Acute kidney injury diagnostic study of choice: Difference between revisions
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== Overview == | == Overview == | ||
Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output. In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical [[outcome]]. | |||
== Diagnostic Study of Choice == | == Diagnostic Study of Choice == | ||
* Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output. | |||
* In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical [[outcome]]. <ref name="doi10.1038/kisup.2011.34">{{cite journal|author=Kidney Disease Improving Global Outcomes Work Group| title=2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury| journal=Kidey Int Supp |year= 2012 | volume= 2 | pages= 69-88 |doi=10.1038/kisup.2011.34 | pmc=|url=http://www.nature.com/kisup/journal/v2/n1/full/kisup201134a.html }} </ref> The rationale behind AKI staging is the needed to determine overall outcome as higher stags of AKI carry a greater risk of all cause and [[cardiovascular]] [[mortality]], renal replacement, as well as [[chronic kidney disease]] even after AKI resolution.<ref name="pmid16715038">{{cite journal| author=Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C| title=An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. | journal=Crit Care Med | year= 2006 | volume= 34 | issue= 7 | pages= 1913-7 | pmid=16715038 | doi=10.1097/01.CCM.0000224227.70642.4F | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16715038 }} </ref><ref name="pmid17962378">{{cite journal| author=Bagshaw SM, George C, Dinu I, Bellomo R| title=A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients. | journal=Nephrol Dial Transplant | year= 2008 | volume= 23 | issue= 4 | pages= 1203-10 | pmid=17962378 | doi=10.1093/ndt/gfm744 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17962378 }} </ref><ref name="pmid18160961">{{cite journal| author=Ricci Z, Cruz D, Ronco C| title=The RIFLE criteria and mortality in acute kidney injury: A systematic review. | journal=Kidney Int | year= 2008 | volume= 73 | issue= 5 | pages= 538-46 | pmid=18160961 | doi=10.1038/sj.ki.5002743 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18160961 }} </ref><ref name="pmid17314324">{{cite journal| author=Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W et al.| title=Incidence and outcomes in acute kidney injury: a comprehensive population-based study. | journal=J Am Soc Nephrol | year= 2007 | volume= 18 | issue= 4 | pages= 1292-8 | pmid=17314324 | doi=10.1681/ASN.2006070756 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17314324 }} </ref> | |||
In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes | |||
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* The guidelines also advocated that in case of discordance between [[urine output]] and serum creatinine patients should be classified to the highest applicable AKI stage. Also, new emphasis on the differences seen in the [[pediatric]] population gave rise to revised definition of Stage 3 AKI in patients less than 18 years of age.<ref name="doi10.1038/kisup.2011.34">{{cite journal|author=Kidney Disease Improving Global Outcomes Work Group| title=2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury| journal=Kidey Int Supp |year= 2012 | volume= 2 | pages= 69-88 |doi=10.1038/kisup.2011.34 | pmc= |url=http://www.nature.com/kisup/journal/v2/n1/full/kisup201134a.html }} </ref> | |||
The guidelines also advocated that in case of discordance between [[urine output]] and serum creatinine patients should be classified to the highest applicable AKI stage. Also, new emphasis on the differences seen in the [[pediatric]] population gave rise to revised definition of Stage 3 AKI in patients less than 18 years of age.<ref name="doi10.1038/kisup.2011.34">{{cite journal|author=Kidney Disease Improving Global Outcomes Work Group| title=2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury| journal=Kidey Int Supp |year= 2012 | volume= 2 | pages= 69-88 |doi=10.1038/kisup.2011.34 | pmc= |url=http://www.nature.com/kisup/journal/v2/n1/full/kisup201134a.html }} </ref> | |||
==References== | ==References== | ||
Revision as of 00:39, 12 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:
Overview
Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output. In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical outcome.
Diagnostic Study of Choice
- Acute kidney injury is diagnosed and staged clinically on the basis of GFR and urinary output.
- In 2012, the KDIGO AKI guidelines proposed a combined staging scheme that takes into account both criteria and clinical outcome. [1] The rationale behind AKI staging is the needed to determine overall outcome as higher stags of AKI carry a greater risk of all cause and cardiovascular mortality, renal replacement, as well as chronic kidney disease even after AKI resolution.[2][3][4][5]
| 2012 KDIGO AKI Guidelines - Proposed staging criteria for AKI modified from AKIN | ||
|---|---|---|
| Staging | GFR criteria | Urine output criteria |
| Stage 1 | 1.5 - 1.9 times baseline or ≥ 0.3 mg/dl increase | <0.5 ml/kg/h for 6 - 12 hours |
| Stage 2 | 2.0 - 2.9 times baseline | <0.5 ml/kg/h for ≥ 12 hours |
| Stage 3 | 3.0 times baseline or increase in serum creatinine to 4.0 mg/dL or initiation of renal replacement therapy or decrease in eGFR to <35 ml/min per 1.73 m2 (in patients <18 years) |
<0.3 mL/kg/h for 24 hours or anuria for 12 hours |
- The guidelines also advocated that in case of discordance between urine output and serum creatinine patients should be classified to the highest applicable AKI stage. Also, new emphasis on the differences seen in the pediatric population gave rise to revised definition of Stage 3 AKI in patients less than 18 years of age.[1]
References
- ↑ 1.0 1.1 Kidney Disease Improving Global Outcomes Work Group (2012). "2012 KDIGO Clinical Practice Guideline for Acute Kidney Injury". Kidey Int Supp. 2: 69–88. doi:10.1038/kisup.2011.34.
- ↑ Uchino S, Bellomo R, Goldsmith D, Bates S, Ronco C (2006). "An assessment of the RIFLE criteria for acute renal failure in hospitalized patients". Crit Care Med. 34 (7): 1913–7. doi:10.1097/01.CCM.0000224227.70642.4F. PMID 16715038.
- ↑ Bagshaw SM, George C, Dinu I, Bellomo R (2008). "A multi-centre evaluation of the RIFLE criteria for early acute kidney injury in critically ill patients". Nephrol Dial Transplant. 23 (4): 1203–10. doi:10.1093/ndt/gfm744. PMID 17962378.
- ↑ Ricci Z, Cruz D, Ronco C (2008). "The RIFLE criteria and mortality in acute kidney injury: A systematic review". Kidney Int. 73 (5): 538–46. doi:10.1038/sj.ki.5002743. PMID 18160961.
- ↑ Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W; et al. (2007). "Incidence and outcomes in acute kidney injury: a comprehensive population-based study". J Am Soc Nephrol. 18 (4): 1292–8. doi:10.1681/ASN.2006070756. PMID 17314324.