ACUTE KIDNEY INJURY (AKI) (ACUTE RENAL FAILUR).

Acute renal failure (ARF) has commonly been recognized as sudden the loss of kidney function

Acute kidney injury (AKI) (acute renal failure)

 

Acute renal failure (ARF) has commonly been recognized as sudden the loss of kidney function leading to retained urea and other nitrogenous waste metabolites in addition to dysregulation of extracellular volume and electrolytes.

RIFLE CRITERIA

The RIFLE criteria are composed of 3 grades of injury levels (Risk, Injury, and complete Failure) based on either the magnitude of rise of serum creatinine (SCr) or urine output, and 2 outcome values (Loss and ESRD “End-stage renal disease”).

The RIFLE strata can be explained as follows:

v  Risk: 1.5-fold rise in SCr or GFR drop by 25 % or urine output (UO) <0.5 mL/kg/h/ 6 hs.

v  Injury: Double fold rise in SCr or GFR decline by 50 % or UO <0.5 mL/kg/h/12 h.

v  Failure: 3-folds rise in the SCr or GFR drop by 75 % or UO of <0.3 mL/kg/h/24 hs, or anuria (no urine) for 12 hs.

v  Loss: Total loss of renal function (e.g., need for dialysis) for > 4 weeks

v  ESRD: Total loss of renal function (eg, need for dialysis) for > 3 months

 

The RIFLE criteria could be correlated with patient’s outcome in many studies. Patients enrolled in the RIFLE stages of "risk," "injury," and "failure" may express an elevated relative risk of mortalities as compared to patients lacking AKI.

v  Despite the wide spread use of SCr levels in estimation of kidney function decline, this quantitative measuring has been associated with many criticism, actually there is no enough consensus to a quantitative recognition of ARF.

v  So, the Acute Dialysis Quality Initiative (ADQI) design a proposal for a categorized definition of ARF that currently named the RIFLE criteria.

v  On the other hand, the Acute Kidney Injury Network (AKIN) has modified the RIFLE categories so that a less intense ARF can be included, for imposing a time constraint of 48 h., and to give a chance for correcting the volume overload and obstructive uropathy causes of ARF before commencing the classification.

v  Moreover, these criteria have gained the greatest applications in the epidemiologic researches.

v  The AKIN have proposed the terminology of acute kidney injury (AKI) for representing the whole course of acute renal failure.

v  A given proposal of diagnostic criteria as follows:

1)     Sudden (within 48 hs) absolute rise in SCr of ≥ 0.3 mg/dL (= 26.4 micro-mol/L) from its baseline,

2)    Rise in the SCr of ≥50 %, or

3)    Oliguria (low urine output) of < 0.5 mL/kg per h for > 6 hours.

v  However, these parameters are vulnerable for more revision, and could be replaced with the advent of the newly introduced tubular injury biomarkers.

v  A more recent proposal given by the KDIGO:  a consensus recognition to admit a 48 h. time frame from AKIN for a 0.3 mg/dL change in SCr while utilizing a 7-day time frame for the 50 % rise in SCr that is previously applied by the RIFLE criteria, while keeping the tri-partite recognition of both systems.

v  Finally, the term AKI “acute kidney injury” can be adopted to replace the previous term of ARF “acute renal failure” and appropriately accepted.

v  The term AKI offer a better representation to the complete course of acute renal dysfunction.

https://www.wjgnet.com/2220-3230/full/v6/i4/682.htm

N.B. This Blogger is created to declare acute risky events to the human kidney.

References

•       Hoste EA, Clermont G, Kersten A, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care 2006; 10:R73.
•       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.
•       Ostermann M, Chang RW. Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007; 35:1837
•      Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality in acute kidney injury: A systematic review. Kidney Int 2008; 73:538.

•       Pickering JW, Endre ZH. GFR shot by RIFLE: errors in staging acute kidney injury. Lancet 2009; 373:1318.
•       Bagshaw SM, George C, Bellomo R, ANZICS Database Management Committe. A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008; 23:1569.
•       Kidney Int Suppl 2012; 2:8.