Acute Kidney Injury: RIFLE and Causes

By VeriScorePrep Team · 5 min

Acute kidney injury (AKI) is a sudden decline in kidney function, often reversible if the cause is treated promptly. Classifying the cause drives the response.

Pre-renal (most common)

Reduced renal perfusion: hypovolemia, hemorrhage, dehydration, heart failure, sepsis. Correct the perfusion problem first — fluids, blood, or hemodynamic support. Pre-renal AKI usually reverses rapidly once perfusion is restored.

Intrinsic

Direct kidney injury: acute tubular necrosis from prolonged ischemia or nephrotoxins, glomerulonephritis, acute interstitial nephritis (often from medications like NSAIDs, penicillins, PPIs). Remove the offending agent; supportive care.

Post-renal

Obstruction: BPH, stones, tumors, catheter kinking. Relieve the obstruction — often a foley catheter reveals the diagnosis by producing a large post-void residual.

Nursing priorities

Strict intake and output, daily weights, monitor electrolytes (especially potassium), avoid nephrotoxic drugs, and notify the provider for rising creatinine, falling urine output, or hyperkalemia. Hyperkalemia can be lethal — peaked T waves or widened QRS demand immediate response.