ARF classification


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.
KDIGO staging of AKI
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


Content by Dr Íomhar O' Sullivan 25/11/2004. Last review Dr ÍOS<3/07/20 -->