Moore E M, Bellomo R, Nichol A D
Australian and New Zealand Intensive Care Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Anaesth Intensive Care. 2012 Nov;40(6):929-48. doi: 10.1177/0310057X1204000604.
Acute kidney injury (AKI) is the new consensus term for acute renal failure. The term describes a continuum of kidney injury, a common condition in the critically ill and after major surgery, which is associated with increased mortality. The incidence of AKI in intensive care unit patients in Australia is >30% and sepsis is a major contributory factor. However, there is limited knowledge about its incidence after major surgery, except for cardiac surgery. The creation of staged AKI classification systems (RIFLE [Risk, Injury, Failure, Loss, End-stage], Acute Kidney Injury Network and the new Kidney Disease: Improving Global Outcomes criteria) has accelerated progress in critical care nephrology research by showing that even small changes in serum creatinine are associated with increased risk of death and that this risk increases progressively with severity of AKI. Recent thought and research has cast doubt over previously accepted pathophysiological views of AKI. Moreover, terms such as 'prerenal azotaemia' and 'acute tubular necrosis' are now being challenged as lacking validity, having little supportive evidence and carrying limited clinical utility. In this review, we explore the limitations of animal and human models of AKI and the implications of recent research on our current understanding of the pathophysiology of AKI. In addition, we describe conventional and novel diagnostic methods and therapies, and explore the clinical implications of the effect of fluid administration and perioperative management. Finally, we identify priorities for clinical investigations and future directions in AKI research.
急性肾损伤（AKI）是急性肾衰竭的新共识术语。该术语描述了一系列的肾损伤情况，这在重症患者和大手术后很常见，且与死亡率增加相关。在澳大利亚，重症监护病房患者中AKI的发病率超过30%，脓毒症是一个主要促成因素。然而，除心脏手术外，关于大手术后AKI发病率的了解有限。分期AKI分类系统（RIFLE [风险、损伤、衰竭、丧失、终末期]、急性肾损伤网络和新的改善全球肾脏病预后标准）的建立，通过表明即使血清肌酐的微小变化也与死亡风险增加相关，且这种风险随AKI严重程度的增加而逐渐升高，加速了重症监护肾脏病学研究的进展。最近的思考和研究对先前被接受的AKI病理生理学观点提出了质疑。此外，诸如“肾前性氮质血症”和“急性肾小管坏死”等术语现在正受到挑战，因为它们缺乏有效性且几乎没有支持证据，临床实用性有限。在本综述中，我们探讨了AKI动物模型和人体模型的局限性以及近期研究对我们目前对AKI病理生理学理解的影响。此外，我们描述了传统和新型的诊断方法及治疗方法，并探讨了液体输注和围手术期管理效果的临床意义。最后，我们确定了AKI临床研究的重点和未来研究方向。
