Acute Kidney Injury : Clinical Manifestations

  • Clinical Manifestations
    • RIFLE classification
      • Risk (R)
      • Injury (I)
      • Failure (F)
      • Loss (L)
      • End-stage renal disease (E)


GFR Criteria

Urine Output Criteria

Clinical Example


Serum creatinine increased × 1.5


GFR decreased by 25%

Urine output <0.5 mL/kg/hr for 6 hr

68-yr-old African American woman with type 2 diabetes, hypertension, CAD, and CKD.

Scheduled to undergo emergency coronary artery bypass graft.

Serum creatinine is 1.8 mg/dL (increased) and she weighs 60 kg.

Calculated GFR is 35 mL/min/1.73 m2.

She has Stage 3b CKD.


Serum creatinine increased × 2


GFR decreased by 50%

Urine output <0.5 mL/kg/hr for 12 hr

During surgery, she experiences hypotension for a sustained period.

Acute tubular necrosis is diagnosed.

After surgery: Serum creatinine is 3.6 mg/dL and urine output is reduced to 28 mL/hr


Serum creatinine increased × 3


GFR decreased by 75%


Serum creatinine >4 mg/dL with

acute rise ≥0.5 mg/dL

Urine output <0.3 mL/kg/hr for 24 hr (oliguria)


Anuria for 12 hr

72 hours after surgery and in ICU develops ventilator-associated pneumonia and sepsis.

Serum creatinine rises to 5.2 mg/dL and urine output drops to 10 mL/hr.

BP remains low despite dopamine therapy.


Persistent acute kidney failure.

Complete loss of kidney function >4 wk

Continuous venovenous hemodialysis is started.

After 3 wk of therapy she has a cardiopulmonary arrest and does not survive.


Renal Disease

Complete loss of kidney function >3 mo