Acute kidney injury
Acute kidney injury
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DOI：
10.1038/s41572-021-00284-z
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发表时间：
2021-07-15
影响因子：
81.5
通讯作者：
Anders, Hans-Joachim
中科院分区：
文献类型：
--
作者：
Kellum, John A.;Romagnani, Paola;Anders, Hans-Joachim
急性肾损伤（阿基）描述了排泄肾功能的突然丧失，可导致长期肾损伤。本书介绍了阿基在不同经济环境下的流行病学和病理生理学，讨论了当前的诊断和管理原则，并强调了对生活质量的长期影响和改善患者护理的措施。急性肾损伤（阿基）的定义是排泄肾功能的突然丧失。阿基是急性肾脏疾病和病症（AKD）的一系列病症的一部分，其中肾功能缓慢恶化或持续性肾功能障碍与肾细胞和肾单位的不可逆损失相关，这可能导致慢性肾脏疾病（CKD）。在功能丧失之前识别损伤的新生物标志物有待临床实施。阿基和AKD是全球关注的问题。在低收入和中等收入国家，感染和低血容量性休克是阿基的主要原因。在高收入国家，阿基大多发生在住院的老年患者中，与败血症、药物或侵入性操作有关。感染和创伤相关的阿基和AKD在所有地区都很常见。阿基的大范围意味着不同的病理生理机制。重症监护环境中的阿基管理具有挑战性，包括适当的容量控制、肾毒性药物管理以及肾脏支持的时间和类型。液体和电解质管理至关重要。由于阿基可能致命，因此经常需要肾脏替代治疗。阿基在危重患者中预后不良。阿基和AKD的长期后果包括CKD和心血管发病率。因此，预防和早期发现阿基至关重要。
Acute kidney injury (AKI) describes a sudden loss of excretory kidney function that can result in long-term kidney damage. This Primer describes AKI epidemiology and pathophysiology in different economic settings, discusses current diagnostic and management principles, and highlights long-term effects on quality of life and initiatives to improve patient care.Acute kidney injury (AKI) is defined by a sudden loss of excretory kidney function. AKI is part of a range of conditions summarized as acute kidney diseases and disorders (AKD), in which slow deterioration of kidney function or persistent kidney dysfunction is associated with an irreversible loss of kidney cells and nephrons, which can lead to chronic kidney disease (CKD). New biomarkers to identify injury before function loss await clinical implementation. AKI and AKD are a global concern. In low-income and middle-income countries, infections and hypovolaemic shock are the predominant causes of AKI. In high-income countries, AKI mostly occurs in elderly patients who are in hospital, and is related to sepsis, drugs or invasive procedures. Infection and trauma-related AKI and AKD are frequent in all regions. The large spectrum of AKI implies diverse pathophysiological mechanisms. AKI management in critical care settings is challenging, including appropriate volume control, nephrotoxic drug management, and the timing and type of kidney support. Fluid and electrolyte management are essential. As AKI can be lethal, kidney replacement therapy is frequently required. AKI has a poor prognosis in critically ill patients. Long-term consequences of AKI and AKD include CKD and cardiovascular morbidity. Thus, prevention and early detection of AKI are essential.