Screening and diagnosis

Classification and risk stratification

Perioperative care

Quality improvement

Patient education

Nonpharmacologic interventions

Therapeutic procedures

Respiratory support

Follow-up and surveillance

Specific circumstances

Preventative measures

Medical management

Surgical interventions

Inpatient care

Diagnostic procedures

Diagnostic investigations

Insufficient evidence to make a recommendation.

Strongly favor this test or intervention.

The tool assesses whether a person meets the KDIGO (Kidney Disease: Improving Global Outcomes) diagnostic criteria for acute kidney injury (AKI). It evaluates three specific medical measurements provided by the user. Each measurement is checked against defined thresholds to determine if the criteria for AKI are met.

The tool uses the following diagnostic criteria:

The first criterion checks for an increase in serum creatinine by 0.3 mg/dL (or 26.5 mcmol/L) within 48 hours. If this is true, it indicates a potential diagnosis of AKI.

The second criterion evaluates whether there is an increase in serum creatinine to 1.5 times the baseline level in the previous 7 days. Again, a positive result supports a diagnosis of AKI.

The third criterion assesses urine volume, specifically whether it is 0.5 mL/kg/hour or less over 6 hours. If this condition is met, it further supports the diagnosis of AKI.

The tool processes the inputs by checking which of these conditions have been met:

| Criterion Description                                                         | Condition                                                     |
|-------------------------------------------------------------------------------|---------------------------------------------------------------|
| Increase in serum creatinine by >= 0.3 mg/dL (>= 26.5 mcmol/L) within 48 hours| If this condition is true, it supports AKI diagnosis.         |
| Increase in serum creatinine to >= 1.5 times baseline within the previous 7 days| If this condition is true, it supports AKI diagnosis.         |
| Urine volume of <= 0.5 mL/kg/hour for 6 hours                                 | If this condition is true, it supports AKI diagnosis.         |
| All conditions false                                                          | "Diagnostic criteria are not met"                             |
| At least one condition true                                                   | "Diagnostic criteria are met"                                 |

The calculator in question is the KDIGO (Kidney Disease: Improving Global Outcomes) diagnostic criteria for acute kidney injury (AKI). This calculator is used in the patient population of individuals suspected of having acute kidney injury, which can occur in various clinical settings such as hospitalization, critical illness, or after certain procedures like surgery.

The KDIGO criteria for AKI are based on changes in serum creatinine levels and urine output. It helps in the early detection of AKI, stratification of its severity, and guides the management and treatment decisions. The clinical utility of this calculator is to identify patients at risk of developing complications related to AKI, including chronic kidney disease, end-stage renal disease, and increased mortality.

There are no specific exclusion criteria for the use of KDIGO criteria. However, it may not be applicable or accurate in patients with chronic kidney disease, as their baseline creatinine levels are already elevated. Also, it may not be suitable for patients with conditions that can affect serum creatinine levels independently of kidney function, such as muscle wasting diseases.

KDIGO diagnostic criteria for acute kidney injury

The AKIN diagnostic criteria tool helps identify the severity of acute kidney injury (AKI) by evaluating changes in serum creatinine levels and urine output. The user starts by selecting one diagnostic criterion from a list of options, each reflecting different clinical measures.

These criteria include:

- Serum creatinine increase of at least 0.3 mg/dL (26.4 mcmol/L) or 1.5 to 2 times the baseline, with urine output less than 0.5 mL/kg/hour lasting over 6 hours.
- Serum creatinine increase of more than 2 to 3 times from baseline, combined with urine output less than 0.5 mL/kg/hour over a 12-hour period.
- Serum creatinine increase to or beyond 4 mg/dL (354 mcmol/L), with a rapid increment of at least 0.5 mg/dL (44 mcmol/L), or over 3 times the baseline value. This is associated with urine output below 0.3 mL/kg/hour for 24 hours, or complete lack of urine for 12 hours.

Using these criteria, the tool assigns an AKI stage:

- Stage 1 corresponds to the selection where serum creatinine increases are at least 0.3 mg/dL or 1.5-2 times above baseline paired with specified urine output reduction over 6 hours.
- Stage 2 signifies a creatinine increase of more than 2-3 times from baseline with decreased urine output extending past 12 hours.
- Stage 3 is indicated by the most severe changes in creatinine and urine output metrics, the latter showing significant reduction or lack of production over longer durations.

Each stage reflects increasing AKI severity, impacting clinical evaluation and management decisions. Recognizing the stage is critical for patient outcomes, steering appropriate interventions and monitoring.

The AKIN (Acute Kidney Injury Network) classification for acute kidney injury is a diagnostic and severity grading system used in patients with suspected acute kidney injury (AKI). This calculator is applicable to all patient populations, including those in the intensive care unit, hospitalized patients, and outpatients. 

The AKIN classification system is used to identify and stratify the severity of AKI based on changes in serum creatinine levels or urine output. It helps clinicians to determine the appropriate treatment strategies and predict patient outcomes. 

The AKIN classification system is not suitable for patients with chronic kidney disease or those with pre-existing renal dysfunction, as the changes in serum creatinine levels or urine output may not accurately reflect the acute changes in kidney function in these patients.

AKIN diagnostic criteria for acute kidney injury

The Licurse score for renal ultrasound helps assess a patient's risk for hydronephrosis, based on specific health and demographic factors. These factors are evaluated to generate a score that stratifies patients into different risk groups. Here's how it works:

Patients are assessed based on the following criteria:
- **Race**: Non-black individuals receive 1 point, while Black individuals receive 0 points.
- **History of Recurrent Urinary Tract Infections**: If a patient has experienced recurrent infections, they score 1 point; otherwise, they score 0.
- **Diagnosis Consistent with Possible Obstruction**: Conditions like benign prostatic hyperplasia or a neurogenic bladder add 1 point to the score when present.
- **History of Congestive Heart Failure**: A history of this condition scores 0 points, while its absence scores 1 point.
- **History of Prerenal Acute Kidney Injury, Use of Vasopressors, Sepsis, or Hypotension**: Patients without this history score 1 point; those with the history score 0.
- **Exposure to Nephrotoxic Medications Before Acute Kidney Injury Episode**: No exposure is worth 1 point and any exposure results in 0 points.
- **History of Hydronephrosis**: Having a documented history of hydronephrosis scores a significant 4 points, while its absence scores 0.

Adding these scores gives a total that can range from 0 to 10. The interpretation of this score distributes patients into low, medium, or high-risk categories for hydronephrosis, with potential intervention requirements:

- **Low-risk Group**: Scores ranging from 0 to 2 place a patient in this category, indicating a 4.0% risk of hydronephrosis on imaging and a 1.1% risk of requiring a stent or nephrostomy tube.
- **Medium-risk Group**: A score of 3 places a patient in this group, which implies a 6.8% risk of hydronephrosis on imaging and a 0.5% risk of needing a stent or tube.
- **High-risk Group**: Scores above 3 signify a 20.9% likelihood of hydronephrosis on imaging and a 4.9% chance of needing an intervention like a stent or nephrostomy tube. 

This scoring structure provides a clear framework for evaluating and managing the risk for hydronephrosis, guiding subsequent medical decision-making.

The Licurse Score for Renal Ultrasound is a clinical calculator used in the field of nephrology. It is specifically designed to predict the likelihood of finding significant pathology on renal ultrasound in patients presenting with acute kidney injury (AKI). The score is based on several clinical parameters including age, sex, baseline creatinine, peak creatinine, and presence of urinary tract symptoms. 

The clinical utility of the Licurse Score lies in its ability to guide clinicians in deciding whether to order a renal ultrasound for patients with AKI. A higher score indicates a higher probability of finding significant pathology, thus helping to prioritize patients who are most likely to benefit from this diagnostic procedure.

The Licurse Score is not applicable to patients with chronic kidney disease or those with known renal pathology. It is also not intended for use in patients with AKI due to obvious causes such as post-renal obstruction or glomerulonephritis, as these conditions would necessitate a renal ultrasound regardless of the score.

Licurse score for renal ultrasound

The RIFLE criteria for diagnosing acute kidney injury involve assessing the severity based on changes in serum creatinine, glomerular filtration rate (GFR), and urine output. Based on user input, the criteria determine a classification level: Risk, Injury, Failure, Loss, or End-stage Renal Disease (ESRD).

Here's how the computation works:

- **Risk, RIFLE-R**: Identified when the serum creatinine level is 1.5 to 2 times above baseline, or the GFR shows more than a 25% decrease below baseline. Urine output is less than 0.5 mL/kg/hour for 6 hours.
  
- **Injury, RIFLE-I**: Occurs if the serum creatinine level is more than 2 to 3 times above baseline, or there is more than a 50% decrease in GFR below baseline. This stage includes urine output less than 0.5 mL/kg/hour for 12 hours.
  
- **Failure, RIFLE-F**: Determined when serum creatinine exceeds 3 times above baseline or reaches 4 mg/dL (350 mcmol/L) or an acute rise of at least 0.5 mg/dL (44 mcmol/L). It also indicates a GFR decrease of over 75% below baseline. Urine output is critically low, at less than 0.3 mL/kg/hour for 24 hours, or anuria (complete absence of urine) for 12 hours.
  
- **Loss, RIFLE-L**: Describes persistent acute kidney injury lasting over 4 weeks.
  
- **ESRD, RIFLE-E**: Represents end-stage renal disease extending for more than 3 months.

The user's input concerning these criteria leads to a categorical diagnosis aligning with the RIFLE classification system, providing a structured perspective on the severity and progression of acute kidney injury.

The RIFLE criteria is a clinical calculator used to classify the severity of acute kidney injury (AKI). The acronym RIFLE stands for Risk, Injury, Failure, Loss, and End-stage kidney disease. This scoring system applies to patients who are at risk of developing AKI, particularly those in critical care settings such as the intensive care unit.

The RIFLE criteria is used to identify and stratify the severity of AKI based on changes in serum creatinine levels, glomerular filtration rate (GFR), and urine output. It helps clinicians to determine the appropriate treatment strategy and predict patient outcomes.

There are no specific exclusion criteria for the use of the RIFLE criteria. However, it may not be applicable or accurate in patients with chronic kidney disease or other conditions that affect baseline creatinine levels or urine output. It's also important to note that the RIFLE criteria does not identify the cause of AKI, so further diagnostic evaluation may be necessary.

RIFLE diagnostic criteria for acute kidney injury

The process evaluates potential cases of hepatorenal syndrome-acute kidney injury using six specific diagnostic criteria. Each criterion presents a requirement that must be addressed:

- Diagnosis of liver cirrhosis and ascites
- Diagnosis of acute kidney injury, noted by an increase in serum creatinine either by 0.3 mg/dL (26.5 µmol/L) within 48 hours or by 50% from the baseline, occurring over the last 7 days
- Lack of response after two consecutive days of diuretic withdrawal and plasma volume expansion with albumin at a dosage of 1 g/kg/day
- Absence of shock
- No current or recent usage of nephrotoxic drugs, like nonsteroidal anti-inflammatory drugs, aminoglycosides, or iodinated contrast media
- No signs of structural kidney injury, such as proteinuria over 500 mg/day, microhematuria exceeding 50 red blood cells per high-power field, and/or abnormal renal ultrasound results

For the diagnosis of hepatorenal syndrome-acute kidney injury to be confirmed, all criteria must be fulfilled. If all conditions are met, the result is "Diagnostic criteria are met". If one or more of these are not satisfied, the output is "Diagnostic criteria are not met". This structured approach ensures that only patients meeting comprehensive criteria are recognized under this diagnosis, which could guide corresponding medical interventions.

The Revised International Club of Ascites (ICA) diagnostic criteria for hepatorenal syndrome-acute kidney injury (HRS-AKI) is a clinical calculator used in the diagnosis of HRS-AKI in patients with cirrhosis and ascites. This scoring system is specifically designed for patients with liver cirrhosis who have developed ascites, a condition characterized by the accumulation of fluid in the peritoneal cavity, and are suspected of having hepatorenal syndrome, a type of kidney failure that occurs in individuals with severe liver disease. 

The clinical utility of this calculator is to aid in the early and accurate diagnosis of HRS-AKI, which is crucial for the initiation of appropriate treatment and management strategies. The Revised ICA diagnostic criteria for HRS-AKI takes into account factors such as the absence of shock, no current or recent treatment with nephrotoxic drugs, and no signs of parenchymal kidney disease.

Exclusion criteria for the use of this calculator include patients without cirrhosis and ascites, those with shock, those who have been treated with nephrotoxic drugs, and those showing signs of parenchymal kidney disease.

Revised ICA diagnostic criteria for hepatorenal syndrome-acute kidney injury

Acute kidney injury

Risk assessment

As per JSBPCC/JSDT/JSICM/…/JSPN 2018 guidelines, 

Follow-up

Prevention of contrast-induced nephropathy

Prevention of contrast-induced nephropathy, RRT

Definitions

Prevention of acute kidney injury in intensive care unit

Prevention of AKI in ICU (vasopressors and inotropes)

Prevention of rhabdomyolysis-induced acute kidney injury

Prevention of rhabdomyolysis-induced AKI

Evaluation for etiology

Prevention of contrast-induced nephropathy, other agents

Prevention of contrast-induced nephropathy, risk assessment

Prevention of cardiac surgery-associated acute kidney injury

Prevention of cardiac surgery-associated AKI, cardiopulmonary bypass strategies

Prevention of aminoglycoside-induced nephrotoxicity

Renal replacement therapy

RRT, insertion of dialysis catheter

Pediatric patients

Pediatric patients (monitoring)

Prevention of AKI in ICU (vasodilators)

Renal function monitoring

Renal function monitoring, patients with AKI

Fluid management

Prevention of postoperative acute kidney injury

Prevention of postoperative AKI

Diagnostic criteria

Nutritional support

Nutritional support, electrolyte intake

Prevention of cardiac surgery-associated AKI (postoperative care)

Novel biomarkers

Pediatric patients (RRT)

Prevention of cardiac surgery-associated AKI (minimally invasive extracorporeal circulation)

Prevention of AKI in ICU (other measures)

Prevention of contrast-induced nephropathy, IV and oral fluids

Renal ultrasound

Vasopressors

Nutritional assessment

Nutritional assessment, referral to a dietitian

RRT (evaluation of fistula malfunction)

Prevention of contrast-induced nephropathy, N-acetylcysteine

Prevention of contrast-induced nephropathy (discontinuation of medications)

Measures with no evidence for benefit

Nutritional support, route of administration

Urinalysis

RRT, indications

Patients with COVID-19-associated acute kidney injury

Patients with COVID-19-associated AKI (hemodynamic support)

Baseline renal function testing

Prevention of cardiac surgery-associated AKI (pharmacologic strategies)

Nutritional assessment (clinical assessment)

Prevention of AKI in ICU (nutritional support)

Differential diagnosis

Management of hyperglycemia

Prevention of AKI in ICU (fluid therapy)

Nutritional support, protein intake

Patients with COVID-19-associated AKI, RRT

Nutritional assessment, calorimetry

Patients with COVID-19-associated AKI (general principles of management)

Hemodynamic monitoring

Prevention of contrast-induced nephropathy, restriction of contrast medium use

RRT, dosing

Patients with COVID-19-associated AKI (evaluation)

Nutritional support (glucose control)

Prevention of contrast-induced nephropathy, creatinine monitoring

Nutritional support (timing)

RRT, choice of modality

Nutritional support (supplements with no evidence for benefit)

Renal function monitoring, patients at risk for AKI

RRT, periprocedural anticoagulation

General principles

Nutritional support, energy intake

Nutritional assessment (body composition assessment)

Prevention of cardiac surgery-associated AKI (intravascular volume maintenance)

Updated 2024 ESPEN guidelines for nutritional support in hospitalized patients with acute kidney injury


Acute kidney injury

Background

Overview

Guidelines

Key sources