Acute Kidney Injury
Common in hospitalized patients, increasing in incidence, and associated with adverse outcomes. But, hard to identify.
AKI Risk Factors
Acute kidney injury (AKI) is a rapid loss of kidney function, which typically happens as a complication of another serious illness or intervention. Because pain and other symptoms don’t usually occur, rapid identification of patients who are at riski is critical, as there is no specific treatment for AKI.
Identify AKI earlier with The NGAL Test.
AKI is Associated with Adverse, Long-Term Outcomes
1 in 5
Hospitalized patients at risk
+7 to 23
Days in hospital
AKI Classification Systems
The definition of AKI, previously known as acute renal failure (ARF), has evolved for nearly two decades, as clinicians have struggled to classify the condition.vi
Developed in 2012, the current KDIGO definition and staging of AKIvii are summarized here. These guidelines are under review with updates expected in 2025.
KDIGO - Kidney Disease Improving Global Outcomes Criteria
Stage | Serum Creatinine | Urine Output |
---|---|---|
1 | 1.5–1.9 times baseline,or ≥0.3 mg/dL >26.5 µmol/L increase | <0.5 mL/kg/h for 6-12h |
2 | 2–2.9 times baseline | <0.5 mL/kg/h for ≥12h |
3 | 3 times baseline, OR Increase in serum creatinine to ≥4 mg/dL, OR Initiation of renal replacement therapy | <0.3 mL/kg/h for ≥24h, or anuria for ≥12h |
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AKI Assessment Using Functional and Damage Biomarkers
In 2020, the Acute Disease Quality Initiative (ADQI) workgroup recommended that “a combination of damage and functional biomarkers, along with clinical information, be used to improve the diagnostic accuracy of AKI, to recognize the different pathophysiological processes, to discriminate AKI etiology, and to assess AKI severity.”viii
Neutrophil gelatinase-associated lipocalin (NGAL) is a renal damage biomarker with extensive research in different patient populations and clinical settings.
i Ronco C, Bellomo R, Kellum JA. Acute kidney injury. Lancet. 2019;394(10212):1949-1964.
iiSusantitaphong P, Cruz DN, Cerda J, et al. World incidence of AKI: a meta-analysis. Clin J Am Soc Nephrol. 2013;8(9):1482–1493.
iiiSutherland SM, Ji J, Sheikhi FH, Widen E, Tian L, Alexander SR, Ling XB. AKI in hospitalized children: epidemiology and clinical associations in a national cohort. Clin J Am Soc Nephrol. 2013 Oct;8(10):1661-9.
ivMehta RL, Cerdá J, Burdmann EA, et al. International Society of Nephrology's 0by25 initiative for acute kidney injury (zero preventable deaths by 2025): a human rights case for nephrology. Lancet. 2015;385(9987):2616-2643.
vAskenazi DJ, Feig DI, Graham NM, Hui-Stickle S, Goldstein SL. 3-5 year longitudinal follow-up of pediatric patients after acute renal failure. Kidney Int. 2006;69(1):184-189.
viKellum JA, Levin N, Bouman C, Lameire N. Developing a consensus classification system for acute renal failure. Curr Opin Crit Care. 2002;8(6):509-514.
viiKhwaja A. KDIGO clinical practice guidelines for acute kidney injury. Nephron Clin Pract. 2012;120(4):c179-c184.
viiiOstermann M, Zarbock A, Goldstein S, et al. Recommendations on Acute Kidney Injury Biomarkers From the Acute Disease Quality Initiative Consensus Conference: A Consensus Statement JAMA Netw Open. 2020;3(10):e2019209.