Modified RIFLE Criteria of Akcan-Arikan et al for a Critically-Ill Pediatric Patient

Description

Akcan-Arikan et al modified adult RIFLE criteria for critically-ill pediatirc patients with acute renal injury (pRIFLE). These can help to identify a pediatric patient with renal injury who may benefit from more aggressive management. The authors are from Baylor College of Medicine and Texas Children’s Hospital in Houston.

RIFLE = risk, injury, failure, loss, end-stage

pRIFLE = pediatric RIFLE criteria

Parameters:

(1) urine output

(2) estimated creatinine clearance (CrCl) in mL/min/1.73 square meter (suing the Schwartz equation)

(3) ratio of estimated creatinine clearance to value 3 months prior to PICU admission

Urine Output	Estimated CrCl	Ratio of Current CrCl to value 3 months ago	Status
< 0.5 mL/kg/h for 8 hours	>= 35	75%	risk
< 0.5 mL/kg/h for 16 hours	>= 35	50%	injury
< 0.5 mL/kg/h for 24 hours	>= 35	<= 25%	failure
< 0.5 mL/kg/h for 24 hours	< 35	NA	failure
anuria for 12 h	>= 35	<= 25%	failure
anuria for 12 h	< 35	NA	failure

where:

• The estimated creatinine clearance from 3 months ago was based on a measured serum creatinine or estimated at 100 mL/min/1.73 square meters.

• A ratio of 75% for creatinine clearance is a 25% decrease. A ratio of 25% is a 75% decrease.

• Urine output may vary over time.

• There are gaps in the cutoffs for the ratio of current to past creatinine clearance. For the ratio of CrCl ranges of 67 to 90%, 34 to 66% and <= 33% are used in the implementation.

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Description

Specialty

ICD-10