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AKI stage 3

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

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Staging of AKI

Stage of AKI

Serum creatinine (SCr) criteria

Urine output criteria

1

increase >=26 µmol/L within 48hrs or

increase >= 1.5 to 1.9 X reference SCr

<0.5 mL/kg/hr for > 6 consecutive hrs

2

increase >= 2 to 2.9 X reference SCr

<0.5 mL/kg/ hr for > 12 hrs

3

increase >=3 X reference SCr or

increase >=354 µmol/L or

commenced on renal replacement therapy (RRT) irrespective of stage

<0.3 mL/kg/ hr for > 24 hrs or anuria for >= 12 hrs

Definition of AKI

Acute kidney injury is defined when one of the following criteria is met

  • serum creatinine rises by >= 26 µmol/L within 48 hours or

  • serum creatinine rises >= 1.5 fold from the reference value, which is known or presumed to have occurred within one week or

  • oliguria (urine output is < 0.5ml/kg/hr for >6 consecutive hours) or

  • a 25% or greater fall in eGFR in children and young people within the past 7 days (3)

The reference serum creatinine should be the lowest creatinine value recorded within 3 months of the event

If a reference serum creatinine value is not available within 3 months and AKI is suspected

  • repeat serum creatinine within 24 hours
  • a reference serum creatinine value can be estimated from the nadir serum creatinine value if patient recovers from AKI

Notes:

  • formula-based estimated GFR should be interpreted with caution in AKI - this is because the formulae rely on a stable serum creatinine concentration
  • is a clinical syndrome characterised by a rapid decline in excretory function occurring over a period of hours or day
  • if a patient has suspected AKI the s/he should be referred to a nephrologist
  • acute on chronic renal failure
    • if there has been a fall in estimated GFR of >25% since the last measurement of kidney function in a patient with CKD should prompt a repeat measurement of kidney function, assessment as for AKI and referral if the deterioration is confirmed

Reference:

  1. The Renal Association (May 2006).UK CKD Guidelines
  2. UK Renal Association (2011). Acute Kidney Injury
  3. NICE (August 2013). Acute kidney injury - Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy

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