Changes in urine output and glomerular filtration rate are neither necessary nor sufficient for the diagnosis of renal pathology. Yet no simple alternative for the diagnosis currently exists. Until recently, there has been no consensus as to diagnostic criteria or clinical definition of acute renal failure. Depending on the definition used, acute renal failure has been reported to affect from 1 to 25% of ICU patients and has led to mortality rates from 15 to 60%. The RIFLE criteria were developed to standardize the diagnosis of acute renal failure and in the process the term acute kidney injury (AKI) has been proposed to encompass the entire spectrum of the syndrome from minor changes in renal function to requirement for renal replacement therapy. Thus, AKI is not acute renal failure but a more general description. Small changes in kidney function in hospitalized patients are important and are associated with significant changes in short and possibly long-term outcomes. The RIFLE criteria provide a uniform definition of AKI and have now been validated in numerous studies.

1.
Kellum JA: Acute kidney injury. Crit Care Med 2008;36:S141–S145.
2.
Thurau K, Boylan JW: Acute renal success: the unexpected logic of oliguria in acute renal failure. Am J Med 1976;61:308–315.
3.
Bagshaw SM, Langenberg C, Wan L, May CN, Bellomo R: A systematic review of urinary findings in experimental septic acute renal failure. Crit Care Med 2007;36:1592–1598.
4.
Bagshaw SM, Langenberg C, Bellomo R: Urinary biochemistry and microscopy in septic acute renal failure: a systematic review. Am J Kidney Dis 2006;48:695–705.
5.
Kellum JA: Prerenal azotemia: still a useful concept? Crit Care Med 2007;35:1630–1631.
6.
Kellum JA, Levin N, Bouman C, Lameire N: Developing a consensus classification system for acute renal failure. Curr Opin Crit Care 2002;8:509–514.
7.
Liano F: Epidemiology of acute renal failure: a prospective, multicenter, community-based study. Madrid Acute Renal Failure Study Group. Kidney Int 1996;50:811–818.
8.
Brivet FG, Kleinknecht DJ, Loirat P, Landais PJ: Acute renal failure in intensive care units: causes, outcome, and prognostic factors of hospital mortality; a prospective, multicenter study. French Study Group on Acute Renal Failure. Crit Care Med 1996;24:192–198.
9.
Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu H, Morgera S, Schetz M, Tan I, Bouman C, Macedo E, Gibney N, Tolwani A, Ronco C: Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA 2005;294:813–818.
10.
Bellomo R, Kellum JA, Ronco C: Acute renal failure: time for consensus. Intensive Care Med 2001;27:1685–1688.
11.
Kellum JA, Mehta RL, Ronco C: Acute Dialysis Quality Initiative (ADQI). Contrib Nephrol. Basel, Karger, 2001, vol 132, pp 258–265.
12.
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:R204–R212.
13.
Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, Levin A: Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007;11:R31.
14.
Hoste EA, Clermont G, Kersten A, Venkataram R, Angus DC, De Bacquer D, Kellum JA: RIFLE criteria for acute kidney injury is associated with hospital mortality in critical ill patients: a cohort analysis. Crit Care 2006;10:R73.
15.
Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW: Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005;16:3365–3370.
17.
Bellomo R, Kellum JA, Ronco C: Defining and classifying acute renal failure: from advocacy to consensus and validation of the RIFLE criteria. Intensive Care Med 2006.
18.
Hoste EA, Kellum JA: Acute kidney injury: epidemiology and diagnostic criteria. Curr Opin Crit Care 2006;12:531–537.
19.
Himmelfarb J, Ikizler TA: Acute kidney injury: changing lexicography, definitions, and epidemiology. Kidney Int 2007;71:971–976.
20.
Ostermann M, Chang RW: Acute kidney injury in the intensive care unit according to RIFLE. Crit Care Med 2007;35:1837–1843.
21.
Bagshaw SM, George C, Dinu I, Bellomo R: A Multi-centre evaluation of the rifle criteria for early acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;23:1203–1210.
22.
Bagshaw SM, George C, Bellomo R: A comparison of the RIFLE and AKIN criteria for acute kidney injury in critically ill patients. Nephrol Dial Transplant 2008;Epub ahead of print.
23.
Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P, and the ADQI workgroup: 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:R204–R212.
24.
Abosaif NY, Tolba YA, Heap M, Russell J, El Nahas AM: The outcome of acute renal failure in the intensive care unit according to RIFLE: model application, sensitivity, and predictability. Am J Kidney Dis 2005;46:1038–1048.
25.
Uchino S, Bellomo R, Goldsmith D: An assessment of the RIFLE criteria for acute renal failure in hospitalized patients. Crit Care Med 2006;34:1913–1917.
26.
Ali T, Khan I, Simpson W, Prescott G, Townend J, Smith W, Macleod A: Incidence and outcomes in acute kidney injury: a comprehensive population-based study. J Am Soc Nephrol 2007;18:1292–1298.
27.
Venkataraman R, Kellum JA: Defining acute renal failure: the RIFLE criteria. J Intensive Care Med 2007;22:187–193.
28.
Mishra J, Dent C, Tarabishi R, Mitsnefes MM, Ma Q, Kelly C, Ruff SM, Zahedi K, Shao M, Bean J, Mori K, Barasch J, Devarajan P: Neutrophil gelatinase-associated lipocalin (NGAL) as a biomarker for acute renal injury after cardiac surgery. Lancet 2005;365:1231–1238.
29.
Han WK, Bailly V, Abichandani R, Thadhani R, Bonventre JV: Kidney Injury Molecule-1 (KIM-1): A novel biomarker for human renal proximal tubule injury. Kidney Int 2002;62:237–244.
30.
Muramatsu Y, Tsujie M, Kohda Y, Pham B, Perantoni AO, Zhao H, Jo SK, Yuen PS, Craig L, Hu X, Star RA: Early detection of cysteine rich protein 61 (CYR61, CCN1) in urine following renal ischemic reperfusion injury. Kidney Int 2002;62:1601–1610.
31.
Zahedi K, Wang Z, Barone S, Prada AE, Kelly CN, Casero RA, Yokota N, Porter CW, Rabb H, Soleimani M: Expression of SSAT, a novel biomarker of tubular cell damage, increases in kidney ischemia-reperfusion injury. Am J Physiol Renal Physiol 2003;284:F1046–F1055.
32.
Ahlstrom A, Tallgren M, Peltonen S, Pettila V: Evolution and predictive power of serum cystatin C in acute renal failure. Clin Nephrol 2004;62:344–350.
33.
Parikh CR, Jani A, Melnikov VY, Faubel S, Edelstein CL: Urinary interleukin-18 is a marker of human acute tubular necrosis. Am J Kidney Dis 2004;43:405–414.
34.
Parikh CR, Abraham E, Ancukiewicz M, Edelstein CL: Urine IL-18 is an early diagnostic marker for acute kidney injury and predicts mortality in the intensive care unit. J Am Soc Nephrol 2005;16:3046–3052.
35.
Levin A, Stevens LA: Executing change in the management of chronic kidney disease: perspectives on guidelines and practice. Med Clin North Am 2005;89:701–709.
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