The Meaning of Transient Azotemia
The Meaning of Transient Azotemia
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DOI：
10.1159/000313775
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发表时间：
2010-01-01
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影响因子：
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通讯作者：
Uchino, Shigehiko
中科院分区：
文献类型：
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作者：
Uchino, Shigehiko
急性肾损伤（阿基）在住院患者中很常见，其相关死亡率很高。阿基的原因通常分为3组：肾前性、肾内性和肾后性。根据这种模式，肾前性氮质血症（PRA）代表一个独立的实体，其特征在于血清肌酐和尿素浓度的快速可逆增加。这种快速可逆性被认为反映了肾小球滤过率的功能性降低，而不是导致急性肾小管坏死（ATN）的既定结构性肾损伤。这种PRA与ATN的范例在医学和肾脏文献中得到了很好的确立，并在教科书中得到了广泛的讨论。然而，对于PRA或ATN没有一致的定义。文献中对PRA的典型描述是“血清肌酐和尿素浓度可逆性升高;”特征为肾实质功能完整但肾灌注不足“。因此，尽管术语PRA意味着它是由组织病理学定义的，但它也包含功能方面（短暂性氮质血症，TA）。PRA或ATN的早期识别被认为是重要的，因为PRA可以通过液体复苏逆转，但这种治疗会导致肺和其他组织水肿，因此在ATN中可能是有害的。然而，有证据表明，PRA不能前瞻性诊断，临床上与TA相同，尿分析和生化不能区分脓毒症阿基中的PRA和ATN，并且ATN在脓毒症阿基中在组织学上不常见。最近的观察性研究也发现TA在流行病学上不能与ATN区分开来，TA的存在与高住院死亡率有关。这些研究结果表明，有必要进行针对性和集中性的调查，以确定有效的治疗方法，以减少住院患者TA的发生率。版权所有（C）2010 S. Karger AG，巴塞尔
Acute kidney injury (AKI) is common in hospitalized patients and its associated mortality is high. The causes of AKI are commonly divided into 3 groups: pre-renal, intra-renal, and post-renal. According to this paradigm, pre-renal azotemia (PRA) represents a separate entity characterized by a rapidly reversible increase in serum creatinine and urea concentration. This rapid reversibility is believed to reflect a functional reduction in glomerular filtration rate as opposed to established structural kidney injury, which leads to acute tubular necrosis (ATN). This PRA vs. ATN paradigm is well established in the medical and renal literature and widely discussed in textbooks. However, there is no consensus definition for PRA or ATN. The typical description for PRA in the literature is 'reversible increase in serum creatinine and urea concentrations; 'characterized by intact renal parenchymal function but renal hypoperfusion'. Therefore, although the term PRA implies that it is defined histopathologically, it also contains a functional aspect (transient azotemia, TA). Early recognition of PRA or ATN is considered important because PRA can be reversed with fluid resuscitation, but such treatment causes edema in lungs as well as other tissues and therefore can be harmful in ATN. However, evidence suggests that PRA cannot be diagnosed prospectively and is clinically the same as TA, that urinary analysis and biochemistries cannot distinguish PRA and ATN in septic AKI, and that ATN is histologically uncommon in septic AKI. Recent observational studies also found that TA cannot be distinguished from ATN epidemiologically and that the existence of TA is related to high hospital mortality. These findings suggest the need for specific and focused investigations directed at identifying effective treatments to decrease the incidence of TA in hospitalized patients. Copyright (C) 2010 S. Karger AG, Basel