Pathophysiology of acute kidney injury.
Pathophysiology of acute kidney injury.
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DOI：
10.1002/cphy.c110041
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发表时间：
2012-04
影响因子：
5.8
通讯作者：
Sutton TA
中科院分区：
文献类型：
--
作者：
Basile DP;Anderson MD;Sutton TA
急性肾损伤(AKI)是肾脏内科会诊的主要原因，并与高死亡率相关。AKI的主要原因包括缺血、缺氧或肾毒性。一个潜在的特征是肾小球滤过率迅速下降，通常伴随着肾血流量的减少。炎症是AKI的一个重要附加成分，导致损伤的延伸期，这可能与对血管扩张剂治疗不敏感有关。有人建议，以延伸期为目标代表了一个可能产生最大影响的潜在治疗领域。肾脏损伤的潜在基础似乎是肾外髓内高度代谢活跃的肾单位段(即近端小管和粗大的上肢)的能量受损，可触发从一过性低氧到内源性肾功能衰竭的转换。对肾脏细胞的损伤可能是致命的或亚致命的。亚致死性损伤是AKI的一个重要组成部分，因为它可能深刻地影响GFR和肾脏血流。恢复反应的性质与亚致死细胞恢复正常功能和促进再生的程度有关。AKI的成功康复取决于随后这些修复过程的程度，而这些修复过程在老年或CKD患者中可能会受到影响。最近的数据表明，在存活的患者中，AKI可能与CKD有关。最后，AKI的早期诊断是治疗AKI患者的一个重要领域，它提高了人们对AKI生物标记物未来可能发挥作用的认识。
Acute kidney injury (AKI) is the leading cause of nephrology consultation and is associated with high mortality rates. The primary causes of AKI include ischemia, hypoxia or nephrotoxicity. An underlying feature is a rapid decline in GFR usually associated with decreases in renal blood flow. Inflammation represents an important additional component of AKI leading to the extension phase of injury, which may be associated with insensitivity to vasodilator therapy. It is suggested that targeting the extension phase represents an area potential of treatment with the greatest possible impact. The underlying basis of renal injury appears to be impaired energetics of the highly metabolically active nephron segments (i.e., proximal tubules and thick ascending limb) in the renal outer medulla, which can trigger conversion from transient hypoxia to intrinsic renal failure. Injury to kidney cells can be lethal or sublethal. Sublethal injury represents an important component in AKI, as it may profoundly influence GFR and renal blood flow. The nature of the recovery response is mediated by the degree to which sublethal cells can restore normal function and promote regeneration. The successful recovery from AKI depends on the degree to which these repair processes ensue and these may be compromised in elderly or CKD patients. Recent data suggest that AKI represents a potential link to CKD in surviving patients. Finally, earlier diagnosis of AKI represents an important area in treating patients with AKI that has spawned increased awareness of the potential that biomarkers of AKI may play in the future.
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影响因子：
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