PROBLEMS OF DIAGNOSTICS AND STRATIFICATION OF SEVERITY OF ACUTE KIDNEY INJURY

Abstract

In 2002 a group of Acute Dialysis Quality Initiative (ADQI) experts developed definition of acute renal failure (ARF) and created the system of stratification of its severity (RIFLE-criteria). In 2004 the concept of «acute kidney injury» (AKI) was offered, and in 2007 study group of Acute Kidney Injury Network (AKIN) presented a system of criteria for diagnostics and assessment of the injury severity (AKIN-criteria), this system is a modified RIFLE classification. Both systems have proved in practice their use to predict the AKI development and its outcome for the critical-ill patients. However, initially either RIFLE scheme, or AKIN scheme were not intended to include patients with acute primary parenchymatous kidney diseases what cannot meet the demands of nephrological society. We have offered modification of AKIN system which could help to eliminate this restriction. Nevertheless, results of some latest works, including ours, give the reason to suggest, that available RIFLE or AKIN criteria should be essentially revised. When diagnosing and estimating the AKI severity special attention should be paid to the initial state of kidneys function and, what is most important, to absolute but not relative changes in concentration of serum creatinine.