House Andrew A, Ronco Claudio
Division of Nephrology, University Hospital, London Health Sciences Centre, London, Ontario, Canada.
Blood Purif. 2008;26(1):30-5. doi: 10.1159/000110560. Epub 2008 Jan 10.
Sepsis-related acute kidney injury (AKI) is an important complicating feature of sepsis, and is associated with greater complexity of care and higher mortality. Until recently, AKI lacked a standard, widely accepted definition, rendering it difficult to compare previously published strategies to prevent, recognize and treat this entity. Recently, the RIFLE classification of AKI has been developed, and confirmed in observational studies to be associated with subsequent morbidity and mortality. The management of sepsis-related AKI is evolving with new basic discoveries and ongoing translational clinical research, and will likely include nephroprotective strategies to protect kidneys in patients at risk, early recognition and amelioration of renal damage and pharmacological interventions to minimize injury and promote recovery. Furthermore, extracorporeal blood purification (EBP) has an important role to play, not only in the replacement of certain aspects of renal organ function such as acid-base/electrolyte homeostasis and extracellular fluid volume, but also in an immunomodulatory fashion. As a therapy that has the potential to influence the course of disease in sepsis, EBP in sepsis and sepsis-related AKI is the subject of this review.
脓毒症相关急性肾损伤（AKI）是脓毒症的一个重要并发症特征，与更复杂的护理及更高的死亡率相关。直到最近，AKI仍缺乏一个标准的、被广泛接受的定义，这使得难以比较先前发表的预防、识别和治疗该病症的策略。最近，AKI的RIFLE分类已被制定出来，并在观察性研究中得到证实与随后的发病率和死亡率相关。随着新的基础研究发现和正在进行的转化临床研究，脓毒症相关AKI的管理正在不断发展，可能会包括肾保护策略以保护有风险的患者的肾脏、早期识别和改善肾损伤以及药物干预以尽量减少损伤并促进恢复。此外，体外血液净化（EBP）不仅在替代肾脏器官功能的某些方面（如酸碱/电解质平衡和细胞外液量）发挥重要作用，而且还具有免疫调节作用。作为一种有可能影响脓毒症病程的治疗方法，脓毒症及脓毒症相关AKI中的EBP是本综述的主题。
