老年急性肾损伤临床诊治的特殊性

Acute kidney injury in the elderly:special considerations

急性肾损伤(acute kidney injury,AKI)是老年人常见急危重症,其病因复杂,可发生在临床各专科,是多器官功能衰竭综合征(multiple organ dysfunction syndrome,MODS)的一部分,院内病死率高,医疗资源消耗大,发展为终末期肾脏疾病(end stage renal disease,ESRD)风险明显增加。由于缺少早期诊断方法和循证医学治疗措施,给临床防治带来困难。应了解衰老肾脏特点,掌握药物、感染、低血容量、围手术期AKI防治原则。对高危个体应密切监测,综合液体、药物、肾脏替代治疗(renal replacement therapy,RRT)以改善预后。

AKI is a common, acute and critical illness with various etiologies in the elderly, which occurs in many clinical specialties. AKI in the elderly is usually a part of MODS, which contributes to high hospital mortality high medical resource consumption and significantly increased risk of progress to ESRD. Due to lack of early diagnosis and evidence-based treatment strategy, it is difficult to prevent and treat AKI in the elderly Doctors should be aware of the characteristics of aging kidneys and know about the principles of drugs, infections, hypovolemia, and perioperative associated AKI. High-risk individuals should be monitored closely and treated with integration of liquid resucitation, medical treatment and RRT to improve the prognosis.