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Renal Failure (Acute Kidney Injury)

Renal Failure (Acute Kidney Injury) is a topic covered in the 5-Minute Emergency Consult.

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  • The disorder is now known as acute kidney injury (AKI); the term renal failure is outdated.
  • Changes in glomerular filtration rate (GFR) and urine output (UO) encompassing a spectrum ranging from normal physiologic response to end-stage renal disease (ESRD) and measured by accumulation of nitrogenous by-products.
  • Defined by the RIFLE criteria:
    • 3 stages of renal injury:
      • Risk: Increased creatinine (Cr) ×1.5 or GFR decrease >25%, UO <0.5 mL/kg/h × >6 h
      • Injury: Increased Cr ×2 or GFR decrease >50%, UO <0.5 mL/kg/h × >12 h
      • Failure: Increased Cr ×3 or GFR decrease >75% or Cr ≥4 mg/dL (acute rise of ≥0.5 mg/dL), UO <0.3 mL/kg/h × 24 h or anuria × 12 h
    • 2 stages of outcome:
      • Loss: Loss of renal function >4 wk
      • ESRD: Loss of renal function >3 mo
  • The most severe marker defines stage.
  • AKI based upon changes within last 48h; however, must often base on most recent data.
  • Higher RIFLE stages correlate with higher 1 and 6 mo mortality rates for hospitalized patients.


  • Prerenal AKI:
    • Caused by renal hypoperfusion
    • Renal tissue remains normal unless severe/prolonged hypoperfusion.
  • Intrarenal AKI:
    • Caused by diseases of the renal parenchyma
  • Iatrogenic AKI causes include:
    • Aminoglycoside antibiotics
    • Radiocontrast material administration
    • NSAIDs
    • ACE inhibitors
    • Angiotensin receptor blockers
  • Postrenal AKI:
    • Due to urinary tract obstruction (e.g., prostatic hypertrophy, prostatitis)

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Rosen, Peter, et al., editors. "Renal Failure (Acute Kidney Injury)." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307652/all/Renal_Failure__Acute_Kidney_Injury_.
Renal Failure (Acute Kidney Injury). In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307652/all/Renal_Failure__Acute_Kidney_Injury_. Accessed April 25, 2019.
Renal Failure (Acute Kidney Injury). (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307652/all/Renal_Failure__Acute_Kidney_Injury_
Renal Failure (Acute Kidney Injury) [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 25]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307652/all/Renal_Failure__Acute_Kidney_Injury_.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Renal Failure (Acute Kidney Injury) ID - 307652 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307652/all/Renal_Failure__Acute_Kidney_Injury_ PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -