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
 The most common causes of intrinsic AKI are sepsis, ischemia, and
nephrotoxins, 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, leading to increased retrograde
hydrostatic pressure and interference
with glomerular filtration.
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
 intratubular pressures. An initial period of hyperemia from afferent arteriolar
dilation is followed by intrarenal vasoconstriction from the generation of
angiotensin II, thromboxane A2, and vasopressin, and a reduction in NO
production. Reduced GFR is due to underperfusion of glomeruli and, possibly,
changes in the glomerular ultrafiltration coefficient.

The RIFLE classification

Create: May 2002, the Acute Dialysis Quality Initiative (ADQI) group for the
study of AKI.
RIFLE is an acronym of Risk, Injury, and Failure; and Loss; and End-stage
kidney disease.

Note: Patients can be classified either by GFR criteria or by UO criteria. The

criteria that support the most severe classification should be used.

AKIN Classification

In September 2004, the Acute Kidney Injury Network (AKIN) was formed.
The AKIN classification ,it is a later version of the RIFLE classification with
some modifi- cations: the diagnosis of AKI is only considered after achieving
an adequate status of hydration and after excluding urinary obstruction;
the AKIN classification only relies on SCr and not on GFR changes; baseline
SCr is not necessary in the AKIN classification, and it requires at least two
values of SCr obtained within a period of 48 h;
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 0.3 mg/dL or more (26.4
mol/L) or
A percentage increase in serum creatinine of 50% or more (1.5-fold from
baseline) or
A reduction in urine output (documented oliguria of < 0.5 mL/kg/h for >6
h)
 *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), which build off of the
RIFLE criteria and the AKIN criteria.

KDIGO defines AKI as any of the following:

Increase in serum creatinine by 0.3mg/dL or more within 48 hours or

Increase in serum creatinine to 1.5 times baseline or more within the last 7
days or
Urine output less than 0.5 mL/kg/h for 6 hours

The KDIGO has also recommended a staging system for the severity of the AKI.