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 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 Criteria	Serum creatinine	GFR	Urine output
Risk, RIFLE-R	1.5-2x 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-L	Persistent AKI (on renal replacement therapy for >4 weeks)
ESRD, RIFLE-E	End 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