KDIGO Clinical Practice Guideline for Acute Kidney Injury
ARF

ARF

In a recent review, Eknoyan notes that the first description of ARF, then termed ischuria renalis, was by William Heberden in 1802.¹⁶ At the beginning of the twentieth century, ARF, then named Acute Bright’s disease, was well described in William Osler’s Textbook for Medicine (1909), as a consequence of toxic agents, pregnancy, burns, trauma, or operations on the kidneys. During the FirstWorldWar the syndrome was named ‘‘war nephritis’’,¹⁷ and was reported in several publications. The syndrome was forgotten until the Second World War, when Bywaters and Beall published their classical paper on crush syndrome.¹⁸ However, it is Homer W. Smith who is credited for the introduction of the term ‘‘acute renal failure’’, in a chapter on ‘‘Acute renal failure related to traumatic injuries’’ in his textbook The kidney-structure and function in health and disease (1951). Unfortunately, a precise biochemical definition of ARF was never proposed and, until recently, there was no consensus on the diagnostic criteria or clinical definition of ARF, resulting in multiple different definitions. A recent survey revealed the use of at least 35 definitions in the literature.¹⁹ This state of confusion has given rise to wide variation in reported incidence and clinical significance of ARF. Depending on the definition used, ARF has been reported to affect from 1% to 25% of ICU patients and has lead to mortality rates from 15–60%.^7,20,21