Acute Kidney Injury (AKI)
Acute kidney injury (formerly known as acute renal failure) is a complex disorder with many underling conditions. It is seen in SIRS/sepsis and associated with a mortality of 60 % [1]. In 2007, a uniform definition was proposed which now replaces the more
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Marcus Hiß and Jan T. Kielstein
13.1
Definition
Acute kidney injury (formerly known as acute renal failure) is a complex disorder with many underling conditions. It is seen in SIRS/sepsis and associated with a mortality of 60 % [1]. In 2007, a uniform definition was proposed which now replaces the more than 30 definitions that existed previously [2]. The diagnostic criteria for AKI were proposed based on acute alterations in serum creatinine or urine output. The Acute Kidney Injury Network (AKIN) criteria (Table 13.1) are based on epidemiological studies. Those studies indicated that modest changes in serum creatinine were significantly associated with mortality, hospital length of stay, and costs [3]. The old classification of prerenal, renal, and postrenal AKI is becoming less important as more than 90 % of the AKI patients suffer from a combination of prerenal and renal AKI. The incidence of AKI is increasing worldwide. From 2000 to 2009, the incidence of dialysis-requiring AKI in the USA increased about 10 % per year [4]. This increase in incidence was evident in all age, sex, and race subgroups examined. The total number of deaths associated with dialysis-requiring AKI rose from 18,000 in 2000 to nearly 39,000 in 2009 [4]. Old age, higher degree of baseline renal impairment, and advanced diagnostic and therapeutic procedures epitomized by high-dose chemotherapy or implantation of cardiac assist devices are factors associated with this increase. There is no specific treatment for AKI! Dozens of compounds that were tested to be effective in preclinical studies failed in the clinical setting; hence preventive measures are of importance. Prevention starts by identifying patients at risk. Table 13.2 summarizes risk factors.
M. Hiß (*) • J.T. Kielstein Department of Nephrology and Hypertension, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany e-mail: [email protected]; [email protected] A.S. Merseburger et al. (eds.), Urology at a Glance, DOI 10.1007/978-3-642-54859-8_13, © Springer-Verlag Berlin Heidelberg 2014
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Table 13.1 AKIN criteria for the diagnosis of AKI Stage 1
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Serum creatinine 1.5–1.9 times baseline OR >0.3 mg/dl (>26.5 μmol/l) increase 2.0–2.9 times baseline 3.0 times baseline OR Increase in serum creatinine to >4.0 mg/dl (>353.6 μmol/l) OR Initiation of renal replacement therapy OR in patients
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