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Acute Kidney Injury (AKI) affects up to 20% of critically ill patients[1] and is an independent predictor of mortality. [2] Measurement of serum creatinine levels has been in use from the 1940s to detect renal dysfunction.[3] However, it is clear that creatinine level is an imperfect tool in assessing kidney function. Creatinine levels are influenced by extraneous factors such as age, gender, race, muscle mass, and the extent of volume resuscitation; besides, levels begin to rise only after the glomerular filtration rate (GFR) falls to 60% of baseline.[4] Once a day creatinine levels, as practiced in many intensive care units (ICUs), bear little real time correlation with renal function in the dynamic milieu typical of critically ill patients.[5] The RIFLE [6] and its modification, the AKIN criteria,[7] have been validated as tools to assess the severity of AKI. However, they too require baseline creatinine levels, which may not always be known. Clearly, we need better tools to diagnose AKI sufficiently early and follow its course more precisely to enable appropriate therapeutic interventions.

Assessment of renal function in the critically ill - Shall we look beyond predictive equations?