Kidney, acute renal failure NOS

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ICD10 Diagnosis
Dx: Kidney, acute renal failure NOS
ICD10 code: N17.9
Pre-ICD10 counterpart: ARF, ARI
Charlson/ALERT Scale: none
APACHE Como Component: none
APACHE Acute Component: Renal/Metabolic NOS, Metabolic/Renal NOS
External ICD10 Documentation
This diagnosis is a part of ICD10 collection.


Additional Info

  • Acute renal failure is an old term. Nephrologists want us to use the term Acute Kidney Injury (AKI).
    • The reason is that this entity, whatever it's called, includes the full range of levels of kidney injury from minor all the way up to complete renal shutdown.
    • And yet another synonym is Acute Renal Insufficiency (ARI).
  • The criteria for AKI are as follows:

KDIGO Guidelines for Acute Kidney Injury (AKI)

  • In order to reduce the workload for identifying ARF/AKI, we will implement a first stage screening process to try and filter out the majority of people, who will NOT have AKI/ARF.
    • We expect that this screening will misclassify a few people who do have AKI as not having it, but we also expect that most of those who are missed will continue to experience declining renal function and their AKI/ARF will be identified in the following days.

First stage - screening

Second stage - Full assessment

  • Acute Kidney Injury (AKI) is present if ANY ONE OR MORE of the following are true (these are the KDIGO guidelines):
  • (a) Urine output < 0.5 mL/kg/hour for 6 hours
    • so, obviously, you can't make this determination until there has been at least 6 hours of observation of urine output
    • also you need a weight -- if there isn't one already measured you have the following options: Wait for one to be done; Ask the nurse to do one; Do your best to estimate the weight, remembering that if the person appears to be of average size, then you could use default values based on average values in the Canadian population, i.e. 85 kg for men and 70 kg for women
  • (b) Increase in serum creatinine by 27 micromoles/L or more within 48 hours
    • so, while this may happen quickly and thus this criterion be met before 48 hrs, you cannot make a full determination that it is NOT true until you have at least 2 serum creatinine values separated by at least 48 hours
    • in the case that the creatinine rises by >27, say in the first 12 hours, but then declines back down so that at the end of 48 hrs the net rise is <27, THEN THIS DOES QUALIFY AS AKI
  • (c) Increase in serum creatinine to 1.5 times baseline or more within the last 7 days
    • this criterion is important because since many people have some degree of CHRONIC renal insufficiency or failure, a solitary serum creatinine can't tell you if the high value is acute or chronic
    • thus, to evaluate this criterion, seek a serum creatinine value at least 7 days old -- use whatever is the most recent value more than 7 days old that is available, even if it's years old
    • if there ARE NO values >7 days old, then you can use the sex-specific normal value as follows:
      • Men: 100 micromoles/L
      • Women: 85 micromoles/L

ESRD vs Acute renal failure

 Has ICD10Code
Kidney, acute tubular necrosis (ATN)N17.0
Kidney, acute renal failure NOSN17.9
Kidney, renal failure/insufficiency/uremia, unspecified as acute or chronicN19
Kidney, acute renal failure, postproceduralN99.0

Alternate ICD10s to consider coding instead or in addition

Renal failure codes:
Chronic kidney disease codes:

Candidate Combined ICD10 codes

  • Also code the cause, if known.

Data Integrity Checks

There are a number of coding rules related to renal diagnoses, centralized info about them is in Renal Coding Considerations for ICD10.

Data Integrity Checks (SMW)

 AppStatus
Query check ICD10 ESRD vs ARFCCMDB.mdbneeds review
Can't check ICD10 ARF vs APACHE ARFCCMDB.mdbnot feasible
Query NDC Dxs vs TISS DialysisCentralized data front end.accdbneeds review
Check CRF vs ARF across multiple encountersCentralized data front end.accdbneeds review

Related CCI Codes

Legacy Info

We understand that the definition in the ICD10 codes is different than the definition in ARF (Diagnosis) and ARI and CRF - Chronic Renal Failure was. We are OK with that and will use the new definitions for the new codes, and the old ones for the old codes. Hopefully we can limit the amount of time where we consider both.

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