Last updated: Lesson of the Month - August 2014…
on 04 Aug 2014

History Of Acute Kidney Injury (AKI)


It is unclear when the concept of AKI was first recognised. A landmark article was first published in 1941 by Eric Bywaters and Beall­­during World War II. They reported four cases of crush injury followed by impaired renal function. In addition to the description of the natural history of renal injury, they examined the pathology of the kidney and demonstrated widespread tubular damage and pigmented casts inside the tubular lumen

In 1946-7 Eric Bywaters and Adolf Marcus Joekes, at the Hammersmith Hospital, London and Michael Darmady in Portsmouth carried out the first haemodialyses in the UK, for patients with AKI. Darmady never published his clinical results using this dialyser. And, as the views of Bull and Geerd Borst (1902–1975) in the Netherlands (and others) in favour of ‘conservative’ management grew in strength in UK, he finally abandoned his dialysis machine. However, it was used on at least 19 patients, of whom we know at least two survived (Cameron, 2007)

This provided the basic knowledge for subsequent studies that led to the development of the principle of acute renal failure (ARF) during the ensuing decade. Ten years after the report of Beall and Bywaters, Homer W Smith introduced the term ‘acute renal failure’ in a chapter related to traumatic injuries in his textbook 'The Kidney: Structure and Function in Health and Disease' in 1951

Based on th earlier work of SIlverstein, Lee Henderson introduced haemofiltration in 1967, increasing the range of treatments for AKI. Kramer, in 1979, further developed this technique in the form of continuous arteriovenous haemfiltration

There are few RCTs in AKI. One important one, by Phu in 2002, in sepsis-induced AKI in Vietnam, showed a clear survival advantage­for Haemofiltration over acute Automated Peritoneal Dialysis (APD); which cannot­therefore be recommended for such­patients with septic AKI.

However, before 2004 there was no consensus on the diagnostic criteria or clinical definition of ARF, resulting in at least 35 definitions in the medical literature. This situation of having various definitions has given rise to a wide range of incidence estimates for AKI from 1 to 25% of intensive care unit (ICU) patients and has led to mortality rate estimates from 15 to 60%

For this reason, the term ARF was replaced by ‘acute kidney injury’ (AKI) in 2004 (Bellomo, 2004), as defined by RIFLE criteria (risk, injury, failure, loss, end-stage kidney disease). AKI is not just ARF. It also incorporates the entire spectrum of the syndrome, from minor changes in renal function to the requirement for renal replacement therapy (RRT)


1560s, from Latin acutus "sharp, pointed," figuratively "shrill, penetrating; intelligent, cunning," pp. of acuere "sharpen". Medical sense of "coming and going quickly" (of a fever or disease, as opposed to a chronic one) first recorded 1660s. Meaning "intense" is from 1727

Early 14c., of unknown origin, originally kidenere, perhaps a compound of Old English cwið ("womb") + ey ("egg"), in reference to the shape of the organ. Figurative sense of "temperament" is from 1550s. Kidney bean is from 1540s, so called for its shape

Late 14c., meaning "harm, damage, loss; a specific injury," from Anglo-French injurie ("wrongful action") from Latin injuria ("wrong, hurt, injustice, insult")