Table 1.
Acute Kidney Injury (AKI) | Acute Kidney Diseases and Disorders (AKD) | Chronic Kidney Disease (CKD) | |
---|---|---|---|
Duration | Within 2-7 days | ≤ 3 months | > 3 months |
Functional Criterion | Rise in serum creatinine by 50% (7days) OR Rise in serum ceatinine by 0.3 mg/dl (26.5 micromol/l) (2 days) OR Urine output <0.5 for 6 hours |
GFR <60 ml/min/1.73 m2 OR Decline in GFR by >35% times baseline OR Rise in serum creatinine by >50% times baseline |
GFR <60 ml/min/1.73 m2 |
Structural Criterion | None required | Marker of kidney damage (hematuria or pyuria are most common) | Marker of kidney damage (albuminuria is most common) |
Examples** | Decreased kidney perfusion (“pre-renal disorders”) Urinary tract obstruction (“post-renal” disorders) Intrinsic kidney diseases (acute tubular necrosis, acute interstitial nephritis) |
Acute and rapidly progressive glomerulonephritis Acute presentations of nephrotic syndrome Acute pyelonephritis Partial obstruction of the urinary tract |
Diabetic kidney disease Hypertensive nephrosclerosis Chronic glomerulonephritis Chronic interstitial nephritis Chronic pyelonephritis Polycystic kidney disease Chronic heart failure Chronic liver disease |
Staging | Serum creatinine (mg/dl) and urine output (ml/kg/h) categories: Stage 1: serum creatinine rise by ≥0.3 from baseline OR serum creatinine rise by 1.5 to1.9 times baseline OR urine output <0.5 for 6-12 hours. Stage 2: serum creatinine rise by 2.0 to 2.9 times baseline OR urine output <0.5 for ≥12 hours. Stage 3: serum creatinine rise by ≥ 3.0 times baseline OR serum creatinine ≥ 4 OR renal replacement therapy |
Not defined | Albuminuria categories (ACR mg/g approximately equivalent to AER mg/d) and related terms: A1: <30, normal to mildly increased A2: 30-300, moderately increased (formerly “microalbuminuria”) A3: >300, severely increased (includes nephrotic syndrome, >~ 2000) GFR categories (ml/min/1.73 m2) and related terms: G1: >90, normal or high G2: 60-89, mildly decreased G3a: 45-59, mildly to moderately decreased G3b: 40-44, moderately to severely decreased G4: 15-29, severely decreased G5:<15 OR treated by dialysis, kidney failure |
Burden | Incidence 10-20 % among adults requiring hospitalization (0.3% requiring dialysis) | Unknown | Prevalence ~ 10% in non-hospitalized adults (higher in the elderly) Life time risk ~ 50% Prevalence of kidney failure treated by dialysis or transplantation ~0.3% (higher in the elderly) Life time risk of kidney failure 2-8% (higher in blacks) |
GFR, glomerular filtration rate; ACR, albumin-to-creatinine ratio; AER, albumin excretion rate. Rise in serum creatinine of 0.3 mg/dl is equivalent to 26.5 micromol/l. ACR of 30, 300 and 2000 mg/g are approximately equivalent to 3, 30 and 200 mg/mol, respectively. Modified from Eckardt KU, Coresh J, Devuyst O, et al. Evolving importance of kidney disease: from subspecialty to global health burden. Lancet. Jul 13 2013; 382(9887):158-169.3
Additional diagnostic testing is required to determine the cause of disease and treatment.