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AKI and CKD were defined by separate Work Groups according to different criteria. The definition for each is based on alterations in kidney function or structure. AKI and CKD have many causes which may lead to alterations of kidney function and structure that do not meet the criteria for the definition of either AKI or CKD, yet patients with these diseases and disorders may need medical attention to restore kidney function and reverse damage to kidney structure to avoid adverse outcomes. A uniform and systematic nomenclature could enhance understanding and communication about these diseases and disorders, and lead to improved medical care, research, and public health. For these reasons, the Work Group proposed an operational definition for AKD to provide an integrated clinical approach to patients with abnormalities of kidney function and structure.
Table 11 compares the definitions for AKI, CKD, and AKD. We have also included an operational definition of ‘‘no known kidney disease’’ (NKD) for those who do not meet these criteria, with the understanding that clinical judgment is required to determine the extent of the evaluation that is necessary to assess kidney function and structure. In the following sections, we will elaborate on each component of these definitions.
| Functional criteria | Structural criteria | |
|---|---|---|
| AKI | Increase in SCr by 50% within 7 days, OR Increase in SCr by 0.3 mg/dl (26.5 µmol/l) within 2 days, OR Oliguria |
No criteria |
| CKD | GFR < 60 ml/min per 1.73m2 for > 3 months | Kidney damage for > 3 months |
| AKD | AKI, OR GFR < 60 ml/min per 1.73m2 for < 3 months, OR Decrease in GFR by ≥ 35% or increase in SCr by >50% for < 3 months |
Kidney damage for < 3 months |
| NKD | GFR ≥ 60 ml/min per 1.73m2 Stable SCr | No damage |
GFR assessed from measured or estimated GFR. Estimated GFR does not reflect measured GFR in AKI as accurately as in CKD. Kidney damage assessed by pathology, urine or blood markers, imaging, and—for CKD—presence of a kidney transplant. NKD indicates no functional or structural criteria according to the definitions for AKI, AKD, or CKD. Clinical judgment is required for individual patient decision-making regarding the extent of evaluation that is necessary to assess kidney function and structure.
AKD, acute kidney diseases and disorders; AKI, acute kidney injury; CKD, chronic kidney disease; GFR, glomerular filtration rate; NKD, no known kidney disease; SCr, serum creatinine.
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