危重病人的急性肾损伤

M. Valero, Zara Cooper
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摘要

急性肾损伤是危重病人的常见病,发病率和死亡率均较高。尽管已经为预防这种疾病做出了广泛的努力,但在过去十年中,发病率仍在稳步上升。这可归因于更好的认识或根据最新的共识标准对疾病的高估。急性肾损伤的并发症对患者的生活质量、发病率和死亡率有显著影响。尽管该领域取得了进展,但这种疾病仍然是一个挑战,降低与之相关的死亡率仍然很困难。关于该疾病的适当定义、诊断和治疗,已经发表了大量文献。正在进行的讨论的主题之一是关于肾脏替代治疗(RRT)开始的确切时间缺乏共识。尽管RRT增加了治疗的复杂性,但最近的出版物表明,早期和晚期开始RRT与降低危重患者的死亡率有关。有必要对这种干预措施进行进一步的高水平研究,以使治疗标准化。本综述包含5个图,7个表,77篇参考文献。关键词:急性肾损伤网络(AKIN),急性肾损伤,慢性肾脏疾病,肾脏疾病:改善全球预后(KDIGO),肾脏生物标志物,替代疗法,风险,损伤,衰竭,肾功能丧失和终末期肾脏疾病(RIFLE)
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Acute Kidney Injury in Critically Ill Patients
Acute kidney injury is a common disease that affects critically ill patients and increases morbidity and mortality. Even though there have been extensive efforts to prevent this disease, the incidence has steadily increased over the last decade. This could be attributed to better recognition or to overestimation of the disease based on the most recent consensus criteria. Complications of acute kidney injury have a significant effect on quality of life, morbidity, and mortality. Despite advances in the field, this disease continues to be a challenge, and decreasing the mortality associated with it remains difficult. Plenty of literature has been published about the appropriate definition, diagnosis, and treatment of the disease. One of the topics of ongoing discussion deals with the lack of consensus about the exact timing for initiation of renal replacement therapy (RRT). Even though RRT adds more complexity to the treatment, recent publications suggest that early versus late initiation of RRT is related to reduced mortality in critically ill patients. Further high-level studies of this intervention are warranted to standardize treatment. This review contains 5 figures, 7 tables, and 77 references.               Key words: Acute Kidney Injury Network (AKIN), acute kidney injury, chronic kidney disease, Kidney Disease: Improving Global Outcomes (KDIGO), renal biomarkers, replacement therapy, Risk, Injury, Failure, Loss of kidney function and End-stage kidney disease (RIFLE)
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