Nephrology – ClinCaseQuest https://clincasequest.hospital Medical education in clinical cases Fri, 04 Oct 2024 22:53:23 +0000 en-US hourly 1 https://wordpress.org/?v=6.2.13 https://clincasequest.hospital/wp-content/uploads/sites/7/2020/02/logo-ru-project-90x90.png Nephrology – ClinCaseQuest https://clincasequest.hospital 32 32 RIFLE Criteria for Acute Kidney Injury (AKI) Online calculator https://clincasequest.hospital/rifle-online-calculator/ Mon, 21 Feb 2022 10:55:25 +0000 https://clincasequest.hospital/?p=33567 Classifies severity of acute kidney injury. The RIFLE score сclassifies the severity of acute kidney injury as the AKIN classification. The RIFLE score includes: Presence…

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]]> Classifies severity of acute kidney injury.

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On dialysis for >3 months

On RRT for >4 weeks

* Required


The RIFLE score сclassifies the severity of acute kidney injury as the AKIN classification.

The RIFLE score includes:

  • Presence or absence of end-stage renal disease (being on dialysis for more than 3 months)
  • Presence or absence of persistent acute kidney injury – more than 4 weeks on renal replacement therapy
  • Serum creatinine
  • GFR
  • Diuresis

Interpretation

  • Having end-stage renal disease (more than 3 months on dialysis) is classified as End Stage, RIFLE-E
  • Presence of persistent acute kidney injury – on renal replacement therapy for more than 4 weeks is classified as Loss, RIFLE-L

Other criteria are evaluated by the worst parameter of serum creatinine, GFR and Urine output (details in the table).

RIFLE CriteriaSerum creatinineGFRUrine output
Risk, RIFLE-R1.5-2x above baseline>25% decrease below baseline<0.5 mL/kg/hr x 6 hr
Injury, RIFLE-I>2–3x above baseline>50% decrease below baseline<0.5 mL/kg/hr x 12 hr
Failure, RIFLE-F (RIFLE-FO if oliguria)>3x above baseline, ≥4 mg/dL (350 µmol/L), or acute rise ≥0.5 mg/dL (44 µmol/L)>75% decrease below baseline<0.3 mL/kg/hr x 24 hr (oliguria), or anuria x 12 hrs
Loss, RIFLE-LPersistent AKI (on renal replacement therapy for >4 weeks)
ESRD, RIFLE-EEnd stage renal disease (on dialysis for >3 months)

NB!

AKI may be present even with “normal” serum creatinine, if GFR is decreased, or if creatinine is significantly elevated above baseline.

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Literature:

  1. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P. Acute renal failure – definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4): R204-12.
  2. Van Biesen W, Vanholder R, Lameire N. Defining acute renal failure: RIFLE and beyond. Clin J Am Soc Nephrol. 2006;1(6):1314-9.
  3. Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clinical Kidney Journal. 2013;6(1):8-14. doi:10.1093/ckj/sfs160.
  4. Xiong J, Tang X, Hu Z, Nie L, Wang Y, Zhao J. The RIFLE versus AKIN classification for incidence and mortality of acute kidney injury in critical ill patients: A meta-analysis. Sci Rep. 2015;5:17917.

Read also:

AKIN Classification for Acute Kidney Injury (AKI) online calculator
Glomerular filtration rate online calculator

Сообщение RIFLE Criteria for Acute Kidney Injury (AKI) Online calculator появились сначала на ClinCaseQuest.

]]> AKIN Classification for Acute Kidney Injury (AKI) online calculator https://clincasequest.hospital/akin-classification/ Sun, 21 Nov 2021 02:05:00 +0000 https://clincasequest.hospital/?p=31460 NB! Patients on renal replacement therapy (RRT) are considered to be stage 3 regardless of whether they meet formal criteria! AKI severity Serum creatinine Normal…

Сообщение AKIN Classification for Acute Kidney Injury (AKI) online calculator появились сначала на ClinCaseQuest.

]]> NB! Patients on renal replacement therapy (RRT) are considered to be stage 3 regardless of whether they meet formal criteria!

AKI severity

Normal creatinine, or < 1.5x from baseline
Absolute increase ≥ 0.3 mg/dL (≥ 26.4 μmol/L), or ≥ 1.5-2x from baseline
Increase to >2-3x from baseline
Increase to > 3x from baseline, or ≥ 4.0 mg/dL (≥ 354 μmol/L) with acute increase ≥ 0.5 mg/dL (≥ 44 μmol/L)

Urine output:
≥ 0.5 mL/kg per hour for > 6 hours
< 0.5 mL/kg per hour for > 6 hours
< 0.5 mL/kg per hour for > 12 hours
< 0.3 mL/kg per hour for ≥ 24 hours, or anuria for 12 hours



Patient AKI severity
0 0

To be diagnosed with acute kidney injury by the AKIN definition, patient must have at least one of the following within the past 48 hours:

  • Absolute increase in serum creatinine ≥0.3 mg/dL (≥26.4 μmol/L).
  • Increase in serum creatinine ≥1.5x above baseline.
  • Oliguria (urine output <0.5 mL/kg per hour) for >6 hours.

Criteria for AKI (must have ≥1 within the past 48 hrs)

Absolute increase in serum creatinine ≥0.3 mg/dL (≥26.4 μmol/L)NoYes
Increase in serum creatinine ≥1.5x above baselineNoYes
Oliguria (urine output <0.5 mL/kg per hour) for >6 hoursNoYes

Note: Patients on renal replacement therapy (RRT) are considered to be stage 3 regardless of whether they meet formal criteria.

Then, select the appropriate criterion leading to the highest possible stage, e.g. if serum creatinine is normal but urine output is <0.5 mL/kg/hour for >12 hours, AKIN Stage is 2.

AKIN ClassificationSerum creatinineUrine output
Not AKI according to AKINNormal creatinine, or <1.5x from baseline≥0.5 mL/kg per hour for >6 hours
Stage 1Absolute increase ≥0.3 mg/dL (≥26.4 μmol/L), or ≥1.5-2x from baseline<0.5 mL/kg per hour for >6 hours
Stage 2Increase to >2-3x from baseline<0.5 mL/kg per hour for >12 hours
Stage 3Increase to >3x from baseline, or ≥4.0 mg/dL (≥354 μmol/L) with acute increase ≥0.5 mg/dL (≥44 μmol/L)<0.3 mL/kg per hour for ≥24 hours, or anuria for 12 hours

References:

  1. Mehta, R.L., Kellum, J.A., Shah, S.V. et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 11, R31 (2007). https://doi.org/10.1186/cc5713
  2. Lopes JA, Jorge S. The RIFLE and AKIN classifications for acute kidney injury: a critical and comprehensive review. Clin Kidney J. 2013 Feb;6(1):8-14. doi: 10.1093/ckj/sfs160. Epub 2012 Jan 1. PMID: 27818745; PMCID: PMC5094385.
  3. Xiong, J., Tang, X., Hu, Z. et al. The RIFLE versus AKIN classification for incidence and mortality of acute kidney injury in critical ill patients: A meta-analysis. Sci Rep 5, 17917 (2015). https://doi.org/10.1038/srep17917

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Mehran Score for Post-PCI Contrast Nephropathy

Charlson Comorbidity Index (CCI) Online Calculator

Charlson Comorbidity Index predicts 10-year survival in patients with multiple comorbidities.

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History of definite or probable MI (EKG changes and/or enzyme changes)

Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

History of a cerebrovascular accident with minor or no residua and transient ischemic attacks

Chronic cognitive deficit

Any history of treatment for ulcer disease or history of ulcer bleeding

Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)

Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)

* Required
VariablePointsAge <50…
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≥1 of the following (A or B)

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]]> Mehran Score for Post-PCI Contrast Nephropathy https://clincasequest.hospital/mehran-score/ Tue, 16 Nov 2021 12:00:00 +0000 https://clincasequest.hospital/?p=31451 Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Mehran Scoreshould be used in patients undergoing PCI. NB! Do not use in patients…

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]]> Predicts risk of contrast-induced nephropathy (CIN) after percutaneous coronary intervention (PCI). Mehran Scoreshould be used in patients undergoing PCI.

NB! Do not use in patients with pre-existing end-stage renal disease on dialysis or patients with contrast exposure within 1 week of the index procedure.

Hypotension (SBP <80 for ≥1 hr requiring inotrope or balloon pump within 24 hrs of cath)
Yes
No

Intra-aortic balloon pump:
Yes
No

Congestive heart failure (CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema):
Yes
No

Age >75 years:
Yes
No

Anemia (Baseline hematocrit value <39% for men and <36% for women):
Yes
No

Diabetes:
Yes
No

Contrast Media Volume in ml:

eGFR, mL/min/1.73 m²:
≥ 60
40 to < 60
20 to < 40
<20



Patient’s Score CIN Risk Score Risk of any post-PCI CIN Risk of post-PCI CIN requiring dialysis
0 0 0 0

Hypotension (SBP <80 for ≥1 hr requiring inotrope or balloon pump within 24 hrs of cath)+5
Intra-aortic balloon pump+5
Congestive heart failure (CHF class III/IV by New York Heart Association Classification and/or history of pulmonary edema)+5
Age >75 years+4
Anemia (Baseline hematocrit value <39% for men and <36% for women)  +3
Diabetes+3
Contrast Media Volume1 pt./100 mL contrast
eGFR, mL/min/1.73 m² 
≥600
40 to <60+2
20 to <40+4
<20+6

Interpretation:

CIN Risk ScoreRisk of any post-PCI CINRisk of post-PCI CIN requiring dialysis
≤57.5%0.04%
6-1014.0%0.12%
11-1526.1%1.09%
≥1657.3%12.6%

In the original study, “contrast-induced nephropathy” was defined as an increase ≥0.5 mg/dL (or ≥25%) in pre-PCI serum creatinine at 48 hours post-PCI.

Consider renal protective measures such as N-acetylcysteine and limiting contrast volume in patients at high risk of CIN.

References:

  1. Mehran R, Aymong ED, Nikolsky E, et al. A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention: development and initial validation. J Am Coll Cardiol. 2004;44(7):1393-9. https://doi.org/10.1016/j.jacc.2004.06.068
  2. Sgura FA, Bertelli L, Monopoli D, Leuzzi C, Guerri E, Spartà I, Politi L, Aprile A, Amato A, Rossi R, Biondi-Zoccai G, Sangiorgi GM, Modena MG. Mehran contrast-induced nephropathy risk score predicts short- and long-term clinical outcomes in patients with ST-elevation-myocardial infarction. Circ Cardiovasc Interv. 2010 Oct;3(5):491-8. doi: 10.1161/CIRCINTERVENTIONS.110.955310. Epub 2010 Oct 5. PMID: 20923986.
  3. Bonnie Raingruber, Holly Kirkland-Walsh, Nikky Chahon, Michael Kellermann; Using the Mehran Risk Scoring Tool to Predict Risk for Contrast Medium–Induced Nephropathy in Patients Undergoing Percutaneous Angiography. Crit Care Nurse 1 February 2011; 31 (1): e17–e22. doi: https://doi.org/10.4037/ccn2011746
  4. Wi J, Ko YG, Shin DH, Kim JS, Kim BK, Choi D, Ha JW, Hong MK, Jang Y. Prediction of Contrast-Induced Nephropathy With Persistent Renal Dysfunction and Adverse Long-term Outcomes in Patients With Acute Myocardial Infarction Using the Mehran Risk Score. Clin Cardiol. 2013 Jan;36(1):46-53. doi: 10.1002/clc.22060. Epub 2012 Oct 1. PMID: 23027701; PMCID: PMC6649613.
  5. Abellás-Sequeiros RA, Raposeiras-Roubín S, Abu-Assi E, González-Salvado V, Iglesias-Álvarez D, Redondo-Diéguez A, González-Ferreiro R, Ocaranza-Sánchez R, Peña-Gil C, García-Acuña JM, González-Juanatey JR. Mehran contrast nephropathy risk score: Is it still useful 10 years later? J Cardiol. 2016 Mar;67(3):262-7. doi: 10.1016/j.jjcc.2015.05.007. Epub 2015 Jul 10. PMID: 26169247.

Register on our website right now to have access to more learning materials!

AKIN Classification for Acute Kidney Injury (AKI) online calculator

Charlson Comorbidity Index (CCI) Online Calculator

Charlson Comorbidity Index predicts 10-year survival in patients with multiple comorbidities.

History of definite or probable MI (EKG changes and/or enzyme changes)

Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

History of a cerebrovascular accident with minor or no residua and transient ischemic attacks

Chronic cognitive deficit

Any history of treatment for ulcer disease or history of ulcer bleeding

Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)

Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)

VariablePointsAge <50…
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≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…
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]]> Glomerular filtration rate online calculator https://clincasequest.hospital/glomerular-filtration-rate-calculator/ Mon, 31 Aug 2020 12:30:31 +0000 https://clincasequest.org/?p=26353 Cockcroft-Gault glomerular filtration rate calculator Gender male female Specify the patient’s gender Creatinine μmol/l mg/dl Enter serum creatinine Age (years) Enter the patient’s age Weight,…

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]]>

Cockcroft-Gault glomerular filtration rate calculator

Gender

Specify the patient’s gender

Enter serum creatinine

Enter the patient’s age

Enter patient weight
— fields required to estimate GFR
Cockcroft-Gault
Cockcroft-Gault (norm):
Body surface area:
Body mass index

Glomerular filtration rate calculator MDRD

Gender

— fields required to estimate GFR
Result: ml/min/1.73m2

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Subscribe to our pages:

Charlson Comorbidity Index (CCI) Online Calculator

Charlson Comorbidity Index predicts 10-year survival in patients with multiple comorbidities.

History of definite or probable MI (EKG changes and/or enzyme changes)

Exertional or paroxysmal nocturnal dyspnea and has responded to digitalis, diuretics, or afterload reducing agents

Intermittent claudication or past bypass for chronic arterial insufficiency, history of gangrene or acute arterial insufficiency, or untreated thoracic or abdominal aneurysm (≥6 cm)

History of a cerebrovascular accident with minor or no residua and transient ischemic attacks

Chronic cognitive deficit

Any history of treatment for ulcer disease or history of ulcer bleeding

Severe = cirrhosis and portal hypertension with variceal bleeding history, moderate = cirrhosis and portal hypertension but no variceal bleeding history, mild = chronic hepatitis (or cirrhosis without portal hypertension)

Severe = on dialysis, status post kidney transplant, uremia, moderate = creatinine >3 mg/dL (0.27 mmol/L)

VariablePointsAge <50…
Read More

Multiple Myeloma Diagnostic Criteria – Online Calculator

≥1 of the following (A or B)

≥1 myeloma defining event (C1 or C2)

For Multiple Myeloma Diagnostic Criteria assessment necessary to provide selection of the…
Read More

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