Hoste Eric A J, De Corte Wouter
Contrib Nephrol. 2011;174:56-64. doi: 10.1159/000329236. Epub 2011 Sep 9.
Acute kidney injury (AKI) can no longer be considered a surrogate marker for severity of illness. Recent epidemiologic data demonstrate the association of AKI and mortality. Even small decreases of kidney function are associated with increased mortality. Several clinical consequences of AKI may explain the association of AKI and mortality. Decreased free water clearance leading to volume overload contributes to morbidity and mortality, but also to deterioration of kidney function. Acid-base disorders and electrolyte abnormalities interfere with normal functioning of many processes in the body. Critically ill patients have an increased prevalence of infection. Infection and antimicrobial therapy can be the cause of AKI, but infection can also be a consequence of AKI. Finally, inadequate antimicrobial dosing probably plays an important role in the morbidity and mortality of AKI. These findings have led to a paradigm shift: patients die because of AKI rather than with AKI.
急性肾损伤（AKI）不再被视为疾病严重程度的替代标志物。近期的流行病学数据表明了AKI与死亡率之间的关联。即使肾功能出现轻微下降也与死亡率增加相关。AKI的若干临床后果或许可以解释AKI与死亡率之间的关联。导致容量超负荷的自由水清除率降低会导致发病和死亡，同时也会促使肾功能恶化。酸碱紊乱和电解质异常会干扰身体许多过程的正常运作。重症患者感染的发生率更高。感染和抗菌治疗可能是AKI的病因，但感染也可能是AKI的后果。最后，抗菌药物剂量不足可能在AKI的发病和死亡中起着重要作用。这些发现导致了一种范式转变：患者死于AKI而非伴有AKI。
