Acute Kidney Injury in the Tropics: Epidemiology, Presentation, Etiology, Specific Diseases, and Treatment
Acute Kidney Injury in the Tropics: Epidemiology, Presentation, Etiology, Specific Diseases, and Treatment
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DOI：
10.1007/978-1-4939-8628-6_14
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发表时间：
2018-05-02
期刊：
影响因子：
--
通讯作者：
Jha V
中科院分区：
文献类型：
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作者：
Parameswaran S;Jha V
阿基的特征受其发生的环境的显著影响。热带生态系统的独特特征沿着该地区的主要社会经济环境，使得热带地区的阿基在病因、临床特征和结局方面有所不同。由感染、动物、植物或化学毒素以及产科并发症引起的社区获得性阿基在热带地区很常见，而其他地区主要是由败血症以及诊断和治疗干预引起的医院获得性阿基。在热带地区可以辨别出某些不同的“阿基综合征”，如伴有阿基的发热性疾病、与毒液蛰入相关的阿基和产科阿基，其中患者沿着典型的临床特征，从而允许更特异和快速的诊断和治疗方法。热带地区疾病流行病学的变化和正在进行的社会经济转型反映在热带阿基流行病学的变化中。虽然产科阿基的发病率已显示出稳步下降，但在过去几十年中，HIV相关阿基在HIV流行的地区已成为一个重要的实体。随着更好的诊断技术的可用性，人们更好地认识到恙虫病是阿基的重要促成因素，并且人们普遍认识到，与感染后肾小球肾炎相关的阿基的流行病学在热带地区不同。快速的城市化使大量人口容易受到登革热等新出现的感染，阿基的发病率增加。气候变化和饮用水短缺预计将在未来对热带地区的肾脏健康构成重大挑战。然而，热带地区的社区获得性阿基也为预防阿基以及随之而来的发病率和死亡率提供了一个独特的机会，因为大多数促成因素可以通过公共卫生干预和创新战略来解决。
The characteristics of AKI are significantly influenced by the setting in which it develops. The unique characteristics in the tropical ecosystem along with the prevailing socioeconomic circumstances in the region make AKI in the tropics different regarding etiology, clinical characteristics, and outcomes. Community-acquired AKI caused by infections; animal, plant, or chemical toxins; and obstetric complications are common in the tropics, compared to predominantly hospital-acquired AKI from sepsis and diagnostic and therapeutic interventions elsewhere. It is possible to discern certain distinct “AKI syndromes” in the tropics, like febrile illness with AKI, envenomation-related AKI, and obstetric AKI, where the patients develop AKI along with a typical constellation of clinical features, allowing more specific and quick diagnostic and therapeutic approach. Changes in disease epidemiology and ongoing socioeconomic transitions in the tropics are reflected in changing epidemiology of tropical AKI. While the incidence of obstetric AKI has shown a steady decline, HIV-associated AKI emerged as a significant entity in regions where HIV was endemic in the past few decades. There is better recognition of scrub typhus as a significant contributor to AKI with availability of better diagnostic techniques, and it is well recognized that the epidemiology of AKI associated with post-infectious glomerulonephritis is different in the tropics. Rapid urbanization has made large swaths of population susceptible to emerging infections like dengue fever, with increased incidence of AKI. Climate change and scarcity of potable water are expected to pose significant challenges to kidney health in the tropics in the future. However, community-acquired AKI in the tropics also presents a unique opportunity for prevention of AKI, and attendant morbidity and mortality as most of the contributing factors can be addressed by public health interventions and innovative strategies to deliver healthcare.