Definitions, Classification, and Screening of Acute Kidney Injury

2017 ◽  
Author(s):  
Andrew Davenport
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Glomerular Filtration Rate ◽  
Serum Creatinine ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Creatinine Concentration

Acute kidney injury (AKI; previously acute renal failure) is defined as an acute and sustained deterioration in kidney function. As AKI is a descriptive term, an attempt should be made to establish a diagnosis in patients with AKI. There are numerous causes of AKI, and all or part of the kidney may be affected. This review discusses the definitions of AKI, measurement of renal function, incidence of AKI, baseline serum creatinine, grading and severity of AKI, and screening for AKI. Figures show renal reserve and renal tubule. Tables list consensus definitions of AKI, effect of patient demographics on serum creatinine concentration, endogenous compounds that can interfere with colorimetric modified Jaffe-based reactions for determining serum creatinine concentration, risk factors for developing AKI in adult patients proposed by the Renal Angina Index, and risk factors for developing acute contrast-induced kidney injury in adult patients. Key Words: Acute kidney injury; Acute renal failure; Glomerular filtration rate; Serum creatinine; Kidney function; Estimated glomerular filtration rate; Biomarkers of AKI

Acute kidney injury

2018 ◽  
Author(s):  
Aron Chakera ◽  
William G. Herrington ◽  
Christopher A. O’Callaghan
Keyword(s):  
Acute Kidney Injury ◽  
Renal Failure ◽  
Renal Function ◽  
Acute Renal Failure ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Urine Volume ◽  
Kidney Injury ◽  
Rapid Decrease

Acute renal failure (also referred to as acute kidney injury) refers to a rapid decrease in renal function; it is reflected by an increase in blood urea and creatinine and is often associated with oliguria (a urine volume of less than 400 ml/24 hours). It usually develops over days to weeks. Acute kidney injury has been variously classified, but the current classifications are based on the glomerular filtration rate (or creatinine), looking at changes from baseline, and the presence of oliguria or anuria. The potential etiologies of acute kidney injury are usually considered anatomically under the headings prerenal, renal (intrinsic), and postrenal. This chapter looks at the etiology, symptoms, clinical features, demographics, complications, diagnosis, and treatment of acute kidney injury.

scholarly journals Exploration of the Relationship Among Key Risk Factors of Acute Kidney Injury for Elderly Patients Considering Covid-19

2021 ◽  
Vol 8 ◽  
Author(s):  
Yen-Ching Chuang ◽  
Tao-Hsin Tung ◽  
Jau-Yuan Chen ◽  
Ching-Wen Chien ◽  
Kao-Yi Shen
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Elderly Patients ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Nutritional Assessment ◽  
Kidney Injury ◽  
The Elderly ◽  
The Relationship

Background: Previous systematic reviews and meta-analyses supported the relationship between frailty and risk of acute kidney injury (AKI) in elderly patients. However, few studies evaluated proactive management to wear down AKI risk in such frail populations.Purpose: To understand how AKI risk factors might influence each other and to identify the source factors for clinical decision aids.Methods: This study uses the decision-making trial and evaluation laboratory (DEMATEL) method to establish influential network-relationship diagrams (INRDs) to form the AKI risk assessment model for the elderly.Results: Based on the DEMATEL approach, the results of INRD identified the six key risk factors: comorbidity, malignancy, diabetes, creatinine, estimated glomerular filtration rate, and nutritional assessment. (The statistical significance confidence is 98.423%, which is higher than 95%; the gap error is 1.577%, which is lower than 5%). After considering COVID-19 as an additional risk factor in comorbidity, the INRD revealed a similar influential relationship among the essential aspects.Conclusion: While evaluating the geriatric population, physicians need to pay attention to patients' comorbidities and nutritional assessment; also, they should note patients' creatinine values and glomerular filtration rate. Physicians could establish a preliminary observation index and then design a series of preventive guidelines to reduce the incidence of AKI risk for the elderly.

FREQUENCY RISK FACTORS AND OUTCOMES ACUTE KIDNEY INJURY IN THE EARLY PERIOD IN PATIENTS WITH CHRONIC KIDNEY DISEASE AFTER CABG SURGERY

2018 ◽  
Vol 22 (4) ◽  
pp. 96-101 ◽  
Author(s):  
V. V. Bazylev ◽  
A. A. Gornostaev ◽  
A. A. Schegol’kov ◽  
A. V. Bulygin
Keyword(s):  
Risk Factors ◽  
Chronic Kidney Disease ◽  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Kidney Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Bypass Graft ◽  
Early Period ◽  
Kidney Injury

AIM: To evaluate risk factors and prevalence of acute kidney injury (AKI) in patients with chronic kidney disease (CKD) in the early period after isolated coronary artery bypass graft (CABG).PATIENTS AND METHODS:The study included 830 patients with  isolated CABG. All surgeries were performed in 2016. To evaluate  kidney function in preoperative period glomerular filtration rate  (GFR) was estimated by Chronic Kidney Disease Epidemiology  Collaboration (CKD-EPI) formula. AKI was diagnosed according to  KDIGO criteria. Patients were stratified into two groups according to  estimated glomerular filtration rate (eGFR).RESULTS:The prevalence of AKI in patients group without CKD after CABG was 11,5% (n=59), in CKD-AKI group – 12,3% (n=39).  In patients with CKD and after intraoperative inotropic/vasopressor  therapy use of only 2 medicinal drugs of this group the probability of  AKI development increases 11,16 times (OR 11,46; 95% CI 3,47- 37,83; р<0,01). During complete bypass (CB) when haematocrit  decreases on 1% AKI probability increases on 12,36% (OR 0,89; 95% CI 0,81-0,98; р=0,02). The necessity of haemodialisys,  duration of stay in intensive care unit and hospitalization duration  were equal to all groups. AKI-CKD development significantly increases intrahospital mortality (p<0,05). CONCLUSIONS: History of CKD increases probability of severe AKI and also mortality in early postoperative period. Revealed risk factors for AKI development are potentially modifiable.

scholarly journals A Simple Method to Detect Recovery of Glomerular Filtration Rate following Acute Kidney Injury

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
John W. Pickering ◽  
John Mellas
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Plasma Creatinine ◽  
Creatinine Concentration ◽  
Simple Method ◽  
Creatinine Excretion ◽  
Excretion Rates

In acute kidney injury (AKI), elevated plasma creatinine is diagnostic of an earlier loss of glomerular filtration rate (GFR) but not of the concomitant GFR. Only subsequent creatinine changes will inform if GFR had already recovered or not. We hypothesized that the creatinine excretion rate to production rate ratio would provide this information. A retrospective analysis of 482 critically ill patients from two intensive care units (ICU) is shown. Plasma creatinine was measured on ICU entry and 12 hours later. Four-hour creatinine excretion rates (E) were measured on entry. Creatinine production rates were estimated (eG). The ability of the ratioE/eGto predict a decrease in plasma creatinine concentration, identify recovered AKI (≥0.3 mg/dL decrease), and predict AKI (≥0.3 mg/dL increase) was assessed by the area under the receiver operator characteristic curves (AUC). There was a linear relationship between reduced creatinine concentration andE/eG(r2=0.15;P<0.0001).E/eGpredicted a decrease in creatinine (AUC 0.70 (0.65 to 0.74)), identified recovered AKI (0.75 (0.67 to 0.84)), and predicted AKI (0.80 (0.73 to 0.86)). A ratio of the rates of creatinine excretion to estimated production much less than 1 indicated a concomitant GFR below baseline, whereas a ratio much more than 1 indicated a recovering or recovered GFR.

scholarly journals Acute Kidney Injuries in Children with Severe Malaria

2020 ◽  
Vol 20 (4) ◽  
pp. e312-317
Author(s):  
Folake M. Afolayan ◽  
Olanrewaju T. Adedoyin ◽  
Mohammed B. Abdulkadir ◽  
Olayinka R. Ibrahim ◽  
Sikiru A. Biliaminu ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Severe Malaria ◽  
Diagnostic Criteria ◽  
Cystatin C ◽  
Filtration Rate ◽  
Kidney Injury ◽  
Serum Cystatin C ◽  
Serum Cystatin

Objectives: Serum creatinine levels are often used to diagnose acute kidney injury (AKI), but may not necessarily accurately reflect changes in glomerular filtration rate (GFR). This study aimed to compare the prevalence of AKI in children with severe malaria using diagnostic criteria based on creatinine values in contrast to cystatin C. Methods: This prospective cross-sectional study was performed between June 2016 and May 2017 at the University of Ilorin Teaching Hospital, Ilorin, Nigeria. A total of 170 children aged 0.5–14 years old with severe malaria were included. Serum cystatin C levels were determined using a particle-enhanced immunoturbidmetric assay method, while creatinine levels were measured using the Jaffe reaction. Renal function assessed using cystatin C-derived estimated GFR (eGFR) was compared to that measured using three sets of criteria based on creatinine values including the Kidney Disease: Improved Global Outcomes (KDIGO) and World Health Organization (WHO) criteria as well as an absolute creatinine cut-off value of >1.5 mg/dL. Results: Mean serum cystatin C and creatinine levels were 1.77 ± 1.37 mg/L and 1.23 ± 1.80 mg/dL, respectively (P = 0.002). According to the KDIGO, WHO and absolute creatinine criteria, the frequency of AKI was 32.4%, 7.6% and 16.5%, respectively. In contrast, the incidence of AKI based on cystatin C-derived eGFR was 51.8%. Overall, the rate of detection of AKI was significantly higher using cystatin C compared to the KDIGO, WHO and absolute creatinine criteria (P = 0.003, <0.001 and <0.001, respectively). Conclusion: Diagnostic criteria for AKI based on creatinine values may not indicate the actual burden of disease in children with severe malaria. Keywords: Biomarkers; Acute Kidney Injury; Renal Failure; Glomerular Filtration Rate; Cystatin C; Creatinine; Malaria; Nigeria.

scholarly journals THE STUDY OF RENOPROTECTIVE PROPERTIES OF ERYTROPOETIN DERIVATIVES ON THE KIDNEY ISCHEMIA-REPERFUSION MODEL

2018 ◽  
Vol 25 (6) ◽  
pp. 73-77 ◽  
Author(s):  
V. V. Elagin ◽  
D. A. Kostina ◽  
O. I. Bratchikov ◽  
M. V. Pokrovsky ◽  
T. G. Pokrovskaya
Keyword(s):  
Acute Kidney Injury ◽  
Glomerular Filtration Rate ◽  
Glomerular Filtration ◽  
Sodium Excretion ◽  
Filtration Rate ◽  
Ischemia Reperfusion ◽  
Kidney Injury ◽  
Fractional Sodium Excretion ◽  
Male Wistar Rats ◽  
Microcirculatory Disorders

Aim.The research was designed to study the renoprotective properties of erythropoietin derivatives on the kidney ischemiareperfusion experimental model.Materials and methods.The renoprotective properties of asialo erythropoietin (0.4 μg/kg and 2.4 μg/kg 30 minutes before the induction of ischemia) and carbamylated darbepoetin (50 μg/kg 24 hours before the ischemic stimulus) were studied in comparison with erythropoietin and darbepoetin in a series of experiments on male Wistar rats on a 40-minute bilateral model of renal ischemia-reperfusion. The renoprotective properties were evaluated by the results of biochemical markers of acute kidney injury, the dynamics of glomerular filtration rate and fractional sodium excretion, as well as the severity of microcirculatory disorders.Results.It was found that the prophylactic use of asialo erythropoietin (dose-dependent) and carbamylated darbepoetin leads to a decrease in the serum concentration of markers of acute renal damage, an increase in the glomerular filtration rate, a decrease in fractional sodium excretion, and a decrease in microcirculatory disorders.Conclusion.Asialo erythropoietin and carbamylated darbepoetin have the pronounced renoprotective properties and are the promising agents for the prevention and treatment of acute kidney injury.

DIAGNOSIS AND TREATMENT: ACUTE RENAL FAILURE

PEDIATRICS ◽  
1965 ◽  
Vol 35 (3) ◽  
pp. 478-481
Author(s):  
Malcolm A. Holliday
Keyword(s):  
Renal Failure ◽  
Acute Renal Failure ◽  
Glomerular Filtration Rate ◽  
Renal Disease ◽  
Glomerular Filtration ◽  
Filtration Rate ◽  
Obstructive Uropathy ◽  
Urine Flow ◽  
Water Restriction ◽  
Plasma Electrolyte

ACUTE RENAL FAILURE is an uncommon emergency which faces pediatricians. It is usually easy to recognize. The management in the early phase is critical to the survival potential of the patient. The purpose of this review is to cite the causes, characteristics, and principally the management of acute renal failure. Renal failure is defined as a state in which there is not sufficient kidney function to prevent the development of severe uremia or to maintain plasma electrolyte values in a range compatible with ordinary activities. Clinically the condition is associated with mental confusion, stupor, and frequently convulsions. Persistent hiccoughs, irregular respirations, and muscle cramps also may occur. Usually though not always, there is obvious oliguria. Since urine flow is ordinarily but 0.2-2,0% of glomerular filtration rate, and since glomerular filtration rate reduction to 5-10% may be associated with uremia, it is possible to have renal failure without oliguria. It is also possible to have physiological oliguria (&lt; 300 ml per square meter) in response to rigid water restriction that is not related to renal failure. Hence, the term must be defined in terms of its effect on plasma composition rather than in terms of urine flow. The presence of certain clinical conditions known to result in acute renal failure should alert the physician. These include: nephrotoxie agents; hemoglobinuria or myoglobinuria; shock with anoxic damage; acute, diffuse renal disease; acute dehydration in patients with chronic advanced renal disease; and acute obstructive uropathy. Nephrotoxic agents, hemoglobinuria, and shock all result in acute tubular necrosis, and recovery depends upon the capacity of the nephron to regenerate on an intact basement membrane.

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