Kheterpal et al developed an index for predicting the risk for acute renal insufficiency following general surgery. This can help to identify patients who may benefit from more aggressive management of renal function in the perioperative period. The authors are from the University of Michigan in Ann Arbor.
Patient selection: general surgery patient not in renal failure
Parameters:
(1) age
(2) gender
(3) congestive heart failure
(4) ascites
(5) hypertension
(6) timing of the surgery
(7) type of surgery
(8) renal function
(9) diabetes mellitus
|
Parameter |
Finding |
Points |
|
age |
< 56 years |
0 |
|
|
>= 56 years of age |
1 |
|
gender |
female |
0 |
|
|
male |
1 |
|
congestive heart failure |
none or inactive |
0 |
|
|
active |
1 |
|
ascites |
absent |
0 |
|
|
present |
1 |
|
hypertension |
absent |
0 |
|
|
present |
1 |
|
timing of the surgery |
routine |
0 |
|
|
emergency |
1 |
|
type of surgery |
not intraperitoneal |
0 |
|
|
intraperitoneal |
1 |
|
renal function |
normal |
0 |
|
|
mild to moderate insufficiency |
1 |
|
diabetes mellitus |
normal or does not need therapy |
0 |
|
|
need oral or insulin therapy |
1 |
where:
• Diabetes is scored based on oral or insulin therapy. A person who should be on therapy probably should be included in this group.
total risk score =
= SUM(points for all 9 risk factors)
Interpretation:
• minimum score: 0
• maximum score: 9
• The higher the score the greater the risk of postoperative acute kidney injury.
|
Score |
Class |
Incidence AKI |
|
0 to 2 |
I |
0.2% |
|
3 |
II |
0.8% |
|
4 |
III |
1.8 to 2.0% |
|
5 |
IV |
3.3 to 3.6% |
|
6 to 9 |
V |
8.9 to 9.5% |
Purpose: To identify a general surgical patient at risk for perioperative acute kidney injury (AKI) based on the risk index of Kheterpal et al.
Specialty: Anesthesiology, Nephrology
Objective: risk factors, severity, prognosis, stage
ICD-10: N17, S37.0,
