Division of Nephrology, University of California, San Francisco, San Francisco, California 94143-0532, USA.
Curr Opin Nephrol Hypertens. 2011 May;20(3):211-7. doi: 10.1097/MNH.0b013e3283454f8d.
Acute kidney injury (AKI) is a major public health concern, and preexisting kidney disease may be one of the most important risk factors. We review recent epidemiologic evidence supporting baseline proteinuria and reduced glomerular filtration rate as risk factors for AKI.
In 2008, a case-control study of over 600 000 patients in an integrated healthcare system in California first quantified a graded association between reduced baseline estimated glomerular filtration rate (eGFR) and risk of dialysis-requiring AKI; it also showed proteinuria as an independent predictor for AKI. In 2010, a cohort study consisting of 1235 adults undergoing coronary artery bypass graft in Taiwan demonstrated that mild and heavy degrees of proteinuria detected by dipstick were associated with increasingly higher odds ratio of postoperative AKI, independent of chronic kidney disease stage. A US cohort study in 2010 of over 11 000 patients determined that elevated urine albumin-to-creatinine ratio (UACR) was an independent risk factor for hospitalizations with AKI; this association started with the submicroalbuminuric range (UACR 11-29 mg/g) and increased stepwise along severity of albuminuria, after adjustment for eGFR. A cohort study in 2010 of over 900 000 adults in Alberta demonstrated increased rates of hospital admissions with AKI for patients with mild and moderate dipstick proteinuria across all values of eGFR.
The presence of baseline proteinuria and reduced baseline eGFR are powerful independent predictors for AKI and should be taken into account in clinical practice to identify high-risk patients for receipt of aggressive preventive measures to reduce risk of AKI.
急性肾损伤（AKI）是一个主要的公共卫生关注点，而预先存在的肾脏疾病可能是最重要的危险因素之一。我们回顾了最近支持蛋白尿和肾小球滤过率降低作为 AKI 危险因素的流行病学证据。
2008 年，加利福尼亚州一个综合医疗系统的超过 600000 例患者的病例对照研究首次定量评估了基线估计肾小球滤过率（eGFR）降低与透析需求 AKI 风险之间的分级关联；该研究还表明蛋白尿是 AKI 的独立预测因素。2010 年，台湾一项包含 1235 例接受冠状动脉旁路移植术的成年人的队列研究表明，通过尿试纸检测到的轻度和重度蛋白尿与术后 AKI 的比值比增加相关，独立于慢性肾脏病阶段。2010 年，美国一项超过 11000 例患者的队列研究确定，尿液白蛋白/肌酐比值（UACR）升高是 AKI 住院的独立危险因素；这种关联始于亚微量白蛋白尿范围（UACR 11-29mg/g），并在调整 eGFR 后，随着蛋白尿严重程度的增加而逐步增加。2010 年，阿尔伯塔省一项超过 900000 例成年人的队列研究表明，无论 eGFR 值如何，轻度和中度尿试纸蛋白尿患者的 AKI 住院率均升高。
基线蛋白尿和基线 eGFR 降低的存在是 AKI 的有力独立预测因素，应在临床实践中考虑这些因素，以确定需要积极预防措施降低 AKI 风险的高危患者。
