急性肾脏病的诊断和临床意义及现状思考

Acute kidney disease: diagnosis,clinical significance,and status quo implication

关于急性肾损伤(AKI)及慢性肾脏病(CKD)的定义已获得普遍公认,并广泛用于研究及临床实践。近来人们逐渐认识到AKI与CKD相互影响,在某些情况下应视作连续的疾病过程。改善全球肾脏病预后组织(KDIGO)指南明确定义AKI为在7 d或更短时间内肾脏功能的急剧下降;CKD为超过90 d的肾脏结构或功能异常。部分AKI患者肾脏受损的病理生理过程在7 d后仍持续无明显好转,继发于AKI之后直至CKD之前肾脏结构功能持续受损的时期被定义为急性肾脏病(AKD)。基于尚缺乏关于AKD的准确定义及相应管理策略的现状,急性透析质量倡议工作组(ADQI)提出了AKD定义、分期标准及管理策略的专家共识,以期促进对AKD病情及预后的认识。

Consensuses on definitions of both acute kidney injury （AKI） and chronic kidney disease （CKD） have been reached, and widely used in researches and clinical practice. Recently people have come to realize that AKI interacts with CKD, which should be regarded as a continuous disease process in some cases. Kidney Disease： Improving Global Outcomes （KDIGO） guidelines have clearly defined AKI as a sharp drop in renal function within 7 days, and CKD as the damage in structure or function of kidneys for more than 90 days. In some AKI patients, the pathophysiological process of renal damage shows no obvious improvement after 7 days. The period of continuous structural impairment of kidneys, secondary to AKI until before the onset of CKD, is defined as acute kidney disease （AKD）. Based on the current status of lacking an accurate definition and management strategies for AKD, the Acute Dialysis Quality Initiative （ADQI） Working Group proposed an expert consensus on the definition, staging criteria, and management strategies of AKD so as to promote the awareness of the manifestation and prognosis of AKD.