detection of acute kidney injury (AKI)

Last edited 09/2023 and last reviewed 09/2023

Detecting acute kidney injury

• detect acute kidney injury by using any of the following criteria:
  
  
  • a rise in serum creatinine of 26 micromol/litre or greater within 48 hours
    
    
  • a 50% or greater rise in serum creatinine known or presumed to have occurred within the past 7 days
    
    
  • a fall in urine output to less than 0.5 ml/kg/hour for more than 6 hours in adults and more than 8 hours in children and young people
    
    
  • a 25% or greater fall in eGFR in children and young people within the past 7 days

Think Kindeys have stated (2)

Stage 1, 2 or 3. At present, there is no standard or agreed wording and this can be configured locally. However, an example for adults (age >18 years) is included here:

• Rise in creatinine may indicate Acute Kidney Injury stage x (1, 2 or 3)
  
  
  • Please review urgently (adults):
    
    
    • 1. AKI stage 1 is a rise of >1.5x baseline level, or of > 26 µmol/L within 48h, or a urine output <0.5mL/kg/h for 6-12h
      
      
    • 2. AKI stage 2 is a rise of>2x baseline or a urine output <0.5mL/kg/h for >= 12h
      
      
    • 3. AKI stage 3 is a rise of>3x baseline or a rise of >1.5 baseline to >354 µmol/L, a urine output <0.3mL/kg/h for >=24h or anuria for >=12 h

Reference:

• NICE (September 2023). Acute kidney injury - Prevention, detection and management of acute kidney injury up to the point of renal replacement therapy
• Think Kidneys. Acute Kidney Injury Warning Algorithm Best Practice Guidance (Accessed 7/4/2019)