Kellum John A, Bellomo Rinaldo, Ronco Claudio
Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA, and Department of Intensive Care, Austin Hospital, Melbourne, Victoria, Australia.
Contrib Nephrol. 2007;156:10-6. doi: 10.1159/000102010.
Over last half century, the concept of acute renal failure has evolved and with it our estimates of the incidence, prevalence and mortality. Indeed, until very recently no standard definition of acute renal failure was available, and this lack of a common language created confusion and made comparisons all but impossible. In response to the need for a common definition and classification of acute renal failure, the Acute Dialysis Quality Initiative group of experts developed and published a set of consensus criteria for defining and classifying acute renal failure. These criteria which make up acronym 'RIFLE' classify renal dysfunction according to the degree of impairment present: risk (R), injury (I), and failure (F), sustained loss (L) and end-stage kidney disease (E). However, as these criteria were developed, a new concept immerged. Renal dysfunction was no longer only considered significant when it reached the stage of failure, but a spectrum from early risk to long-term failure was recognized and codified. Subsequent studies have validated these criteria in various populations and have shown that relatively mild dysfunction is associated with adverse outcomes. The term acute kidney injury has subsequently been proposed to distinguish this new concept from the older terminology of failure.
在过去的半个世纪里，急性肾衰竭的概念不断演变，我们对其发病率、患病率和死亡率的估计也随之改变。事实上，直到最近，急性肾衰竭都没有一个标准定义，这种缺乏统一术语的情况造成了混乱，几乎无法进行比较。为了满足对急性肾衰竭进行统一的定义和分类的需求，急性透析质量改进计划专家小组制定并发布了一套用于定义和分类急性肾衰竭的共识标准。这些标准构成了首字母缩写词“RIFLE”，根据肾功能损害的程度对肾功能不全进行分类：风险（R）、损伤（I）、衰竭（F）、持续性肾功能丧失（L）和终末期肾病（E）。然而，在制定这些标准的过程中，一个新的概念出现了。肾功能不全不再仅仅在达到衰竭阶段时才被视为严重，而是认识到并明确了从早期风险到长期衰竭的一个连续谱。随后的研究在不同人群中验证了这些标准，并表明相对轻微的功能障碍也与不良后果相关。随后有人提出了急性肾损伤这一术语，以将这个新概念与旧的肾衰竭术语区分开来。
