Abstract
Since the advent of consensus diagnostic criteria, the presence and severity of acute kidney injury (AKI) has been defined by relative changes in serum creatinine concentration or sustained reduction in weight-adjusted hourly urine output. In comparison to other organ systems urine production and the serum creatinine are easy to measure and directly relate to renal excretory function. However, there are a number of specific limitations of these measurements that can affect determination of the diagnosis and graduation of the severity of AKI, particularly in the context of critical illness. Delayed and imprecise diagnosis of AKI then may preclude specific intervention. In addition, increases in plasma markers of glomerular filtration such as creatinine or small decreases in urine output provide little specific information on the underlying cause of the renal injury and its prognosis to guide treatment. Thus any approach to the critically ill patient with or at risk of AKI requires a sound understanding of the basis of these conventional diagnostic techniques to rationally apply them and interpret the results in clinical context.
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