Renal Association Clinical Practice Guidelines on acute kidney injury.

Acute kidney injury (AKI) has now replaced the term acute renal failure and an universal definition and staging system has been proposed to allow earlier detection and management of AKI. The new terminology enables healthcare professionals to consider the disease as a spectrum of injury. This spectrum extends from less severe forms of injury to more advanced injury when acute kidney failure may require renal replacement therapy (RRT). Clinically AKI is characterised by a rapid reduction in kidney function resulting in a failure to maintain fluid, electrolyte and acid-base homoeostasis. There have previously been many different definitions of AKI used in the literature which has made it difficult to determine the epidemiology and outcomes of AKI. Over recent years there has been increasing recognition that relatively small rises in serum creatinine in a variety of clinical settings are associated with worse outcomes [1]. To address the lack of an universal definition for AKI a collaborative network of international experts representing nephrology and intensive care societies established the Acute Dialysis Quality Initiative (ADQI) and devised the RIFLE definition and staging system for AKI [2]. Shortly after this many of the original members of the ADQI group collaborated to form the Acute Kidney Injury Network (AKIN) [3, 4]. The AKIN group modified the RIFLE staging system to reflect the clinical significance of relatively small rises in serum creatinine. Most recently the international guideline group, Kidney Disease: Improving Global Outcomes (KDIGO) has brought together international experts from many different specialties to produce a definition and staging system that harmonises the previous definitions and staging systems proposed by both ADQI and AKIN [5]. It is anticipated that this definition and staging system