Chawla Lakhmir S
Department of Anesthesiology and Critical Care Medicine, George Washington University Medical Center, 900 23rd Street, NW, Washington, DC 20037, USA.
Clin J Am Soc Nephrol. 2008 Mar;3(2):545. doi: 10.2215/CJN.05711207. Epub 2008 Feb 13.
In decades past, the primary role of the nephrologist in the intensive care unit (ICU) was to provide renal replacement therapy and to assist in the diagnosis and treatment of complex acid-base disorders. As the burden of kidney disease increases in our aging population, clinical nephrologists find themselves practicing more and more critical care medicine. For many nephrologists, particularly those in private practice, they are the intensivist if one of their patients is admitted to the ICU. In other venues, nephrologists are able to consult on critically ill patients with a multispecialty team of treating physicians. The extent of the role placed on the nephrologist in the ICU is often determined by local practice (, presence of closed or open ICU) and geography (rural urban). In locales where a critical care consultant is not immediately available, nephrologists are often drawn into the critical care treatment of these patients because their patients have chronic kidney disease or have developed acute kidney injury (AKI). In either scenario, the increasing complexity of the ICU demands that consulting nephrologists understand the clinical and technologic advances in critical care medicine.
在过去几十年里，肾病学家在重症监护病房（ICU）的主要职责是提供肾脏替代治疗，并协助诊断和治疗复杂的酸碱紊乱。随着老年人口中肾脏疾病负担的增加，临床肾病学家发现自己越来越多地从事重症监护医学工作。对于许多肾病学家，尤其是那些私人执业的医生来说，如果他们的一名患者住进了ICU，他们就成了重症监护医生。在其他情况下，肾病学家能够与多专业治疗医生团队一起为重症患者提供会诊。ICU中赋予肾病学家的职责范围通常由当地的医疗实践（封闭式或开放式ICU的存在情况）和地理位置（农村或城市）决定。在没有重症监护会诊医生的地区，肾病学家常常被卷入这些患者的重症治疗中，因为他们的患者患有慢性肾病或已发展为急性肾损伤（AKI）。在任何一种情况下，ICU日益增加的复杂性都要求会诊肾病学家了解重症监护医学的临床和技术进展。
