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Acute kidney injury (AKI), previously called acute renal failure, has chiefly been described as asyndrome since World War 2. Traditionally ‘acute renal failure’ was regarded as a less common organfailure, with patients typically requiring dialysis and managed by nephrologists. This view has nowbeen overturned. AKI encompasses a wide spectrum of injury to the kidneys, not just ‘kidney failure’.It is a common problem amongst hospitalised patients, in particular the elderly population whosenumbers are increasing as people live longer. Such patients are usually under the care of doctorspracticing in specialties other than nephrology. For normal function the kidneys require a competentcirculation. Conversely, it is known that renal function is vulnerable to even relative or quite modesthypotension or hypovolaemia. Hence AKI is a feature of many severe illnesses. Although theseillnesses may affect many organs, the simple process of monitoring urine output and/or creatininepermits detection of AKI.

The definition of AKI has been evolving in recent years. There is a need for a standardised definitionof AKI that can be applied in a pragmatic fashion in routine clinical practice, research, audit andhealthcare education. With current technology most AKI diagnosis is based on monitoring of serumor plasma creatinine levels, with or without urine output measurement. These methods areimperfect, and there is no ‘gold standard’ for the diagnosis of AKI. Work on AKI has been hamperedby multiple definitions. In 2004 the Acute Dialysis Quality Initiative (ADQI) group14published theirconsensus definition of AKI, known as the RIFLE definition. More recently small rises in creatininehave been recognised as being independently associated with increased mortality. In 2007, the AKINetwork (AKIN)84published their AKI definition, an evolution of the RIFLE definition. The recentInternational Kidney Disease: Improving Global Outcomes (KDIGO) guidelines67proposed a merger ofRIFLE and AKIN, with some simplification.

In developed countries AKI is seen in 13-18% of all people admitted to hospital.64,97,122The frequencyof AKI amongst inpatients means that it has a major patient and economic impact. According to NHSKidney Care, the costs of AKI to the NHS (excluding AKI in the community) are estimated to bebetween ￡434 million - ￡620 million per year which is more than expenditure on breast cancer, orlung and skin cancer combined.2,64It also remains the case that AKI is seen increasingly in primarycare in the absence of any acute illness and there is a need to ensure that awareness of the conditionis raised amongst primary care health professionals and that any identified cases of AKI are managedor referred appropriately

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