Practical approach to detection and management of acute kidney injury in critically ill patient.
Practical approach to detection and management of acute kidney injury in critically ill patient.
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DOI：
10.1186/s40560-017-0251-y
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发表时间：
2017
影响因子：
7.1
通讯作者：
Mohsenin V
中科院分区：
文献类型：
--
作者：
Mohsenin V
急性肾损伤（阿基）是危重患者的常见并发症，与高发病率和死亡率相关。本文对阿基的病因学及其诊断和管理的系统方法进行了批判性综述，重点是液体容量评估以及使用尿液生化特征和显微镜检查确定肾损伤的性质和部位。PubMed检索和论文选择采用了与阿基相关的观察性设计或随机对照试验。阿基的定义是血清肌酐的上升率和尿量的下降。病理生理学是多种多样的，需要仔细和系统的评估诱发因素和损伤部位的定位。大多数AKI是由于肾前原因，如液体容量不足、脓毒症或急性肾小管损伤中的肾脏。使用中心静脉和动脉血压监测和下腔静脉超声心动图，辅以尿液分析和显微镜检查，可以评估液体容量状态和阿基病因。通过避免液体容量不足和肾毒性药物以及血压支持的及时干预可以降低危重患者阿基的发生率。
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury. The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI. AKI is defined by the rate of rise of serum creatinine and a decline in urine output. The pathophysiology is diverse and requires a careful and systematic assessment of predisposing factors and localization of site of injury. The majority of AKIs are due to prerenal causes such as fluid volume deficit, sepsis, or renal as in acute tubular injury. The use of central venous and arterial blood pressure monitoring and inferior vena cava echocardiography complemented by urine analysis and microscopy allows assessment of fluid volume status and AKI etiology. Timely intervention by avoidance of fluid volume deficit and nephrotoxic agents and blood pressure support can reduce the incidence of AKI in critically ill patients.
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