Krouzecký A, Rokyta R, Matĕjovic M, Novák I
I. interní klinika FN a LF UK, Plzen.
Cas Lek Cesk. 2003 Jan 20;142(1):19-23; discussion 23-4.
Acute renal failure often complicates the course of critically illness and can contribute to high morbidity and mortality. In most cases acute renal failure represents a part of the multiple organ dysfunction syndrome and it is usually related to the ischemic and/or toxic injury of tubular cells (acute tubular necrosis, ATN). The presented paper reviews the mechanisms involved in this two types of tubular cells injury. It analyzes the measures of kidney protection during critical illness, which include optimization of systemic and intrarenal hemodynamics as well as avoidance of nephrotoxic drugs. It describes the most common nephrotoxic drugs and proposes principles of their safer use. Potential strategies to stimulate kidney function recovery are also discussed.
急性肾衰竭常使危重病病情复杂化，并可导致高发病率和死亡率。在大多数情况下，急性肾衰竭是多器官功能障碍综合征的一部分，通常与肾小管细胞的缺血性和/或毒性损伤（急性肾小管坏死，ATN）有关。本文综述了这两种肾小管细胞损伤所涉及的机制。分析了危重病期间的肾脏保护措施，包括优化全身和肾内血流动力学以及避免使用肾毒性药物。描述了最常见的肾毒性药物，并提出了更安全使用这些药物的原则。还讨论了促进肾功能恢复的潜在策略。
