Waikar Sushrut S, Liu Kathleen D, Chertow Glenn M
Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Clin J Am Soc Nephrol. 2008 May;3(3):844-61. doi: 10.2215/CJN.05191107. Epub 2008 Mar 12.
Acute kidney injury is an increasingly common and potentially catastrophic complication in hospitalized patients. Early observational studies from the 1980s and 1990s established the general epidemiologic features of acute kidney injury: the incidence, prognostic significance, and predisposing medical and surgical conditions. Recent multicenter observational cohorts and administrative databases have enhanced our understanding of the overall disease burden of acute kidney injury and trends in its epidemiology. An increasing number of clinical studies focusing on specific types of acute kidney injury (e.g., in the setting of intravenous contrast, sepsis, and major surgery) have provided further details into this heterogeneous syndrome. Despite our sophisticated understanding of the epidemiology and pathobiology of acute kidney injury, current prevention strategies are inadequate and current treatment options outside of renal replacement therapy are nonexistent. This failure to innovate may be due in part to a diagnostic approach that has stagnated for decades and continues to rely on markers of glomerular filtration (blood urea nitrogen and creatinine) that are neither sensitive nor specific. There has been increasing interest in the identification and validation of novel biomarkers of acute kidney injury that may permit earlier and more accurate diagnosis. This review summarizes the major epidemiologic studies of acute kidney injury and efforts to modernize the approach to its diagnosis.
急性肾损伤是住院患者中日益常见且可能具有灾难性的并发症。20世纪80年代和90年代的早期观察性研究确立了急性肾损伤的一般流行病学特征：发病率、预后意义以及易患的内科和外科疾病。近期的多中心观察性队列研究和管理数据库加深了我们对急性肾损伤总体疾病负担及其流行病学趋势的理解。越来越多关注特定类型急性肾损伤（如静脉造影剂使用、脓毒症和大手术情况下）的临床研究，为这一异质性综合征提供了更多细节。尽管我们对急性肾损伤的流行病学和病理生物学有了深入了解，但目前的预防策略并不充分，且除肾脏替代治疗外，目前尚无其他治疗选择。这种创新的失败可能部分归因于一种停滞了数十年且仍依赖肾小球滤过标志物（血尿素氮和肌酐）的诊断方法，而这些标志物既不敏感也不特异。人们对识别和验证可能实现更早、更准确诊断的急性肾损伤新型生物标志物的兴趣与日俱增。本综述总结了急性肾损伤的主要流行病学研究以及使其诊断方法现代化的努力。
