Acute Kidney Injury Yi Fang Department of Nephrology Zhongshan Hospital, Fudan University
Yi Fang Department of Nephrology Zhongshan Hospital, Fudan University Acute Kidney Injury
Acute Kidney Injury, AKI AKI is a common problem, especially in the critical care setting It is a complex disorder for which there was no accepted definition acute renal failure(ARF) fails to adequately describe the dynamic process Reported incidence and mortality varies widely Incidence ranges 1-31% Mortality ranges 28-82% Complications poor prognosIs increased cost, LOS. Increased Damage fallure Death
Acute Kidney Injury, AKI • AKI is a common problem, especially in the critical care setting • It is a complex disorder for which there was no accepted definition • acute renal failure (ARF) fails to adequately describe the dynamic process • Reported incidence and mortality varies widely – Incidence ranges 1-31% – Mortality ranges 28-82% poor prognosis increased cost, LOS……
DEFINITION AND CLASSIFICATION
DEFINITION AND CLASSIFICATION
Definitions of aki and incidence 19.△cr72h>50umoL 20.△cr72h>100umoL 1. Creat△0.1mg/lL 21. Cockcroft-Gault cr cl 30 mL/mi 2. Creat increase >0.5 mg/dL 2. Cockcroft-Gault cr cl 30-60 mL/min2o% 3. Creat>=0.5 mg/dl 4. Creat >=1.7 mg/dl 164% 5. Creat >=1.5 mg/dL 6. Creat >=2 mg/dI 7. Creat>= 2. 1 mg/dL and x 2 30% 8. Creat>=177moL△>62μmoL 9. Creat >200umol/L(2.36 mg/dL) 6.5%6.5 10. Creat> 3.2 mg/dL or x 2 11. Creat>5 mg/dL or K>5.5 10% 12. RIFLE 13. Creat increase > 25% 14. Creat increase > 50% 32. U gluthation transferase-TT crmeazo 15. Creat increase >= 100% 33. U gluthation transferase-a 16.△Cr72h>0umoL 34. NGAL 17.△cr72h>25umoL 35. RRT 18.△Cr72h>44umoL 36
1. Creat Δ 0.1 mg/dL 2. Creat increase >0.5 mg/dL 3. Creat>= 0.5 mg/dL 4. Creat >= 1.7 mg/dL 5. Creat >= 1.5 mg/dL 6. Creat >= 2 mg/dL 7. Creat>= 2.1 mg/dL and x 2 8. Creat >= 177µmol/L Δ>62µmol/L 9. Creat > 200µmol/L (2.36 mg/dL) 10. Creat> 3.2 mg/dL or x 2 11. Creat>5 mg/dL or K > 5.5 12. RIFLE 13. Creat increase >= 25% 14. Creat increase >= 50% 15. Creat increase >= 100% 16. ΔCr72h >0µmol/L 17. ΔCr72h >25µmol/L 18. ΔCr72h >44µmol/L 19. ΔCr72h >50µmol/L 20. ΔCr72h >100µmol/L 21. Cockcroft-Gault Cr Cl < 30 mL/min 22. Cockcroft-Gault Cr Cl 30–60 mL/min 23. ΔCockcroft-Gault72hr <0% 24. ΔCockcroft-Gault72hr <-15% 25. ΔCockcroft-Gault72hr <-25% 26. ΔCockcroft-Gault72hr <-50% 27. MDRD: 50% change in GFR 28. UO <100 q 8hr 29. U α1-microglob 30. U β2- microglobulin 31. U N-acetyl- β-D-glucosaminidase 32. U gluthation transferase-π 33. U gluthation transferase- α 34. NGAL 35. RRT 36. … 4.1% 6.5% 6.5% 9.7% 16.4% 2.0% 4.4% 6.5% 7.9% 0% 10% 20% 30% 40% 50% ≥0.3 mg/dL ≥0.5 mg/dL ≥0.5 mg/dL or ≥1.0 mg/dL* ≥1.0 mg/dL ≥2.0 mg/dL 25% 50% 100% 50% AND creatinine≥2.0 mg/dL AKI (%) 0% 4% 8% 12% 16% 20% Mortality (%) Definitions of AKI and incidence
Current criteria for AKI diagnosis Serum Creatinine Scr Increased UO .25% Urine output Increased creatinine x 2 U075% R( Increase creatinine x1.5 x 24 or >0.3mg/dI Failure or creatinine 2 4mg/dl anuria 12 h (Acute rise of 20.5 mg/dl) Uo≤0.5mkgh (II) Increase creatinine x2 x12h Loss Complete loss of renal function >4 w Increase creatinine x3 UO<3ml/kg/h F(nor creatinine 24mg/dIx24 hr or ESRD End stage renal disease (Acute rise of 20.5 mg/d) Anuria x 12 hrs RRT Started RIFLE criteria AKIN criteria
Current criteria for AKI diagnosis • Serum Creatinine • Urine output Scr Increased creatinine x1.5 or GFR decrease > 25% UO 0.3mg/dl Increase creatinine x2 Increase creatinine x3 or creatinine 4mg/dl (Acute rise of 0.5 mg/dl) UO 75% or creatinine 4mg/dl (Acute rise of 0.5 mg/dl) Complete loss of renal function > 4 w End stage renal disease Risk Injury Failure Loss ESRD
DNEY SLOBAL OUTCOME'e KDIGO CLINICAL PRACTICE GUIDELINE FOR ACUTE KIDNEY INJURY
NEY D O SLOBAL AKI is defined as any of the following(Not Graded: Increase in SCr by 20.3 mg/dl (26.5 umol/I) within 48 hours; or Increase 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
NEY D O oBAL. AKI is staged for severity according to the following criteria (Table 1). (Not graded) Table 1. Staging of AKl Stage Serum creatinine Urine output 15-19 times baseline <0.5 mlkg/h for 6-12 hours ≥03mgdl(≥26.5umo) Increase 2. 0-2.9 times baseline <0.5 ml/kg/h for 212 hours 3.0 times baseline 43m/kg/hfor≥24 hours OR OR Increase in serum creatinine to 24.0 mg/dl Anuria for 212 hours (23536pmo) Initiation of renal replacement therapy OR, In patients <18 years, decrease in eGFR to <35 mI/min per 1.73 m2
INCIDENCE
INCIDENCE
Incidence of AKI in general population 300 0 Crit Care Med, 2008, 36(4 Suppl): S146-51 AKl defined as RRt requirement
Incidence of AKI in general population Crit Care Med, 2008,36(4 Suppl):S146-51 AKI defined as RRT requirement