Acute Kidney Injury Due to High Fever

Definition and Diagnosis

The Kidney Disease: Improving Global Outcomes (KDIGO) criteria define Stage 1 acute kidney injury (AKI) as an increase in creatinine of ≥0.3 mg/dL, which can be caused by high fever 1
A creatinine rise from 0.87 to 1.2 mg/dL represents a 0.33 mg/dL increase, meeting the KDIGO criteria for Stage 1 AKI 1
The American College of Physicians recommends using the most recent known creatinine value as the baseline for diagnosing AKI, rather than estimation methods 1

High fever can cause prerenal AKI through volume depletion, which reduces renal perfusion pressure and decreases glomerular filtration rate 2, 3
Fever increases insensible fluid losses, and prerenal causes account for 27-50% of all AKI cases 2, 3
The Infectious Diseases Society of America recommends evaluating for severe infections as a cause of AKI, especially in patients with high fever 4

If the AKI is purely prerenal from fever-related volume depletion, it should be completely reversible with appropriate fluid resuscitation 3
The National Kidney Foundation recommends reassessing creatinine in 48-72 hours to determine if the AKI is reversible 3

The European Renal Association recommends discontinuing or reducing diuretics and providing volume repletion with isotonic crystalloids in patients with prerenal AKI 3
The American College of Emergency Physicians recommends treating the underlying cause of fever aggressively and reassessing creatinine in 48-72 hours 3, 4

The KDIGO guidelines recommend not waiting for higher thresholds of creatinine to diagnose AKI, as small increases in creatinine are associated with increased hospital mortality 1, 3
In patients with cirrhosis and ascites, the American Association for the Study of Liver Diseases recommends focusing exclusively on creatinine changes rather than urine output to diagnose AKI 1, 3