure. Kidney Int. 2006;69(9):1669–74 [Randomized Controlled Trial].PubMedCrossRefGoogle Scholar
  15. 15.
    Friedrich JO, Adhikari N, Herridge MS, Beyene J. Meta-analysis: low-dose dopamine increases urine output but does not prevent renal dysfunction or death. Ann Intern Med. 2005;142(7):510–24 [Meta-Analysis Research Support, Non-U.S. Gov’t Review].PubMedGoogle Scholar
  16. 16.
    Bagshaw SM, Bellomo R, Kellum JA. Oliguria, volume overload, and loop diuretics. Crit Care Med. 2008;36(4 Suppl):S172–8 [Review].PubMedCrossRefGoogle Scholar
  17. 17.
    Uchino S, Doig GS, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Diuretics and mortality in acute renal failure. Crit Care Med. 2004;32(8):1669–77 [Multicenter Study Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  18. 18.
    Townsend DR, Bagshaw SM. New insights on intravenous fluids, diuretics and acute kidney injury. Nephron Clin Pract. 2008;109(4):c206–16 [Review].PubMedCrossRefGoogle Scholar
  19. 19.
    Liangos O, Rao M, Balakrishnan VS, Pereira BJ, Jaber BL. Relationship of urine output to dialysis initiation and mortality in acute renal failure. Nephron Clin Pract. 2005;99(2):c56–60 [Research Support, N.I.H., Extramural Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, P.H.S.].PubMedCrossRefGoogle Scholar
  20. 20.
    Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med. 2006;34(7):1913–7 [Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  21. 21.
    Pannu N, Klarenbach S, Wiebe N, Manns B, Tonelli M. Renal replacement therapy in patients with acute renal failure: a systematic review. JAMA. 2008;299(7):793–805 [Research Support, Non-U.S. Gov’t Review].PubMedCrossRefGoogle Scholar
  22. 22.
    Rabindranath K, Adams J, Macleod AM, Muirhead N. Intermittent versus continuous renal replacement therapy for acute renal failure in adults. Cochrane Database Syst Rev. 2007(3):CD003773 [Meta-Analysis Review].Google Scholar
  23. 23.
    Ronco C, Bellomo R, Homel P, Brendolan A, Dan M, Piccinni P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial. Lancet. 2000;356(9223):26–30 [Clinical Trial Randomized Controlled Trial].PubMedCrossRefGoogle Scholar
  24. 24.
    Palevsky PM, Zhang JH, O’Connor TZ, Chertow GM, Crowley ST, Choudhury D, et al. Intensity of renal support in critically ill patients with acute kidney injury. N Engl J Med. 2008;359(1):7–20 [Multicenter Study Randomized Controlled Trial Research Support, N.I.H., Extramural Research Support, U.S. Gov’t, Non-P.H.S.].PubMedCrossRefGoogle Scholar
  25. 25.
    Bellomo R, Cass A, Cole L, Finfer S, Gallagher M, Lo S, et al. Intensity of continuous renal-replacement therapy in critically ill patients. N Engl J Med. 2009;361(17):1627–38 [Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  26. 26.
    Negash DT, Dhingra VK, Copland M, Griesdale D, Henderson W. Intensity of continuous renal replacement therapy in acute kidney injury in the intensive care unit: a systematic review and meta-analysis. Vasc Endovascular Surg. 2011;45(6):504–10 [Meta-Analysis Review].PubMedCrossRefGoogle Scholar
  27. 27.
    Karvellas CJ, Farhat MR, Sajjad I, Mogensen SS, Leung AA, Wald R, et al. A comparison of early versus late initiation of renal replacement therapy in critically ill patients with acute kidney injury: a systematic review and meta-analysis. Crit Care. 2011;15(1):R72 [Comparative Study Meta-Analysis Review].PubMedCrossRefGoogle Scholar
  28. 28.
    Brown RO, Compher C. A.S.P.E.N. clinical guidelines: nutrition support in adult acute and chronic renal failure. JPEN J Parenter Enteral Nutr. 2010;34(4):366–77 [Practice Guideline].PubMedCrossRefGoogle Scholar
  29. 29.
    Scheinkestel CD, Kar L, Marshall K, Bailey M, Davies A, Nyulasi I, et al. Prospective randomized trial to assess caloric and protein needs of critically Ill, anuric, ventilated patients requiring continuous renal replacement therapy. Nutrition. 2003;19(11–12):909–16 [Clinical Trial Randomized Controlled Trial Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  30. 30.
    Scheinkestel CD, Adams F, Mahony L, Bailey M, Davies AR, Nyulasi I, et al. Impact of increasing parenteral protein loads on amino acid levels and balance in critically ill anuric patients on continuous renal replacement therapy. Nutrition. 2003;19(9):733–40 [Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  31. 31.
    Arroyo V, Fernandez J, Gines P. Pathogenesis and treatment of hepatorenal syndrome. Semin Liver Dis. 2008;28(1):81–95 [Review].PubMedCrossRefGoogle Scholar
  32. 32.
    Moreau R, Durand F, Poynard T, Duhamel C, Cervoni JP, Ichai P, et al. Terlipressin in patients with cirrhosis and type 1 hepatorenal syndrome: a retrospective multicenter study. Gastroenterology. 2002;122(4):923–30 [Multicenter Study Research Support, Non-U.S. Gov’t].PubMedCrossRefGoogle Scholar
  33. 33.
    Kooiman J, Pasha SM, Zondag W, Sijpkens YW, van der Molen AJ, Huisman MV, et al. Meta-analysis: serum creatinine changes following contrast enhanced CT imaging. Eur J Radiol. 2012;81(10):2554–61.PubMedCrossRefGoogle Scholar
  34. 34.
    Dai B, Liu Y, Fu L, Li Y, Zhang J, Mei C. Effect of theophylline on prevention of contrast-induced acute kidney injury: a meta-analysis of randomized controlled trials. Am J Kidney Dis. 2012;60(3):360–70.PubMedCrossRefGoogle Scholar
  35. 35.
    Li Y, Liu Y, Fu L, Mei C, Dai B. Efficacy of short-term high-dose statin in preventing contrast-induced nephropathy: a meta-analysis of seven randomized controlled trials. PLoS One. 2012;7(4):e34450.PubMedCrossRefGoogle Scholar
  36. 36.
    Acetylcysteine for prevention of renal outcomes in patients undergoing coronary and peripheral vascular angiography: main results from the randomized Acetylcysteine for Contrast-induced nephropathy Trial (ACT). Circulation. 2011;124(11):1250–9 [Comparative Study Meta-Analysis Randomized Controlled Trial Research Support, Non-U.S. Gov’t].Google Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Columbia University Mailman School of Public HealthNew YorkUSA
  2. 2.Department of SurgeryBrookdale University Hospital and Medical CenterBrooklynUSA
  3. 3.Division of Trauma, Emergency Surgery, and Surgical Critical Care, Department of SurgeryNew York University Langone Medical CenterNew YorkUSA

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