What do I need to know about N17.9 ?

N17.9

Acute renal failure does not really change with ICD-10. Need a refresher about the disease? here it is.

 
What Do I need to Know about ARF or AKI ?

Acute renal failure or acute kidney injury is the abrupt loss of kidney function. The term AKI has largely replaced acute renal failure (ARF), reflecting the recognition that smaller decrements in kidney function that do not result in overt organ failure are of substantial clinical relevance and are associated with increased morbidity and mortality.

The Acute Dialysis Quality Initiative (ADQI) group proposed consensus- and evidence-based guidelines for the treatment and prevention of AKI ¹. This included a consensus graded definition, called the RIFLE criteria. The Acute Kidney Injury Network included the ADQI group, and proposed a modification of the RIFLE criteria ². In 2012, the Kidney Disease/Improving Global Outcomes (KDIGO) AKI Workgroup proposed a modified definition which now serve as a bridge between the RIFLE and AKIN definitions ³.

None of the criteria pre-specify a particular hydration level prior to the diagnosis. RIFLE includes an increase of serum creatinine of >50 percent developing over <7 days. Acute Kidney Injury Network [AKIN] criteria refers to an increase in serum creatinine by 0.3 mg/dL (27 micromol/L) or ≥1.5 times the baseline value within 48 hours. RIFLE criteria and Kidney Disease Improving Global Outcomes (KDIGO)-AKI combined the criteria into an increase in serum creatinine of 0.3 mg/dL developing over 48 hours or >50 percent developing over 7 days, or an increase ≥1.5 times the baseline value within seven days

References:

1-      Bellomo R, Ronco C, Kellum JA, et al. 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:B204.

2-      Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury. Crit Care 2007; 11:R31.

3-      Kidney Disease: Improving Global Outcomes (KDIGO). Acute Kidney Injury Wrk Group. KDIGO clinical practice guidelines for acute kidney injury. Kidney Int Suppl 2012; 2:1.

	RIFLE	AKIN	KDIGO	Urine output criteria
Definition	Increase in serum creatinine of >50 percent developing over <7 days	Increase in serum creatinine of 0.3 mg/dL or >50 percent developing over <48 hours	Increase in serum creatinine of 0.3 mg/dL developing over 48 hours or >50 percent developing over 7 days	Urine output of <0.5 mL/kg/hr for >6 hours
Staging
RIFLE-R AKIN/KDIGO stage 1	Increase in serum creatinine of >50 percent	Increase in serum creatinine of 0.3 mg/dL or >50 percent	Increase in serum creatinine of 0.3 mg/dL or >50 percent	Urine output of <0.5 mL/kg/hr for >6 hours
RIFLE-I AKIN/KDIGO stage 2	Increase in serum creatinine of >100 percent	Increase in serum creatinine of >100 percent	Increase in serum creatinine of >100 percent	Urine output of <0.5 mL/kg/hr for >12 hours
RIFLE-F AKIN/KDIGO stage 3	Increase in serum creatinine of >200 percent	Increase in serum creatinine of >200 percent	Increase in serum creatinine of >200 percent	Urine output of <0.3 mL/kg/hr for >12 hours or anuria for >12 hours
RIFLE-L	Need for renal replacement therapy for >4 weeks
RIFLE-End-stage	Need for renal replacement therapy for >3 months