Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: RIFLE and AKIN - maintain the momentum and the GFR! | Available online http content 13 5 416 Letter RIFLE and AKIN - maintain the momentum and the GFR John W Pickering and Zoltan H Endre Christchurch Kidney Research Group Department of Medicine University of Otago Christchurch New Zealand Corresponding author John W Pickering Published 11 September 2009 This article is online at http content 13 5 416 2009 BioMed Central Ltd Critical Care 2009 13 416 doi cc8019 See related review by Cruz et al. http content 13 3 211 Cruz and colleagues 1 have called appropriately for a reappraisal of RIFLE and AKIN and have thoughtfully detailed many of the issues with these progressive consensus definitions of acute kidney injury AKI and with the ways in which they have been applied. They see the elimination of the glomerular filtration rate GFR criteria from the AKIN definition as serendipitously discouraging the incorrect use of changes in estimated GFR for AKI diagnosis. We note that it also serendipitously removed the errors in degree of GFR change of the RIFLE R and F criteria definitions compared to the percentage change in creatinine 2 . Nevertheless we would argue that further refinement of AKI definitions should allow for optional measured changes in GFR to await the possibility that real-time measures of GFR become available. After all creatinine is merely a surrogate marker for GFR and a poor one at that. Furthermore the incremental creatinine creep type of AKI mg dl day illustrated by the authors might then be quickly revealed as incremental injury and loss of GfR. We concur that integration of novel biomarkers into the consensus definition is desirable when these biomarkers identify specific types and severity of injury as opposed to change in function and essential when they have been demonstrated to predict hard outcomes such as dialysis or death . A definition of AKI that incorporated both evidence of cellular injury and change in function might
