Kapadia Farhad N, Bhojani Kaushik, Shah Bharat
P.D. Hinduja National Hospital and Medical Research Center, Veer Savarkar Marg Mahim, Mumbai 400016, India.
Crit Care Clin. 2003 Apr;19(2):233-51. doi: 10.1016/s0749-0704(02)00055-6.
Renal failure commonly occurs in an ICU as part of the evolution of an underlying disease process. Appropriate and rapid resuscitation and treatment prevents or reverses prerenal insults. Patients usually make a complete recovery if the disease process is reversible and the renal injury mild or moderate. More severe degrees of renal injury initially require conservative management with attention to maintaining a diuresis, preventing fluid, electrolyte, and acid-base imbalances, and ensuring adequate nutrition. Renal replacement therapy is required for the more severe forms of renal failure. Continuous forms of RRT are gaining favor as they are associated with less hemodynamic instability, though current evidence does not demonstrate any clear outcome benefit. Mortality is high when the severe form of ARF is established. ARF may have some attributable mortality, but the poor outcome is usually related more to the underlying medical problems and concurrent multisystem derangements.
肾衰竭在重症监护病房（ICU）中很常见，是潜在疾病进程发展的一部分。适当且迅速的复苏和治疗可预防或逆转肾前性损伤。如果疾病进程可逆且肾损伤为轻度或中度，患者通常能完全康复。更严重程度的肾损伤最初需要保守治疗，注意维持利尿、预防液体、电解质和酸碱失衡，并确保充足营养。更严重形式的肾衰竭需要进行肾脏替代治疗。连续性肾脏替代治疗（RRT）越来越受到青睐，因为它与血流动力学不稳定程度较低有关，尽管目前的证据并未表明其在改善结局方面有任何明显益处。当严重急性肾衰竭（ARF）确立时，死亡率很高。ARF可能有一定的归因死亡率，但不良结局通常更多地与潜在的医疗问题和并发的多系统紊乱有关。
