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Abstract
he concept of acute renal failure (ARF) has
undergone significant reexamination in recent
years. However, not only has there been a lack of
consensus regarding the concept of ARF, but also
there has been, until very recently, no consensus on
the diagnostic criteria or clinical definition of ARF.
Distressingly, this has resulted in multiple different
definitions being used.
The Acute Dialysis Quality Initiative (ADQI)
proposed the RIFLE criteria to define and stage acute
kidney dysfunction. The acronym RIFLE stands for
the three severity stages of risk, injury, and failure
(in order of increasing severity) and the two outcome
stages of loss and end-stage kidney disease. The three
severity stages are defined on the basis of either
increases in serum creatinine or decreases in urine
output, where the more severe of either criterion is
used. The two outcome criteria, loss and end-stage
kidney disease, are defined by the duration of loss ofkidney function.Renal transplantation is the best form of renal
replacement therapy for patients with end stage renal
disease (ESRD), in comparison to dialysis, as it is
associated with higher patient survivals, lower
hospitalization rate and a superior quality of life.
Renal failure persisting after transplantation is
called delayed graft function (DGF).The major causes
of DGF, which has a major impact on graft survival
are: ATN, hyperacute rejection, acute rejection,
urinary tract obstruction and atheroemboli or
thrombosis of the renal artery or vein.
Causes of acute renal failure in early posttransplantation
include: acute rejection, ATN, cyclosporine
or tacrolimus nephrotoxicity, urinary tract
obstruction, decreased renal perfusion, infection and
recurrence of primary disease.
The aim of this study is to evaluate the
prognostic value of RIFLE criteria in acute renal
failure in early post renal transplant patients.
We applied the RIFLE criteria in renal
transplant recipients (RTRs) who developed acute
kidney injury early post-transplantation.
Summary
215
This study is, to our knowledge, the first study to
apply RIFLE criteria in renal transplant recipients
despite they are exposed to many risk factors, more
vulnerable to develop AKI and managed, in some
centers, in special ICU.
Sixty-eight renal transplant recipients (RTRs),
in the National Institute of Urology and Nephrology
(NIUN) in Cairo, were included in this study.
These 68 RTRs were classified into two groups
(A and B). Group A (57 subjects) were retrospectively
studied while group B (11 subjects) were prospectively
studied.
In our study, we found that the frequency of
acute kidney injury 64.9% in retrospective cohort
(class R 26.3%, class I 22.8% and class F 15.8%) and
45.5% in prospective cohort.
We found that RIFLE criteria as a whole had a
sensitivity for graft loss of 87.5%, specificity of 38.8%,
positive predictive value (PPV) of 18.9%, negative
predictive value(NPV) of 95% and accuracy of 45.6%.
Class F only had sensitivity for graft loss of
80.0%, specificity of 79.2% PPV of 44.4%, NPV of 95%
and accuracy of 79.3%.In prospective cohort, we found that RIFLE
criteria had a sensitivity for graft loss of 100.0%,
specificity of 60.0%, PPV of 20.0%, NPV of 100.0% and
accuracy of 63.6%.
In all subjects with AKI in retrospective cohort,
we found that RIFLE criteria as a whole had a
sensitivity for graft rejection of 77.8% , specificity of
37.5,PPV of 18.9%,NPV of 90% and accuracy of 43.8%.
Class F only had a sensitivity of for graft
rejection 66.7%, specificity of 78.3%, PPV of 44.4 %,
NPV of 90% and accuracy of 75.8%.
In prospective cohort, we found that RIFLE
criteria had a sensitivity for graft rejection of 50.0%,
specificity of 55.6%, PPV of 20.0 %, NPV of 83.3%,
accuracy of 54.5%.
In all subjects with AKI in retrospective cohort,
we found RIFLE criteria as a whole had a sensitivity
for residual kidney injury, at day 90 post-transplantation,of 100.0%, specificity of 43.5%, PPV of
29.7%, NPV of 100.0%, accuracy of 54.3%.
Class F only had a sensitivity for residual kidney
injury, at day 90 post-transplantation of 100.0%,In prospective cohort, we found that RIFLE
criteria had a sensitivity for CAD of 100%, specificity
of 75.0%, PPV of 60.0%, NPV of 100.0%, accuracy of
81.8%.
In the retrospective cohort, we found that odds
ratio was 4.4 for cases for graft loss, 2.1 for cases for
development of graft rejection and 2.5 for cases for
development of CAD but the difference was notstatistically significant while odds ratio was 8 for
cases for development of RKI and the difference was
statistically highly significant.
In class F only in retrospective cohort, we found
that odds ratio was 15.2 for cases for graft loss and the
difference was statistically highly significant while
odds ratio was 7.2 for cases for development of graft
rejection, 9.5 for cases for development of RKI and 6
for cases for development of CAD and the difference
was statistically significant.