Using pRIFLE criteria for acute kidney injury in critically ill children

Main Article Content

Rina Amalia C. Saragih
Jose M. Mandei
Irene Yuniar
Rismala Dewi
Sudung O. Pardede
Antonius Pudjiadi
Abdul Latief


Backgi-ound Incidence of acute kidney injury (AKI) in critically ill
children and its mortality rate is high. The lack of a uniform definition
for AKI leads to failure in determining kidney injury, delayed
treatment, and the inability to generalize research results.
Objectives To evaluate the pediatric RIFLE (pRIFLE) criteria (risk
for renal dysfunction, injury to the kidney, failure of kidney function,
loss of kidney function, and end-stage renal disease) for diagnosing
and following the clinical course of AKI in critically ill children. We
also aimed to compare AKI severity on days 1 and 3 of pediatric
intensive care unit (PICU) stay in critically ill pediatric patients.
Methods This prospective cohort study was performed in PICU
patients. Urine output (UOP), serum creatinine (SCr) , and
glomerular filtration rate on days 1 and 3 of PICU stay were
recorded. Classification of AKI was determined according to
pRIFLE criteria. We also recorded subjects' immune status,
pediatric logistic organ dysfunction (PELOD) score, admission
diagnosis, the use of vasoactive medications, diuretics, and
ventilators, as well as PICU length of stay and mortality.
Results Forty patients were enrolled in this study. AKI was
found in 13 patients (33%). A comparison of AKI severity on
day 1 and day 3 revealed no statistically significant differences for
attainment of pRIFLE criteria by urine output only (pRIFLfu0 p;
P=0.087) and by both UOP and SCr (pRIFLEcr+uo p; P= 0.577).
However, attainment of pRIFLE criteria by SCr only (pRIFLEcrl
was significantly improved between days 1 and 3 (P =0.026). There
was no statistically significant difference in mortality or length of
stay between subjects with AKI and those without AKI.
Conclusion The pRIFLE criteria is feasible for use in diagnosing
and following the clinical course of AKI in critically ill children.

Article Details

How to Cite
Saragih R, Mandei J, Yuniar I, Dewi R, Pardede S, Pudjiadi A, Latief A. Using pRIFLE criteria for acute kidney injury in critically ill children. PI [Internet]. 28Feb.2013 [cited 8Jul.2020];53(1):32-. Available from:
Received 2016-08-18
Accepted 2016-08-18
Published 2013-02-28


1. Andreoli SP. Management of acute kidney injury in
children: a guide for pediatricians. Paediatr Drugs.
2. Pl6tz FB, Bouma AB, van WijkJA, Kneyber MC, Bokenkamp
A. Pediatric acute kidney injury in the ICU: an independent
evaluation of pRIFLE criteria. Intensive Care Med.
3. Akcan-Arikan A, Zappitelh M, Loftis LL, Washburn KK,
Jefferson LS, Goldstein SL. Modified RIFLE criteria in
critically ill children with acute kidney injury. Kidney Int.
4. Zappitelli M, Parikh CR, Akcan-Arikan A, Washburn KK,
Moffett BS, Goldstein SL. Ascertainment and epidemiology
of acute kidney injury varies with definition interpretation.
Clin J Am Soc Nephrol. 2008;3:948-54.
5. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P,
Acute Dialysis Quality Initiative workgroup. Acute renal
failure - definition, outcome measures, animal models, fluid
therapy and information technology needs: the Second
International Consensus Conferences of the Acute Dialysis
Quality Initiative (ADQI) Group. Crit Care. 2004;8:R204-
6. Mak HR. Acute kidney injury in children: the dawn of a new
era. Pediatr Nephrol. 2008;23:2147-9.
7. Bagshaw! SM, George C, Dinu I, Bellomo R. A multi-centre
evaluation of the RIFLE criteria for early acute kidney
injury in critically ill patients. Nephrol Dial Transplant.
8. Ricci Z, Cruz D, Ronco C. The RIFLE criteria and mortality
in acute kidney injury: a systematic review. Kidney Int.
9. Schneider J, Khemani R, Grushkin C, Bart R. Serum creatinine
as stratified in the RIFLE score for acute kidney injury is
associated with mortality and length of stay for children in the
pediatric intensive care unit. Crit Care Med. 2010;38:933-9.
10. Hackbarth RM, Maxfold NJ, Bunchman TE. Acute renal
failure and end-stage renal disease. In: Nichols DG, editor.
Rogers' textbook of pediatric intensive care. 4th ed. Philadelphia:
Lippincott Williams & Wilkins; 2008. p.1661-75.
36 • Paediatr Ind.ones, Vol. 53, No. 1, January 2013
11. Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera
S, Schetz M, et al. Septic acute kidney injury in critically ill
patients: clinical characteristics and outcomes. Clin J Am
Soc Nephrol. 2007;2:43 l-9.
12. Uchino S, Kellum JA, Bellomo R, Doig GS, Morimatsu
H, Morgera S, et al. Acute renal failure in critically ill
patients: a multinational, multicenter study. JAMA.