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Define, calssify, describe stage of AKI and each clinical

manifestation

DEFINITION OF AKI

 Acute kidney injury (AKI), previously known as acute renal failure, is
characterized by the sudden impairment of kidney function resulting in the
retention of nitrogenous and other waste products normally cleared by the
kidneys.
 AKI is not a single disease but, rather, a designation for a heterogeneous
group of conditions that share common diagnostic features: specifically, an
increase in the blood urea nitrogen (BUN) concentration and/or an increase in
the plasma or serum creatinine (SCr) concentration, often associated with a
reduction in urine volume.

CLASSIFICATION

Classification of the major causes of acute kidney injury.

Prerenal Azotemia

 It is the designation for a rise in SCr or BUN concentration due to inadequate
renal plasma flow and intraglomerular hydrostatic pressure to support normal
glomerular filtration. prerenal azotemia involves no parenchymal damage to
the kidney and is rapidly reversible once intraglomerular hemodynamics are
restored.
 Clinical conditions: hypovolemia, decreased cardiac output, and medications
that interfere with renal autoregulatory responses such as nonsteroidal
antiinflammatory drugs (NSAIDs) and inhibitors of angiotensin II.

Intrinsic Aki

and nephrotoxins.  The most common causes of intrinsic AKI are sepsis. both endogenous and exogenous Postrenal Acute Kidney Injury  Postrenal AKI occurs when the normally unidirectional flow of urine is acutely blocked either partially or totally. ischemia.  Obstruction to urinary flow may be caused by functional or structural derangements anywhere from the renal pelvis to the tip of the urethra  The pathophysiology of postrenal AKI involves hemodynamic alterations triggered by an abrupt increase in . leading to increased retrograde hydrostatic pressure and interference with glomerular filtration.

and a reduction in NO production. Injury. and End-stage kidney disease.3 mg/dL or more (≥26.5-fold from baseline) or  A reduction in urine output (documented oliguria of < 0. and vasopressin. and Loss. baseline SCr is not necessary in the AKIN classification. possibly. and it requires at least two values of SCr obtained within a period of 48 h. AKIN Classification  In September 2004.  The AKIN classification . changes in the glomerular ultrafiltration coefficient.5 mL/kg/h for >6 h) .  the AKIN classification only relies on SCr and not on GFR changes. Note: Patients can be classified either by GFR criteria or by UO criteria. intratubular pressures. Reduced GFR is due to underperfusion of glomeruli and.4 μmol/L) or  A percentage increase in serum creatinine of 50% or more (1. and Failure. the Acute Kidney Injury Network (AKIN) was formed. The RIFLE classification  Create: May 2002.  A report by the AKIN proposed the following criteria for AKI :  Abrupt (within 48 h) reduction in kidney function currently defined as an absolute increase in serum creatinine of 0. The criteria that support the most severe classification should be used.it is a later version of the RIFLE classification with some modifi. the Acute Dialysis Quality Initiative (ADQI) group for the study of AKI. thromboxane A2.  RIFLE is an acronym of Risk.cations: the diagnosis of AKI is only considered after achieving an adequate status of hydration and after excluding urinary obstruction. An initial period of hyperemia from afferent arteriolar dilation is followed by intrarenal vasoconstriction from the generation of angiotensin II.

KDIGO defines AKI as any of the following:  Increase in serum creatinine by 0. *the two outcome classes (loss of kidney function and end-stage kidney disease) were removed from the classification. STAGING FOR AKI In 2012 the Kidney Disease Improving Global Outcomes (KDIGO) released their clinical practice guidelines for acute kidney injury (AKI). .3mg/dL or more within 48 hours or  Increase in serum creatinine to 1.5 mL/kg/h for 6 hours The KDIGO has also recommended a staging system for the severity of the AKI.5 times baseline or more within the last 7 days or  Urine output less than 0. which build off of the RIFLE criteria and the AKIN criteria.