Documentation Tip of the Week: Acute Renal Failure (ARF) / Acute Kidney Injury (AKI)

Posted on Wed, Sep 23, 2015
Documentation Tip of the Week: Acute Renal Failure (ARF) / Acute Kidney Injury (AKI)

Our weekly feature of documentation tips for clinicians.

By Timothy Brundage, MD


  • Increase in SCr by ≥0.3 mg/dl (≥ 26.5 lmol/l) within 48 hours OR
  • Increase in SCr to ≥ 1.5 times baseline, which is known or presumed to have occurred within the prior 7 days OR
  • Urine volume < 0.5 ml/kg/h for 6 hours

“Baseline” is the lowest recorded serum  creatinine value for patient in preceding 3 months.
  • When a patient’s SCr dramatically rises above their baseline level, it is more than just “dehydration” or “azotemia” or “acute renal insufficiency.” This is “acute renal failure” or “acute kidney injury.” This is NOT “acute on chronic kidney disease.”
  • In the acute setting, physicians should document “acute renal insufficiency” for those patients with a rise in SCr that do not meet criteria for AKI.


Dr. Timothy Brundage is a hospitalist for EmCare at St. Petersburg General Hospital in St. Petersburg, Fla. Dr. Brundage earned his bachelor’s degree in chemistry and molecular biology at the University of Michigan, his M.D. at the Wayne State University School of Medicine and completed his residency in internal medicine at the University of South Florida College of Medicine. Subscribe to Dr. Brundage’s weekly documentation tips, or ask him about specific documentation issues, by emailing him at

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