Acute Kidney Injury

Acute kidney injury (formerly called acute renal failure) describes an abrupt decline in renal function. Consensus definitions of it have been published and are gaining more widespread acceptance and use. Here is the definition according to AKIN.  These clear criteria allow for earlier recognition and treatment of this condition.

  • An absolute increase in serum creatinine 0.3 mg/dL (26.4 µmol/L) in 48 hours, or
  • A percentage increase in serum creatinine ≥ 50% in 48 hours, or 
  • Urine output < 0.5 mL/kg/hour for > 6 hours.

Below are some great references about AKI treatment and management.

  1. The PICARD Trial: Mehta, Ravindra L., et al. “Diuretics, mortality, and nonrecovery of renal function in acute renal failure.” JAMA: the journal of the American Medical Association288.20 (2002): 2547-2553. Download
  2. DOSE Trial:  Felker, G. Michael, et al. “Diuretic strategies in patients with acute decompensated heart failure.” New England Journal of Medicine 364.9 (2011): 797-805.(High dose of lasix, whether intermittent bolus vs continuous infusion, had greater diuresis and more favorable outcomes in some secondary measures but also with transient worsening of renal function that reversed within 60 days) Download
  3. CARRESS-HF Trial: Bart, Bradley A., et al. “Ultrafiltration in decompensated heart failure with cardiorenal syndrome.” New England Journal of Medicine 367.24 (2012): 2296-2304. (use of a stepped pharmacologic-therapy algorithm was superior to a strategy of ultrafiltration for the preservation of renal function at 96 hours with fewer adverse events) Download
  4. GOTFRIED, JONATHAN, et al. “Finding the cause of acute kidney injury: Which index of fractional excretion is better?.” Cleveland Clinic journal of medicine 79.2 (2012): 121-126. (Nice review of articles validating FeNa and FeUrea) Download


  1. McCullough, Peter A. “Contrast-induced acute kidney injury.” Journal of the American College of Cardiology 51.15 (2008): 1419-1428. Download

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