Division of Critical Care, Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati, Cincinnati, OH, USA.
Pediatr Crit Care Med. 2011 May;12(3):339-47. doi: 10.1097/PCC.0b013e3181fe2e0b.
To inform the pediatric intensivist of recent advancements in acute kidney injury diagnosis and management.
Studies were identified from MEDLINE (OVID), PubMed, and the Cochrane Library for topics relevant to acute kidney injury. We also reviewed bibliographies of relevant studies. DATA EXTRACTION, SYNTHESIS, AND OUTLINE REVIEW: Because of the lack of prospective trials, a majority of information is extracted from observational and retrospective data. The pathophysiology section reviews acute kidney injury mechanisms and highlights data regarding distal injury from experimental acute kidney injury. The epidemiology section focuses on incidence and outcomes of acute kidney injury, highlighting new strategies for diagnosis. The management section cites studies investigating hemodynamic optimization, nutrition, and fluid management, including the indications and impact of continuous renal replacement therapy in fluid overload.
There is limited data-driven evidence in pediatrics regarding effective therapy for acute kidney injury, a significant problem in the pediatric intensive care unit extending length of stay, ventilator days, and overall mortality. Sublethal kidney injury may be contributing to overall morbidity. We conclude that prospective clinical trials are needed to evaluate specific diagnostic aids, such as biomarkers, and therapeutic strategies, such as early initiation of continuous renal replacement therapy in children with fluid overload.
为儿科重症监护医师介绍急性肾损伤诊断和治疗的最新进展。
通过 MEDLINE（OVID）、PubMed 和 Cochrane 图书馆检索与急性肾损伤相关的主题，以获取研究资料。我们还查阅了相关研究的参考文献。
资料提取、综合和概述：由于缺乏前瞻性试验，大多数信息均从观察性和回顾性数据中提取。发病机制部分回顾了急性肾损伤的机制，并强调了来自急性肾损伤实验的远端损伤数据。流行病学部分主要关注急性肾损伤的发生率和结局，重点介绍了新的诊断策略。管理部分引用了研究血流动力学优化、营养和液体管理的研究，包括液体超负荷时连续肾脏替代治疗的适应证和影响。
儿科急性肾损伤的有效治疗方法主要基于有限的循证医学证据，这是儿科重症监护病房的一个重大问题，会延长住院时间、呼吸机使用天数和总体死亡率。亚致死性肾损伤可能导致整体发病率增加。我们得出结论，需要开展前瞻性临床试验来评估特定的诊断辅助手段，如生物标志物，以及治疗策略，如对液体超负荷患儿及早开始连续肾脏替代治疗。
