Pitfalls in Estimating Renal Injury by AKIN, RIFLE, and KDIGO, Overcome by a New Method for Measuring Creatinine Clearance in Acute Kidney Injury

Background: Acute Kidney Injury (AKI) is a common and serious condition encountered in hospitalized patients. The severity of kidney injury is defined by the RIFLE, AKIN, and KDIGO criteria which attempt to establish the degree of renal impairment. The KDIGO guidelines state that the creatinine clearance should be measured whenever possible in AKI and that the serum creatinine concentration and creatinine clearance remain the best clinical indicators of renal function. Neither the RIFLE, AKIN, nor KDIGO criteria estimate actual creatinine clearance. Furthermore there are no accepted methods for accurately estimating creatinine clearance in AKI. The present study describes a new, unique, and simple method for estimating K in AKI using urine creatinine excretion over an established time interval (E), an estimate of creatinine production over the same time interval (P), and the estimated static glomerular filtration rate (sGFR), at time zero, utilizing the CKD-EPI formula. Using these variables estimated creatinine clearance (Ke) = E/P * sGFR. Patient examples are provided to highlight the use of this method and its advantage over AKIN, RIFLE, or KDIGO which have the above mentioned shortcomings while often incorrectly classifying the extent of renal injury in the patient with AKI. Conclusions: The present study provides the practitioner with a new tool to estimate real time K in AKI with enough precision to predict the severity of the renal injury, including progression, stabilization, or improvement in azotemia. It is the author’s belief that this simple method improves on RIFLE, AKIN, and KDIGO for estimating the degree of renal impairment in AKI and allows a more accurate estimate of K in AKI.