Acute renal injury after partial hepatectomy

Table 1 Current diagnostic criteria for acute kidney injury in general population

	RIFLE criteria[27]	AKIN criteria[28]	KDIGO criteria[29]
Diagnostic criteria	Increase in SCr to ≥ 1.5 times baseline, within 7 d; or GFR decrease > 25%; or urine volume < 0.5 mL/kg per hour for 6 h	Increase in sCr by ≥ 0.3 mg/dL (26.5 mmol/L) within 48 h; or increase in sCr ≥ 1.5 times baseline within 48 h; or urine volume < 0.5 mL/kg per hour for 6 h	Increase in sCr by ≥ 0.3 mg/dL (26.5 mmol/L) within 48 h; or increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 d; or urine volume < 0.5 mL/kg per hour for 6 h
	Risk: sCr increase 1.5-1.9 times baseline; or GFR decrease 25%-50%; or urine output < 0.5 mL/kg per hour for 6 h	Stage 1: sCr increase 1.5-1.9 times baseline; or sCr increase ≥ 0.3 mg/dL (26.5 mmol/L); or urine output < 0.5 mL/kg per hour for 6 h	Stage 1: sCr increase 1.5-1.9 times baseline; or sCr increase ≥ 0.3 mg/dL (26.5 mmol/L); or urine output < 0.5 mL/kg per hour for 6-12 h
Staging	Injury: sCr increase 2.0-2.9 times baseline; or GFR decrease 50%-75%; or urine output < 0.5 mL/kg per hour for 12 h	Stage 2: sCr increase 2.0-2.9 times baseline; or urine output < 0.5 mL/kg per hour for 12 h	Stage 2: sCr increase 2.0-2.9 times baseline; or urine output < 0.5 mL/kg per hour for ≥ 12 h
	Failure: sCr increase ≥ 3.0 times baseline: or GFR decrease 50%-75%; or sCr increase ≥ 4.0 mg/dL (353.6 mmol/L) with an acute increase of at least 0.5 mg/dL (44 mmol/L); or urine output < 0.3 mL/kg per hour for ≥ 24 h; or anuria for ≥ 12 h	Stage 3: sCr increase 3.0 times baseline; or sCr increase ≥ 4.0 mg/dL (353.6 mmol/L) with an acute increase of at least 0.5 mg/dL (44 mmol/L); or urine output < 0.3 mL/kg per hour for ≥ 24 h; or anuria for ≥ 12 h	Stage 3: sCr increase 3.0 times baseline; or sCr increase to ≥ 4.0 mg/dL (353.6 mmol/L); or initiation of renal replacement therapy; or urine output < 0.3 mL/kg per hour for ≥ 24 h; or Anuria for ≥ 12 h

AKIN: Acute Kidney Injury Network; GFR: Glomerular filtration rate; KDIGO: Kidney Disease Improving Global Outcome; RIFLE: Risk, Injury, Failure, Loss, End stage renal disease; sCr: Serum creatinine.

Table 2 International Club of Ascites new definitions for the diagnosis and management of acute kidney injury in patients with cirrhosis[68]

Baseline sCr	A value of sCr obtained in the previous 3 mo, when available, can be used as baseline sCr. In patients with more than one value within the previous 3 mo, the value closest to the admission time to the hospital should be used. In patients without a previous sCr value, the sCr on admission should be used as baseline
Definition of AKI	Increase in sCr ≥ 0.3 mg/dL (≥ 26.5 mmol/L) within 48 h; or a percentage increase sCr ≥ 50% from baseline which is known, or presumed, to have occurred within the prior 7 d
Staging of AKI	Stage 1: Increase in sCr ≥ 0.3 mg/dL (26.5 mmol/L) or an increase in sCr ≥ 1.5-fold to twofold from baseline Stage 2: Increase in sCr > two to threefold from baseline Stage 3: Increase of sCr > threefold from baseline or sCr ≥ 4.0 mg/dL (353.6 mmol/L) with an acute increase ≥ 0.3 mg/dL (26.5 mmol/L) or initiation of renal replacement therapy
Progression of AKI	Progression: Progression of AKI to a higher stage and/or need for RRT
	Regression: Regression of AKI to a lower stage
Response to treatment	No response: No regression of AKI
	Partial response: Regression of AKI stage with a reduction of sCr to ≥ 0.3 mg/dL (26.5 mmol/L) above the baseline value
	Full response: Return of sCr to a value within 0.3 mg/dL (26.5 mmol/L) of the baseline value

AKI: Acute kidney injury; RRT: Renal replacement therapy; sCr: Serum creatinine.

Table 3 Diagnostic criteria of hepatorenal syndrome type of acute kidney injury in patients with cirrhosis[68]

HRS-AKI

Diagnosis of cirrhosis and ascites

Diagnosis of AKI according to ICA-AKI criteria (Table 2)

No response after 2 consecutive days of diuretic withdrawal and plasma volume expansion with albumin 1 g/kg bodyweight

Absence of shock

No current or recent use of nephrotoxic drugs (NSAIDs, aminoglycosides, iodinated contrast media, etc.)

No macroscopic signs of structural kidney injury, defined as

Absence of proteinuria (> 500 mg/d)

Absence of microhaematuria (> 50 RBCs per high power field)

Normal findings on renal ultrasonography

Patients who fulfil these criteria may still have structural damage such as tubular damage. Urine biomarkers will become an important element in making a more accurate differential diagnosis between HRS and acute tubular necrosis

HRS: Hepatorenal syndrome; AKI: Acute kidney injury; ICA: International club of ascites; NSAIDs: Non-steroidal anti-inflammatory drugs; RBCs: Red blood cells.