Skip to main content
SpringerLink
Log in
Book cover

Acute Nephrology for the Critical Care Physician pp 3–13Cite as

AKI: Definitions and Clinical Context

  • Chapter

  • 2405 Accesses

Abstract

Acute kidney injury (AKI) is a sudden decrease of glomerular filtration rate and it is a frequent occurrence in hospitalized patients, especially critically ill ones. Acute renal disease may be represented by a continuum of damage from mild to severe forms. However, AKI is a clinical syndrome with several different aetiologies, pathophysiologic mechanisms and prognostic features: It is likely, even if currently not described, that different AKIs will require different treatments. Definition and (early) diagnosis of AKI is currently the focus of most intense research: The KDIGO classification is the latest consensus definition reconciling older criteria and introducing the concept of subclinical AKI. In fact, the AKI syndrome is the inevitable consequence of multiple (cumulative) exposures in susceptible patients over a variable and uncertain amount of time. The clinical expression of these insults is almost silent: It is becoming evident that the identification of the risk of AKI is probably more important than the definition and diagnosis of AKI itself. The hope of the next decade will rely on research and validation of novel biomarkers and the possibility of being informed on silent hits occurring to the kidneys before frank AKI developed.

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   109.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Bellomo R, Kellum JA, Ronco C. Acute kidney injury. Lancet. 2012;380:756–66.

    Article  PubMed  Google Scholar 

  2. Kellum JA, Lameire N; for the KDIGO AKI Guideline Work Group. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care. 2013; 17:204.

    Google Scholar 

  3. Lameire N, Kellum JA; for the KDIGO AKI Guideline Work Group. Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Crit Care. 2013;17:205.

    Google Scholar 

  4. Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol. 2007;18:1292–8.

    Article  CAS  PubMed  Google Scholar 

  5. McCullough PA, Shaw AD, Haase M, Bouchard J, Waikar SS, Siew ED, Murray PT, Mehta RL, Ronco C. Diagnosis of acute kidney injury using functional and injury bio- markers: workgroup statements from the tenth Acute Dialysis Quality Initiative Consensus Conference. Contrib Nephrol. 2013;182:13–29. Basel, Karger.

    PubMed  Google Scholar 

  6. Prowle J, Bagshaw SM, Bellomo R. Renal blood flow, fractional excretion of sodium and acute kidney injury: time for a new paradigm? Curr Opin Crit Care. 2012;18(6):585–92.

    Article  PubMed  Google Scholar 

  7. Thadhani R, Pascual M, Bonventre JV. Acute renal failure. N Engl J Med. 1996;334(22):1448–60.

    Article  CAS  PubMed  Google Scholar 

  8. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, Acute Dialysis Quality Initiative workgroup. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–12.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A, Acute Kidney Injury Network. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 2007;11:R31.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl. 2012;2:1–138.

    Google Scholar 

  11. Kellum JA, Bellomo R, Ronco C. Kidney attack. JAMA. 2012;307:2265–6.

    Article  CAS  PubMed  Google Scholar 

  12. Uchino S, Bellomo R, Bagshaw SM, Goldsmith D. Transient azotaemia is associated with a high risk of death in hospitalized patients. Nephrol Dial Transplant. 2010;25(6):1833–9.

    Article  PubMed  Google Scholar 

  13. Haase M, Kellum JA, Ronco C. Subclinical AKI–an emerging syndrome with important consequences. Nat Rev Nephrol. 2012;8(12):735–9.

    Article  CAS  PubMed  Google Scholar 

  14. Malhotra R, Macedo E, Bouchard J, Wynn S, Mehta RL. Prediction of acute kidney injury (AKI) by risk factors classification [Abstract]. J Am Soc Nephrol. 2009;20:979A.

    Google Scholar 

  15. Basu RK, Zappitelli M, Brunner L, Wang Y, Wong HR, Chawla LS, Wheeler DS, Goldstein SL. Derivation and validation of the renal angina index to improve the prediction of acute kidney injury in critically ill children. Kidney Int. 2014;85:659–67.

    Google Scholar 

  16. Ronco C, McCullough PA, Chawla LS. Kidney attack versus heart attack: evolution of classification and diagnostic criteria. Lancet. 2013;382(9896):939–40.

    Article  PubMed  Google Scholar 

  17. Ronco C. Kidney attack: overdiagnosis of acute kidney injury or comprehensive definition of acute kidney syndromes? Blood Purif. 2013;36:65–8.

    Article  PubMed  Google Scholar 

  18. Rewa O, Bagshaw SM. Acute kidney injury-epidemiology, outcomes and economics. Nat Rev Nephrol. 2014;10(4):193–207.

    Article  CAS  PubMed  Google Scholar 

  19. Goldstein SL, Kirkendall E, Nguyen H, Schaffzin JK, Bucuvalas J, Bracke T, Seid M, Ashby M, Foertmeyer N, Brunner L, Lesko A, Barclay C, Lannon C, Muething S. Electronic health record identification of nephrotoxin exposure and associated acute kidney injury. Pediatrics. 2013;132:e756–67.

    Article  PubMed  Google Scholar 

  20. Ricci Z, Ronco C. New insights in acute kidney failure in the critically ill. Swiss Med Wkly. 2012;142:w13662.

    PubMed  Google Scholar 

  21. Legrand M, Dupuis C, Simon C, Gayat E, Mateo J, Lukaszewicz AC, Payen D. Association between systemic hemodynamics and septic acute kidney injury in critically ill patients: a retrospective observational study. Crit Care. 2013;17:R278.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Coca SG, Garg AX, Swaminathan M, Garwood S, Hong K, Thiessen-Philbrook H, Passik C, Koyner JL, Parikh CR, TRIBE-AKI Consortium. Preoperative angiotensin-converting enzyme inhibitors and angiotensin receptor blocker use and acute kidney injury in patients undergoing cardiac surgery. Nephrol Dial Transplant. 2013;28:2787–99.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  23. Lafrance JP, Miller DR. Selective and non-selective non-steroidal anti-inflammatory drugs and the risk of acute kidney injury. Pharmacoepidemiol Drug Saf. 2009;18:923–31.

    Article  CAS  PubMed  Google Scholar 

  24. Felker GM, Lee KL, Bull DA, Redfield MM, Stevenson LW, Goldsmith SR, LeWinter MM, Deswal A, Rouleau JL, Ofili EO, Anstrom KJ, Hernandez AF, McNulty SE, Velazquez EJ, Kfoury AG, Chen HH, Givertz MM, Semigran MJ, Bart BA, Mascette AM, Braunwald E, O’Connor CM, NHLBI Heart Failure Clinical Research Network. Diuretic strategies in patients with acute decompensated heart failure. N Engl J Med. 2011;364:797–805.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  25. Neuberg GW, Miller AB, O’Connor CM, et al.; PRAISE Investigators. Diuretic resistance predicts mortality in patients with advanced heart failure. Am Heart J. 2002;144:31–8.

    Google Scholar 

  26. Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol. 2005;16:162–8.

    Article  PubMed  Google Scholar 

  27. Lins RL, Elseviers MM, Daelemans R, Arnouts P, Billiouw JM, Couttenye M, Gheuens E, Rogiers P, Rutsaert R, Van der Niepen P, De Broe ME. Re-evaluation and modification of the Stuivenberg Hospital Acute Renal Failure (SHARF) scoring system for the prognosis of acute renal failure: an independent multicentre, prospective study. Nephrol Dial Transplant. 2004;19:2282–8.

    Article  CAS  PubMed  Google Scholar 

  28. Parikh CR, Coca SG, Thiessen-Philbrook H, Shlipak MG, Koyner JL, Wang Z, Edelstein CL, Devarajan P, Patel UD, Zappitelli M, Krawczeski CD, Passik CS, Swaminathan M, Garg AX, TRIBE-AKI Consortium. Postoperative biomarkers predict acute kidney injury and poor outcomes after adult cardiac surgery. J Am Soc Nephrol. 2011;22:1748–57.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  29. Koyner JL, Garg AX, Coca SG, Sint K, Thiessen-Philbrook H, Patel UD, Shlipak MG, Parikh CR, TRIBE-AKI Consortium. Biomarkers predict progression of acute kidney injury after cardiac surgery. J Am Soc Nephrol. 2012;23:905–14.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  30. Ronco C, Ricci Z. The concept of risk and the value of novel markers of acute kidney injury. Crit Care. 2013;17:117.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Kashani K, Al-Khafaji A, Ardiles T, Artigas A, Bagshaw SM, Bell M, Bihorac A, Birkhahn R, Cely CM, Chawla LS, Davison DL, Feldkamp T, Forni LG, Gong MN, Gunnerson KJ, Haase M, Hackett J, Honore PM, Hoste EA, Joannes-Boyau O, Joannidis M, Kim P, Koyner JL, Laskowitz DT, Lissauer ME, Marx G, McCullough PA, Mullaney S, Ostermann M, Rimmelé T, Shapiro NI, Shaw AD, Shi J, Sprague AM, Vincent JL, Vinsonneau C, Wagner L, Walker MG, Wilkerson RG, Zacharowski K, Kellum JA. Discovery and validation of cell cycle arrest biomarkers in human acute kidney injury. Crit Care. 2013;17:R25.

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pediatric Cardiac Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Piazza S. Onofrio 4, Rome, 00165, Italy

    Zaccaria Ricci MD

  2. Department of Nephrology, Dialysis and Transplantation, S. Bortolo Hospital, Viale Rodolfi, Vicenza, 36100, Italy

    Claudio Ronco MD

  3. International Renal Research Institute, Vicenza, Italy

    Claudio Ronco MD

Authors
  1. Zaccaria Ricci MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Claudio Ronco MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zaccaria Ricci MD .

Editor information

Editors and Affiliations

  1. Department of Intensive Care, VU University Hospital, Amsterdam, The Netherlands

    Heleen M. Oudemans-van Straaten

  2. Department of Intensive Care Medicine, Anaesthesia Critical Care Collaborative, Research Group (SPACeR) and Faculty of Health Care Sciences, Royal Surrey County Hospital NHS, Foundation Trust, Surrey Perioperative, University of Surrey, Guildford, United Kingdom

    Lui G. Forni

  3. Department of Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands

    A.B. Johan Groeneveld

  4. Department of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada

    Sean M. Bagshaw

  5. Division of Intensive Care and Emergency Medicine, Department of General Internal Medicine, Medical University Innsbruck, Anichstrasse, Innsbruck, Austria

    Michael Joannidis

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing

About this chapter

Cite this chapter

Ricci, Z., Ronco, C. (2015). AKI: Definitions and Clinical Context. In: Oudemans-van Straaten, H., Forni, L., Groeneveld, A., Bagshaw, S., Joannidis, M. (eds) Acute Nephrology for the Critical Care Physician. Springer, Cham. https://doi.org/10.1007/978-3-319-17389-4_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-17389-4_1

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-17388-7

  • Online ISBN: 978-3-319-17389-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation