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Streamlining the Diagnostic Algorithm

AIN, acute interstitial nephritis; ATN, acute tubular necrosis; UTI, urinary tract infection; UTO, urinary tract obstruction
Acute rise in SCr is detected: Per the definition of AKI, an increase in SCr ≥ 0.3 mg/dL within 48 hours or a ≥ 50% increase in SCr that is known or presumed to have occurred within the preceding 7 days should lead to suspicion of AKI.
Clinical assessment and serum and urine tests: Assess for the following:
Serum tests
Elevations seen in hemoglobin/hematocrit, total protein/albumin, calcium bicarbonate, or uric acid
Urine tests
Decreased urine volume (< 500 mL/day), urine specific gravity > 1.105, urine sodium < 20 mEq/L, fractional excretion of Na < 1%, fractional excretion of urea < 35%*, or fractional excretion of uric acid < 10%*
*Not affected by diuretic use; Na, sodium
If a specific diagnosis is made other than AKI (e.g., ATN, acute interstitial nephritis [AIN], urinary tract infection [UTI], urinary tract obstruction [UTO]), individualized nephrology care is recommended.
If other diagnoses are ruled out and AKI is confirmed, assess for doubling of SCr:
AKI, acute kidney injury; AIN, acute interstitial nephritis; ATN, acute tubular necrosis; UTI, urinary tract infection; UTO, urinary tract obstruction

If the SCr has not doubled, manage as AKI Stage 1.
If the SCr has doubled, manage as AKI Stage 2 or 3.

AKI Stage
Description
1
Increase in creatinine ≥ 0.3 mg/dL up to 2-fold of baseline
2
Increase in creatinine between 20-fold and 3-fold of baseline
3
Increase in creatinine > 3-fold of baseline of creatinine > 4 mg/dL (353.6 μmol/L) with an acute increase of ≥ 0.3 mg/dL (26.5 μmol/L) or the initiation of RRT, renal replacement therapy
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