Topic Highlight
Copyright ©2014 Baishideng Publishing Group Inc.
World J Hepatol. Oct 27, 2014; 6(10): 696-703
Published online Oct 27, 2014. doi: 10.4254/wjh.v6.i10.696
Table 1 Definitions of acute kidney injury using changes in serum creatinine between the Risk Injury Failure EndStage[7], Akute Kidney Injury Network[8] and Kidney Disease Improving Global Outcomes[9] criteria
CriteriaRIFLE[7]AKIN[8]KDIGO[9]
Date of release200420072012
Time intervalDiagnosis and Staging: Within 1-7 d and sustained more than 24 hDiagnosis: Within 48 h Staging: 1 wkDiagnosis: 50% increase within 7 d or ≥ 0.3 mg/dL (26.5 μmol/L) within 48 h
Stage 1 or RIncreased SCr 1.5-1.9 times baselineIncreased SCr 1.5-1.9 times baseline or ≥ 0.3 mg/dL (≥ 26.5 μmol/L) increaseIncreased SCr 1.5-1.9 times baseline (7 d) or ≥ 0.3 mg/dL (≥ 26.5 μmol/L) increase (48 h)
Stage 2 or IIncreased SCr 2.0-2.9 times baselineIncreased SCr 2.0-2.9 times baselineIncreased SCr 2.0-2.9 times baseline
Stage 3 or FIncreased SCr 3.0 times baseline, or Increase in SCr ≥ 4.0 mg/dL (350 μmol/L) with an acute rise of ≥ 0.5 mg/dL (44 μmol/L)Increased SCr 3.0 times baseline, or Increase in SCr ≥ 4.0 mg/dL (350 μmol/L) with an acute rise of ≥ 0.5 mg/dL (44 μmol/L)Increased SCr 3.0 times baseline, or Increase in SCr ≥ 4.0 mg/dL (350 μmol/L)
Table 2 Cohort of 329 adult patients transplanted for advanced cirrhosis
RIFLE[7]AKIN[8]KDIGO[9]
Stage 1 or R539397
Stage 2 or I282828
Stage 3 or R888
Stage 3 initiation of RRT171717
Table 3 Comparison of the established methods for assessing renal function in clinical practice
AdvantagesDisadvantages
Serum marker
CreatinineWidely availableInfluenced by several factors unrelated to renal function, including dehydration and volume expansion, dietary protein, muscle mass, physical activity and thyroid hormones renal tubular secretion affected by chronic kidney disease, proteinuria and drugs not an early biomarker of acute kidney injury Absence of standardization of the laboratory methods for jaundiced patients
Clearance of exogenous marker“Gold standard”technical difficulties and expense make impractical for routine clinical practice stable renal function Less reliable in patients with oedema, ascites, pleural effusions and sarcopenia
Creatinine Clearance f
(24 h urine collection)? more accurate compared to CrInconvenient for outpatientsoverestimates GFR in proteinuria chronic kidney disease influenced by muscle metabolism and diet, inflammatory disease and malnutrition Unexplained variation due to incomplete urine collection and errors in urine volume measurement overestimation of GFR in patients with cirrhosis
Mathematical formulae based on CrEasier method compared to 24 h urine collectionNot validated for patients with changing renal function (acute kidney injury, muscle wasting disorders) Does not overcome the limitations in serum creatinine
C-G formulaRequires only gender, age, body weightDifficult to determine body weight in patients with ascites and post LT
MDRD formulaBody weight is not needed ethnicity, gender and age are taken into accountHas not been validated in patients with chronic liver disease 6-variables formula: needs albumin, urea Only validated in stable chronic kidney disease patients