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KDIGO acute kidney injury criteria staging
RIFLE, AKIN, and KDIGO Criteria for AKI
AKI Diagnostic Definitions (Any one criterion sufficient)
| Criterion | RIFLE | AKIN | KDIGO (current standard) |
|---|---|---|---|
| Serum creatinine | >50% rise within 7 days | >0.3 mg/dL or >50% rise within 48 h | >0.3 mg/dL within 48 h OR >50% (x1.5) rise within 7 days |
| Urine output | <0.5 mL/kg/h for >6 h | <0.5 mL/kg/h for >6 h | <0.5 mL/kg/h for >6 h |
KDIGO combines the best of both: the 48-hour absolute creatinine threshold from AKIN and the 7-day percentage threshold from RIFLE.
Staging Criteria
| Stage | RIFLE Name | Serum Creatinine | Urine Output |
|---|---|---|---|
| 1 | Risk (R) | ≥0.3 mg/dL rise OR ≥50% (x1.5) rise | <0.5 mL/kg/h for >6 hours |
| 2 | Injury (I) | ≥100% rise (x2.0) | <0.5 mL/kg/h for >12 hours |
| 3 | Failure (F) | ≥200% rise (x3.0) OR ≥4 mg/dL with acute rise >0.5 mg/dL OR initiation of RRT | <0.3 mL/kg/h for >24 hours OR anuria for >12 hours |
- Loss (L): Complete loss of kidney function / need for RRT for >4 weeks
- End-stage (E): Need for RRT for >3 months
The urine output criteria are identical across RIFLE, AKIN, and KDIGO for all three stages.
Key Differences: RIFLE vs. KDIGO
| Feature | RIFLE | KDIGO |
|---|---|---|
| Creatinine timeframe | >50% over <7 days only | >0.3 mg/dL in 48 h OR >50% in 7 days |
| GFR included? | Yes (GFR decrease 25-75%) | No |
| Pediatric staging | Not addressed | Stage 3 if GFR <35 mL/min/1.73 m² (<18 yrs) |
| Unknown baseline Scr | Not addressed | Method provided (back-calculation using MDRD) |
| RRT = Stage 3? | No | Yes, regardless of creatinine |
| Outcome stages | L and E included | Not included |
Mortality by RIFLE Class (ICU data)
| RIFLE Class | Attributable Mortality |
|---|---|
| Risk (R) | 8.8% |
| Injury (I) | 11.4% |
| Failure (F) | 26.3% |
| No AKI (matched) | 5.5% |
Important Practical Notes
- KDIGO is the current clinical standard (guidelines published 2012, Kidney Int Suppl; still the operative guideline as of 2025/2026)
- A patient needs to meet only one criterion (creatinine or urine output) to be assigned a stage - use the highest stage met
- For urine output staging, other causes of oliguria (e.g., high ADH after surgery) must be excluded
- Any patient on RRT automatically qualifies for Stage 3 under KDIGO/AKIN regardless of creatinine
- pRIFLE is used for children >1 month old (adjusted for lower muscle mass)
Image more clear please
A clear, high-resolution medical reference diagram comparing RIFLE, AKIN, and KDIGO criteria for Acute Kidney Injury (AKI). Use three separate inverted triangle/funnel shapes side by side, each labeled at the top. RIFLE (left, blue): - R (Risk): Cr x1.5 or GFR decrease >25% | UO <0.5 mL/kg/h for >6h - I (Injury): Cr x2.0 or GFR decrease >50% | UO <0.5 mL/kg/h for >12h - F (Failure): Cr x3.0 or GFR decrease >75% or Cr ≥4 mg/dL | UO <0.3 mL/kg/h for >24h or Anuria >12h - L (Loss): Complete loss of kidney function >4 weeks - E (End-stage): Need for RRT >3 months AKIN (center, purple): - Stage 1: Cr increase ≥0.3 mg/dL or x1.5 within 48h | UO <0.5 mL/kg/h for >6h - Stage 2: Cr x2.0 | UO <0.5 mL/kg/h for >12h - Stage 3: Cr x3.0 or ≥4 mg/dL with acute rise ≥0.5 mg/dL or RRT | UO <0.3 mL/kg/h for >24h or Anuria >12h KDIGO (right, green): - Stage 1: Cr ≥0.3 mg/dL within 48h OR x1.5 within 7 days | UO <0.5 mL/kg/h for >6h - Stage 2: Cr x2.0–2.9 | UO <0.5 mL/kg/h for >12h - Stage 3: Cr x3.0 or ≥4 mg/dL or RRT or (pediatric GFR <35) | UO <0.3 mL/kg/h for >24h or Anuria >12h Each funnel has two columns: left for Creatinine/GFR changes, right for Urine Output criteria. White text on colored backgrounds. Clean, readable fonts. Title at top: "AKI Staging Criteria: RIFLE vs AKIN vs KDIGO". Medical infographic style, white background.
