Acute renal failure classification: Difference between revisions

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Revision as of 20:10, 10 February 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Aarti Narayan, M.B.B.S [2], Serge Korjian

Overview

Acute renal failure can complicate a wide spectrum of disorders, and for the purpose of diagnosis and management is divided according to the mechanism that lead to renal compromise. The three categories are pre-renal azotemia (diseases that cause renal hypoperfusion), renal azotemia (diseases directly affecting the renal parenchyma), and post-renal azotemia (diseases affecting the urinary tract causing obstruction).

Classification

According to the levels of renal dysfunction

Acute renal failure is usually categorised (as in the flowchart below) according to pre-renal, renal and post-renal causes.

Acute Renal
Failure

Pre-renal

Renal

Post-renal

1. Pre-renal

Compromise in the renal blood flow

2. Renal

Damage to the kidney itself

3. Post-renal

Obstructive causes in the urinary tract

According to the RIFLE criteria

The RIFLE (Risk of renal dysfunction, Injury to the kidney, Failure or Loss of kidney function, and End-stage kidney disease) criteria classifies acute renal failure according to the probable clinical outcomes^[1]^[2]. This system is increasingly used for evaluation of patients with acute kidney injury.

Proposed classification scheme for acute kidney injury (RIFLE) according to the Acute Dialysis Quality Initiative.
CLASSIFICATION	GFR CRITERIA	URINE OUTPUT CRITERIA
Risk	1.5x increase in SCr or GFR decrease >25%	<0.5 mL/kg/h for 6 hours
Injury	2x increase in SCr or GFR decrease >50%	<0.5 mL/kg/h for 12 hours
Failure	3x increase in SCr or GFR decrease >75%	<0.3 mL/kg/h for 24 hours or anuria for 12 hours
Loss	Complete loss of renal function >4 weeks
End Stage Renal Disease	Complete loss of renal function >3 months

References

↑ Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004). "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". Critical Care (London, England). 8 (4): R204–12. doi:10.1186/cc2872. PMC 522841. PMID 15312219. Unknown parameter |month= ignored (help)
↑ Lameire N, Van Biesen W, Vanholder R (2005). "Acute renal failure". Lancet. 365 (9457): 417–30. doi:10.1016/S0140-6736(05)17831-3. PMID 15680458.

Template:WH Template:WS

[pmid15312219-1] Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P (2004). "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". Critical Care (London, England). 8 (4): R204–12. doi:10.1186/cc2872. PMC 522841. PMID 15312219. Unknown parameter |month= ignored (help)

[2] Lameire N, Van Biesen W, Vanholder R (2005). "Acute renal failure". Lancet. 365 (9457): 417–30. doi:10.1016/S0140-6736(05)17831-3. PMID 15680458.

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@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Acute renal failure}}
-{{CMG}} {{AE}} {{AN}}
+{{CMG}} {{AE}} {{AN}}, [[User:Sergekorjian| Serge Korjian]]
 ==Overview==
@@ Line 25: / Line 25: @@
 The RIFLE (Risk of renal dysfunction, Injury to the kidney, Failure or Loss of kidney function, and End-stage kidney disease) criteria classifies acute renal failure according to the probable clinical outcomes<ref name="pmid15312219">{{cite journal |author=Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P |title=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 |journal=[[Critical Care (London, England)]] |volume=8 |issue=4 |pages=R204–12 |year=2004 |month=August |pmid=15312219 |pmc=522841 |doi=10.1186/cc2872 |url=}}</ref><ref>{{cite journal |author=Lameire N, Van Biesen W, Vanholder R |title=Acute renal failure |journal=[[The Lancet|Lancet]] |volume=365 |issue=9457 |pages=417–30 |year=2005 |pmid=15680458 |doi=10.1016/S0140-6736(05)17831-3}}</ref>. This system is increasingly used for evaluation of patients with acute kidney injury.
-* Risk: [[GFR]] decrease >25%, serum [[creatinine]] increased 1.5 times or urine production of <0.5 ml/kg/hr for 6 hours
+{| class="wikitable" border="1" style="margin: 1em auto 1em auto; width: 70%;"
-* Injury: [[GFR]] decrease >50%, doubling of [[creatinine]] or urine production <0.5 ml/kg/hr for 12 hours
+|+ Proposed classification scheme for acute kidney injury (RIFLE) according to the Acute Dialysis Quality Initiative.
-* Failure: [[GFR]] decrease >75%, tripling of [[creatinine]] or [[creatinine]] >355 μmol/l (with a rise of >44) (>4&nbsp;mg/dl) OR urine output below 0.3 ml/kg/hr for 24 hours
+| align="center" style="background:#d3ffb0;"|'''CLASSIFICATION'''
-* Loss: persistent AKI or complete loss of [[renal function|kidney function]] for more than 4 weeks
+| align="center" style="background:#d3ffb0;"|'''GFR CRITERIA'''
-* [[End-stage renal disease]]: need for renal replacement therapy (RRT) for more than 3 months
+| align="center" style="background:#d3ffb0;"|'''URINE OUTPUT CRITERIA'''
+|-
+| Risk||style="text-align:center;"|1.5x increase in SCr or GFR decrease >25%||style="text-align:center;"|<0.5 mL/kg/h for 6 hours
+|-
+| Injury||style="text-align:center;"|2x increase in SCr or GFR decrease >50%||style="text-align:center;"|<0.5 mL/kg/h for 12 hours
+|-
+| Failure||style="text-align:center;"|3x increase in SCr or GFR decrease >75%||style="text-align:center;"|<0.3 mL/kg/h for 24 hours or anuria for 12 hours
+|-
+| Loss|| colspan=2 style="text-align:center;"| Complete loss of renal function >4 weeks
+|-
+| End Stage Renal Disease|| colspan=2 style="text-align:center;"| Complete loss of renal function >3 months
+|}
 ==References==