Calculators & Tools

pRIFLE — Paediatric Acute Kidney Injury

Paediatric-modified RIFLE criteria, staged on estimated creatinine clearance and urine output.

1 What is the pRIFLE — Paediatric Acute Kidney Injury?

The pRIFLE — Paediatric Acute Kidney Injury is a renal scoring tool used in paediatric practice. Paediatric-modified RIFLE criteria, staged on estimated creatinine clearance and urine output. It scores 3 criteria and interprets the total across 6 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in renal
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 3 criteria: Change in estimated creatinine clearance (eCCl); Urine output; Duration of failure (if applicable). Totals are then banded: any score - No AKI: neither creatinine-clearance nor urine-output criteria met - no AKI by pRIFLE; 1 point or more - RISK: pRIFLE class R (Risk). Review nephrotoxins, optimise perfusion and fluid balance, monitor creatinine and urine output closely; 2 points or more - INJURY: pRIFLE class I (Injury). Stop nephrotoxic drugs, adjust drug dosing for renal function, and involve nephrology; 3 points or more - FAILURE: pRIFLE class F (Failure). Urgent nephrology input; assess need for renal replacement therapy; 4 points or more - LOSS: class L (Loss) - persistent failure beyond 4 weeks. Ongoing renal replacement and long-term nephrology follow-up; 5 points or more - END-STAGE: class E (End-stage) - ESRD beyond 3 months. Long-term dialysis or transplant planning.
  • Class is assigned by the WORSE of the two criteria (creatinine clearance or urine output).
  • Source: Akcan-Arikan A et al. Modified RIFLE criteria in critically ill children with acute kidney injury. Kidney Int 2007;71:1028-35.

4 Frequently asked questions

How many criteria does the pRIFLE — Paediatric Acute Kidney Injury use?

3. They are Change in estimated creatinine clearance (eCCl); Urine output; Duration of failure (if applicable).

What do the bands of the pRIFLE — Paediatric Acute Kidney Injury mean?

The total is interpreted as: any score - No AKI: neither creatinine-clearance nor urine-output criteria met - no AKI by pRIFLE; 1 point or more - RISK: pRIFLE class R (Risk). Review nephrotoxins, optimise perfusion and fluid balance, monitor creatinine and urine output closely; 2 points or more - INJURY: pRIFLE class I (Injury). Stop nephrotoxic drugs, adjust drug dosing for renal function, and involve nephrology; 3 points or more - FAILURE: pRIFLE class F (Failure). Urgent nephrology input; assess need for renal replacement therapy; 4 points or more - LOSS: class L (Loss) - persistent failure beyond 4 weeks. Ongoing renal replacement and long-term nephrology follow-up; 5 points or more - END-STAGE: class E (End-stage) - ESRD beyond 3 months. Long-term dialysis or transplant planning.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Class is assigned by the WORSE of the two criteria (creatinine clearance or urine output).

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.