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      Acute Kidney Injury Definition and Diagnosis: A Narrative Review

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          Abstract

          Acute kidney injury (AKI) is a complex syndrome characterized by a decrease in renal function and associated with numerous etiologies and pathophysiological mechanisms. It is a common diagnosis in hospitalized patients, with increasing incidence in recent decades, and associated with poorer short- and long-term outcomes and increased health care costs. Considering its impact on patient prognosis, research has focused on methods to assess patients at risk of developing AKI and diagnose subclinical AKI, as well as prevention and treatment strategies, for which an understanding of the epidemiology of AKI is crucial. In this review, we discuss the evolving definition and classification of AKI, and novel diagnostic methods.

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          KDIGO Clinical Practice Guidelines for Acute Kidney Injury

          Arif Khwaja, A. Khwaja (2012)
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            Acute kidney injury, mortality, length of stay, and costs in hospitalized patients.

            Glenn Chertow, Elisabeth Burdick, Melissa M Honour … (2005)
            The marginal effects of acute kidney injury on in-hospital mortality, length of stay (LOS), and costs have not been well described. A consecutive sample of 19,982 adults who were admitted to an urban academic medical center, including 9210 who had two or more serum creatinine (SCr) determinations, was evaluated. The presence and degree of acute kidney injury were assessed using absolute and relative increases from baseline to peak SCr concentration during hospitalization. Large increases in SCr concentration were relatively rare (e.g., >or=2.0 mg/dl in 105 [1%] patients), whereas more modest increases in SCr were common (e.g., >or=0.5 mg/dl in 1237 [13%] patients). Modest changes in SCr were significantly associated with mortality, LOS, and costs, even after adjustment for age, gender, admission International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis, severity of illness (diagnosis-related group weight), and chronic kidney disease. For example, an increase in SCr >or=0.5 mg/dl was associated with a 6.5-fold (95% confidence interval 5.0 to 8.5) increase in the odds of death, a 3.5-d increase in LOS, and nearly 7500 dollars in excess hospital costs. Acute kidney injury is associated with significantly increased mortality, LOS, and costs across a broad spectrum of conditions. Moreover, outcomes are related directly to the severity of acute kidney injury, whether characterized by nominal or percentage changes in serum creatinine.
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              Minimal changes of serum creatinine predict prognosis in patients after cardiothoracic surgery: a prospective cohort study.

              Andrea Lassnigg, Daniel Schmidlin, Mohamed Mouhieddine … (2004)
              Acute renal failure increases risk of death after cardiac surgery. However, it is not known whether more subtle changes in renal function might have an impact on outcome. Thus, the association between small serum creatinine changes after surgery and mortality, independent of other established perioperative risk indicators, was analyzed. In a prospective cohort study in 4118 patients who underwent cardiac and thoracic aortic surgery, the effect of changes in serum creatinine within 48 h postoperatively on 30-d mortality was analyzed. Cox regression was used to correct for various established demographic preoperative risk indicators, intraoperative parameters, and postoperative complications. In the 2441 patients in whom serum creatinine decreased, early mortality was 2.6% in contrast to 8.9% in patients with increased postoperative serum creatinine values. Patients with large decreases (DeltaCrea or =0.5 mg/dl. For all groups, increases in mortality remained significant in multivariate analyses, including postoperative renal replacement therapy. After cardiac and thoracic aortic surgery, 30-d mortality was lowest in patients with a slight postoperative decrease in serum creatinine. Any even minimal increase or profound decrease of serum creatinine was associated with a substantial decrease in survival.
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                Author and article information

                Journal
                Journal ID (nlm-ta): J Clin Med
                Journal ID (iso-abbrev): J Clin Med
                Journal ID (publisher-id): jcm
                Title: Journal of Clinical Medicine
                Publisher: MDPI
                ISSN (Electronic): 2077-0383
                Publication date (Electronic): 28 September 2018
                Publication date Collection: October 2018
                Volume: 7
                Issue: 10
                Electronic Location Identifier: 307
                Affiliations
                Division of Nephrology and Renal Transplantation, Department of Medicine Centro Hospitalar Lisboa Norte, EPE, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal; jose.nuno.agapito@ 123456gmail.com (J.A.F.); sofiacjorge@ 123456sapo.pt (S.J.); jalopes93@ 123456hotmail.com (J.A.L.)
                Author notes
                [* ]Correspondence: joana.estrelagameiro@ 123456gmail.com ; Tel.:+351-939-811-447
                Author information
                https://orcid.org/0000-0001-5563-5132
                Article
                Publisher ID: jcm-07-00307
                DOI: 10.3390/jcm7100307
                PMC ID: 6211018
                PubMed ID: 30274164
                SO-VID: 3d8241cc-3119-4541-8cc3-9d861bba6f3f
                Copyright © © 2018 by the authors.
                License:

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                Date received : 05 September 2018
                Date accepted : 26 September 2018
                Categories
                Subject: Review

                Keywords: acute kidney injury,definition,incidence,classification
                Data availability:
                Keywords: acute kidney injury, definition, incidence, classification

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