Background
We (CUH EM) have traditionally use the RIFLE classification as the AKIN creatinine levels should ideally be taken at 48°.
In RIFLE or AKIN classification, please use either creatinine level or urine output levels to classifiy acute kidney injury level (and indicate which you are using).
RIFLE classification
| Stage | Creatinine | Urine output | |
|---|---|---|---|
| Risk renal failure | Cr. x 1.5 normal | or | UO < 0.5ml / kg / hour for 6 hours |
| Injury to kidney | Cr. x 2 normal | or | UO < 0.5ml / kg / hour for 12 hours |
| Failure of kidney fxn | Cr. x 3 normal | or | Anuric for 12 hours |
| Loss kidney fxn | Need renal replacement therapy x 4 weeks | ||
| End stage renal disease | Need renal replacement therapy for > 13 weeks | ||
AKIN classification
| Stage | Creatinine criteria | Urine output criteria | |
|---|---|---|---|
| 1 | Cr. x 1.5 - 2 baseline | or | <0.5 mL/kg/h for 6 hours |
| 2 | Cr. x 2 -3 from baseline | or | <0.5 mL/kg/h for 12 hours |
| 3 | Cr. x 3 baseline OR Cr. ≥ 354 µmol/l with an acute ↑ > 44 µmol/l OR need RRT |
or | UO <0.3 mLl/kg/h for 24° OR anuria for 12 h OR need for RRT |
DKIGO
AKI is defined as any of the following:
- ↑ in SCr by ≥0.3 mg/dl (≥26.5 lmol/l) within 48 hours; or
- ↑ in SCr to ≥1.5 times baseline, which is known or presumed to have occurred within the prior 7 days; or
- Urine volume <0.5 ml/kg/h for 6 hours
| Stage | Serum creatinine | Urine output |
|---|---|---|
| 1 | 1.5 to 1.9 times baseline OR ↑ ≥26 µmol/L in 48hrs |
<0.5ml/Kg/h for 6-12 hours |
| 2 | 2 to 2.9 times baseline | <0.5 ml/Kg/h for ≥12 hours |
| 3 | 3 times baseline OR ↑ ≥354 µmol/L OR Initiation of renal replacement therapy OR, in patients <18 yrs, ↓in eGFR to <35 ml/min per 1.73m2 |
<0.3 ml/Kg/h for ≥24 hours OR Anuria for ≥12 hours |