Needham Eddie
Emory University School of Medicine, Atlanta, Georgia 30338, USA.
Am Fam Physician. 2005 Nov 1;72(9):1739-46.
Acute renal failure is present in 1 to 5 percent of patients at hospital admission and affects up to 20 percent of patients in intensive care units. The condition has prerenal, intrarenal, and postrenal causes, with prerenal conditions accounting for 60 to 70 percent of cases. The cause of acute renal failure usually can be identified through an appropriate history, a physical examination, and selected laboratory tests. The initial laboratory evaluation should include urinalysis, a determination of the fractional excretion of sodium, a blood urea nitrogen to creatinine ratio, and a basic metabolic panel. Management includes correction of fluid and electrolyte levels; avoidance of nephrotoxins; and kidney replacement therapy, when appropriate. Several recent studies support the use of acetylcysteine for the prevention of acute renal failure in patients undergoing various procedures. The relative risk of serum creatinine elevation was 0.11 in patients undergoing radiocontrast-media procedures (absolute risk reduction: 19 percent) and 0.33 in patients undergoing coronary angiography (absolute risk reduction: 8 percent). In patients pretreated with sodium bicarbonate before radiocontrast-media procedures, the relative risk of serum creatinine elevation was 0.13 and the absolute risk reduction was 11.9 percent. Dopamine and diuretics have been shown to be ineffective in ameliorating the course of acute renal failure.
急性肾衰竭在住院患者中的发生率为1%至5%，在重症监护病房的患者中发生率高达20%。该病症有肾前性、肾性和肾后性病因，其中肾前性病因占病例的60%至70%。急性肾衰竭的病因通常可通过适当的病史、体格检查和特定的实验室检查来确定。初始实验室评估应包括尿液分析、钠排泄分数测定、血尿素氮与肌酐比值以及基本代谢指标检测。治疗措施包括纠正液体和电解质水平；避免使用肾毒素；以及在适当的时候进行肾脏替代治疗。最近的几项研究支持使用乙酰半胱氨酸预防接受各种手术患者的急性肾衰竭。接受放射性造影剂检查的患者血清肌酐升高的相对风险为0.11（绝对风险降低：19%），接受冠状动脉造影的患者为0.33（绝对风险降低：8%）。在放射性造影剂检查前用碳酸氢钠预处理的患者中，血清肌酐升高的相对风险为0.13，绝对风险降低为11.9%。多巴胺和利尿剂已被证明对改善急性肾衰竭病程无效。
