Recent advances in acute kidney injury epidemiology.
Recent advances in acute kidney injury epidemiology.
复制标题
DOI：
10.1097/mnh.0b013e3283521d95
复制
发表时间：
2012-05
影响因子：
3.2
通讯作者：
Deger SM
中科院分区：
文献类型：
--
作者：
Siew ED;Deger SM
急性肾损伤（阿基）的发病率不断增加，加上人们对其短期和长期后遗症的认识不断提高，这使得人们集中精力确定有发生这种疾病及其并发症风险的患者。本综述详细介绍了最近尝试识别阿基的新风险因素，描述了使用损伤生物标志物对这种疾病的诊断和预后方法的进一步改进，并强调了阿基独立预测不良长期结局的特征。蛋白尿的存在预测阿基的发展，与肾小球滤过率（eGFR）无关。心脏手术中阿基生物标志物的大型前瞻性研究的初步结果表明，与早期研究中观察到的相比，血清肌酐作为阿基标准的一致性较低。阿基的严重程度和持续时间是慢性肾脏疾病（CKD）和长期死亡率的重要预测因素。肾科医生发现少数阿基患者存活，但肾功能下降。虽然病理生理学联系尚不清楚，但蛋白尿是阿基的一个容易测量的风险因素，值得在预期手术或具有肾脏风险的药物暴露前考虑。为了充分了解阿基生物标志物的诊断和预后价值，需要进行超出血清肌酐一致性的研究。严重程度和持续时间是阿基的组成部分，可以帮助对需要监测或肾病转诊的幸存者进行风险分层。
Expanding rates of acute kidney injury (AKI) coupled with increasing awareness of its short and long-term sequelae have focused efforts to identify patients at risk for developing this disease and its complications. This review details recent attempts to identify novel risk factors for AKI, describe further refinements in the diagnostic and prognostic approach to this disease using biological markers of injury, and highlights features of AKI that independently predict poor long-term outcomes. The presence of proteinuria predicts the development of AKI independently of glomerular filtration rate (eGFR). Initial results from a large prospective study of AKI biomarkers in cardiac surgery indicate lower agreement with serum creatinine as an AKI standard than observed in early studies. AKI severity and duration are important predictors of chronic kidney disease (CKD) and long-term mortality. A minority of patients surviving AKI with decreased kidney function is seen by a nephrologist. While the pathophysiologic link unclear, proteinuria is an easily measurable risk factor for AKI worth considering before anticipated procedures or medication exposures with nephrologic risk. Investigation extending beyond agreement with serum creatinine is needed to fully understand the diagnostic and prognostic value of AKI biomarkers. Severity and duration are components of AKI that can help risk-stratify survivors in need of monitoring or nephrology referral.