Himmelfarb Jonathan, Joannidis Michael, Molitoris Bruce, Schietz Miet, Okusa Mark D, Warnock David, Laghi Franco, Goldstein Stuart L, Prielipp Richard, Parikh Chirag R, Pannu Neesh, Lobo Suzana M, Shah Sudhir, D'Intini Vincent, Kellum John A
Division of Nephrology, Maine Medical Center, 22 Bramhall Street, Portland, ME 04102, USA.
Clin J Am Soc Nephrol. 2008 Jul;3(4):962-7. doi: 10.2215/CJN.04971107. Epub 2008 Mar 19.
The evaluation and initial management of patients with acute kidney injury (AKI) should include: (1) an assessment of the contributing causes of the kidney injury, (2) an assessment of the clinical course including comorbidities, (3) a careful assessment of volume status, and (4) the institution of appropriate therapeutic measures designed to reverse or prevent worsening of functional or structural kidney abnormalities. The initial assessment of patients with AKI classically includes the differentiation between prerenal, renal, and postrenal causes. The differentiation between so-called "prerenal" and "renal" causes is more difficult, especially because renal hypoperfusion may coexist with any stage of AKI. Using a modified Delphi approach, the multidisciplinary international working group, generated a set of testable research questions. Key questions included the following: Is there a difference in prognosis between volume-responsive and volume-unresponsive AKI? Are there biomarkers whose patterns (dynamic changes) predict the severity and recovery of AKI (maximal stage of AKI, need for RRT, renal recovery, mortality) and guide therapy? What is the best biomarker to assess prospectively whether AKI is volume responsive? What is the best biomarker to assess the optimal volume status in AKI patients? In evaluating the current literature and ongoing studies, it was thought that the answers to the questions posed herein would improve the understanding of AKI, and ultimately patient outcomes.
急性肾损伤（AKI）患者的评估和初始处理应包括：（1）评估肾损伤的促成原因；（2）评估临床病程，包括合并症；（3）仔细评估容量状态；（4）采取适当的治疗措施，旨在逆转或防止功能性或结构性肾脏异常的恶化。AKI患者的初始评估传统上包括区分肾前性、肾性和肾后性原因。区分所谓的“肾前性”和“肾性”原因更为困难，尤其是因为肾灌注不足可能与AKI的任何阶段并存。多学科国际工作组采用改良的德尔菲法，提出了一系列可检验的研究问题。关键问题如下：容量反应性和容量无反应性AKI的预后是否存在差异？是否存在其模式（动态变化）可预测AKI严重程度和恢复情况（AKI的最大阶段、肾脏替代治疗需求、肾脏恢复、死亡率）并指导治疗的生物标志物？前瞻性评估AKI是否为容量反应性的最佳生物标志物是什么？评估AKI患者最佳容量状态的最佳生物标志物是什么？在评估当前文献和正在进行的研究时，认为本文提出问题的答案将增进对AKI的理解，并最终改善患者预后。
