Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
Am Fam Physician. 2012 Oct 1;86(7):631-9.
Acute kidney injury is characterized by abrupt deterioration in kidney function, manifested by an increase in serum creatinine level with or without reduced urine output. The spectrum of injury ranges from mild to advanced, sometimes requiring renal replacement therapy. The diagnostic evaluation can be used to classify acute kidney injury as prerenal, intrinsic renal, or postrenal. The initial workup includes a patient history to identify the use of nephrotoxic medications or systemic illnesses that might cause poor renal perfusion or directly impair renal function. Physical examination should assess intravascular volume status and identify skin rashes indicative of systemic illness. The initial laboratory evaluation should include measurement of serum creatinine level, complete blood count, urinalysis, and fractional excretion of sodium. Ultrasonography of the kidneys should be performed in most patients, particularly in older men, to rule out obstruction. Management of acute kidney injury involves fluid resuscitation, avoidance of nephrotoxic medications and contrast media exposure, and correction of electrolyte imbalances. Renal replacement therapy (dialysis) is indicated for refractory hyperkalemia; volume overload; intractable acidosis; uremic encephalopathy, pericarditis, or pleuritis; and removal of certain toxins. Recognition of risk factors (e.g., older age, sepsis, hypovolemia/shock, cardiac surgery, infusion of contrast agents, diabetes mellitus, preexisting chronic kidney disease, cardiac failure, liver failure) is important. Team-based approaches for prevention, early diagnosis, and aggressive management are critical for improving outcomes.
急性肾损伤的特征是肾功能突然恶化，表现为血清肌酐水平升高，伴有或不伴有尿量减少。损伤谱范围从轻度到重度，有时需要肾脏替代治疗。诊断评估可用于将急性肾损伤分为肾前性、肾性或肾后性。初步检查包括病史，以确定是否使用了可能导致肾脏灌注不良或直接损害肾功能的肾毒性药物或全身疾病。体格检查应评估血管内容量状态，并识别表明全身疾病的皮肤疹。初始实验室评估应包括测量血清肌酐水平、全血细胞计数、尿液分析和钠排泄分数。大多数患者，特别是老年男性，应进行肾脏超声检查，以排除梗阻。急性肾损伤的治疗包括液体复苏、避免使用肾毒性药物和造影剂暴露，以及纠正电解质失衡。肾替代治疗（透析）适用于难治性高钾血症；容量超负荷；难以纠正的酸中毒；尿毒症性脑病、心包炎或胸膜炎；以及某些毒素的清除。认识到危险因素（如年龄较大、脓毒症、血容量不足/休克、心脏手术、造影剂输注、糖尿病、慢性肾脏病、心力衰竭、肝功能衰竭）很重要。基于团队的预防、早期诊断和积极管理方法对于改善预后至关重要。
