RIFLE Criteria for Acute Kidney Injury
Original AKI staging system (Risk, Injury, Failure, Loss, End-stage) based on creatinine rise, GFR reduction, and urine output. Predecessor to KDIGO AKI staging.
Score interpretation
Does not meet RIFLE criteria for AKI.
→ Monitor urine output and creatinine if at risk. Ensure adequate hydration. Avoid nephrotoxins.
RIFLE Risk: 1.5× creatinine rise or UO < 0.5 mL/kg/h × 6h. Hospital mortality 8.8 % in an ICU cohort (Hoste 2006).
→ Identify and treat precipitant. IV fluids if hypovolaemic. Stop nephrotoxic drugs. Monitor 4-hourly urine output.
RIFLE Injury: 2× creatinine rise or UO < 0.5 mL/kg/h × 12h. Hospital mortality 11.4 % (Hoste 2006).
→ Nephrology referral. Optimise haemodynamics. Consider renal dose adjustment of all drugs. Check for obstruction (USS).
RIFLE Failure: 3× creatinine or UO < 0.3 mL/kg/h × 24h. Hospital mortality 26.3 % (Hoste 2006).
→ Urgent nephrology. HDU/ICU. Consider RRT (dialysis/haemofiltration) if: refractory hyperkalaemia, acidosis pH < 7.1, fluid overload, uraemic symptoms.
Complete loss of kidney function > 4 weeks.
→ Nephrology follow-up. RRT ongoing. Assess for reversibility. Renal transplant referral if appropriate.
End-stage renal disease > 3 months.
→ Long-term RRT. Renal transplant workup. Multidisciplinary CKD management.
Interpretation bands for the RIFLE. Apply clinical judgement and local guidance.
References
- Bellomo R, et al. Acute renal failure — definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004;8(4):R204–R212.
- Hoste EA, et al. RIFLE criteria for acute kidney injury are associated with hospital mortality in critically ill patients: a cohort analysis. Crit Care. 2006;10(3):R73.
Related
Curated clinical cross-links plus same-class fallbacks.
- Glyceryl Trinitrate (Sublingual / IV) · Nitrate / Acute Angina
- Dobutamine (Acute HF / Stress Echo) · Inotrope / Acute Heart Failure
- Milrinone · Inodilator / Acute Heart Failure
- Prednisolone (Systemic) · Systemic Corticosteroid — Acute Dermatoses
- Methoxyflurane · Inhaled Analgesic — Acute Pain
- Colchicine (Acute Gout) · Anti-Inflammatory (Microtubule Inhibitor)
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.