急性肾损伤诊治进展

Progress in the treatment of acute kidney injury

急性肾损伤(AKI)发病率逐年递增,其概念、诊断及分期日趋准确,寻找新的生物标志物的研究已成为热点,但仍无法完全替代血肌酐。AKI的预防在于早期发现并祛除危险因素;其治疗包括治疗原发病,防止多器官功能障碍,维持水、电解质、酸碱平衡以及肾脏替代治疗。早期透析可以改善患者预后,血液透析对小分子物质的清除及酸中毒的纠优于腹膜透析,小儿及血流动力学不稳定患者可选择腹膜透析。连续性肾脏替代治疗(CRRT)已被广泛应用于AKI的治疗,但其与间断性血液透析(IHD)互为补充,可随AKI的不同阶段和病情变化而转换,CRRT的治疗剂量仍然推荐传统剂量,对于某些特殊疾病高剂量CRRT可能有效。

The prevalence of acute kidney injury（AKI）is increasing,with its definition,diagnosis and stage being updated.New biomarkers of AKI have become a hot study,but none can be applied clinically as a substitute of serum creatinine.Identification and early intervention of risk factors are important for AKI prevention.Management of AKI includes treatment of primary disease,prevention of multi-organ dysfunction,maintaining the balance of water,electrolytes,and acid-base,and appropriate renal replacement therapy.Early hemodialysis can improve the outcome of AKI.Hemodialysis is better than peritoneal dialysis in removal of small molecule substances and correction of acidosis.Peritoneal dialysis can be used in small children and patients with unstable hemodynamics.Continuous renal replacement therapy has been generally applied in AKI,which can be a complementation of intermittent hemodialysis,although current evidences do not support a higher dosage instead of the traditional prescription of CRRT.High dosage may be effective for several special diseases.