Acute renal failure in the elderly: epidemiology and clinical features
Acute renal failure in the elderly: epidemiology and clinical features
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DOI：
10.5301/jn.5000141
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发表时间：
2012-09-01
影响因子：
3.4
通讯作者：
Aucella, Filippo
中科院分区：
文献类型：
--
作者：
Del Giudice, Antonio;Aucella, Filippo
影响衰老肾脏的结构和功能改变使老年人急性肾衰竭（ARF）的风险增加。这是一个普遍的问题，随着预期寿命的延长，这一问题变得更加重要。由于缺乏统一的定义标准、病因多变、多种合并症共存以及管理该疾病的临床环境和地理区域不同，老年人ARF的流行病学远未得到很好的评估，在老年患者占主导地位的发达地区发病率较高。2004年，急性透析质量倡议小组提出了用于ARF诊断和分层的步枪标准。最近，急性肾损伤网络提出了对步枪标准的几项改进，并建议使用术语急性肾损伤（阿基）表示肾功能的任何突然降低，同时将术语ARF的使用限制为需要肾脏替代治疗的严重功能障碍。尽管在老年患者中，更常见的阿基形式是功能性或阻塞性，但实质性阿基，如急性肾小管坏死和造影剂诱导的肾病，仍经常发生。发生阿基的慢性肾脏病（CKD）老年患者死亡风险高，并且易于从阿基中无法恢复并进展至更晚期的CKD，甚至进展至终末期肾病。阿基生物标志物的小组可能会改善早期诊断和治疗，从而降低未来老年患者的发病率和死亡率。
Structural and functional alterations affecting the aging kidney predispose to an increased risk of acute renal failure (ARF) in the elderly. This is a common problem becoming more relevant because of an increase in life expectancy. The epidemiology of ARF in the elderly is far from being well assessed, because of the lack of uniform definition criteria, variable etiology, coexistence of several comorbidities, and the various clinical settings and geographic areas where the condition is managed, with a higher incidence in developed regions where elderly patients predominate. In 2004, the Acute Dialysis Quality Initiative group proposed the RIFLE criteria for diagnosis and stratification of ARF. More recently, the Acute Kidney Injury Network proposed several refinements to the RIFLE criteria, and the use of the term acute kidney injury (AKI) has been suggested to mean any abrupt reduction in kidney function, while restricting use of the term ARF to severe dysfunction requiring renal replacement treatment. Although in elderly patients the more frequent forms of AKI are functional or obstructive, parenchymal AKI, such as acute tubular necrosis and contrast-induced nephropathy, still frequently occur. Elderly patients with chronic renal disease (CKD) who develop AKI are at high risk for mortality, and are prone to non-recovery from AKI and progression to more advanced stages of CKD and even to end-stage renal disease. Panels of AKI biomarkers are likely to improve early diagnosis and treatment, thus reducing morbidity and mortality of older patients from this condition in the future.