Ávila Maria Olinda Nogueira, Rocha Paulo Novis, Zanetta Dirce Maria Trevisan, Yu Luis, Burdmann Emmanuel de Almeida
Hospital São Rafael.
Universidade Federal da Bahia.
J Bras Nefrol. 2014 Jul-Sep;36(3):379-88. doi: 10.5935/0101-2800.20140054.
Acute kidney injury (AKI) has a high hospital incidence and is associated to significant morbidity and mortality. Sepsis, major surgery and low cardiac output are the main cause of AKI worldwide. In the majority of these situations, volume expansion is part of both prevention and therapeutic management, restoring peripheral perfusion and attenuating drug nephrotoxicity. Early and aggressive volume resuscitation in septic patients halts tissue ischemia and is associated with higher survival. However, a liberal fluid infusion strategy after six hours can cause fluid overload. Fluid overload has been associated with morbidity and mortality increase in critically ill patients. Herein, we present a review of the main studies that assessed the effects of net fluid balance/fluid overload on the morbidity and mortality of critically ill patients. We suggest that positive water balance may be used as a potential early biomarker of AKI in these patients.
急性肾损伤（AKI）在医院中的发病率很高，且与显著的发病率和死亡率相关。脓毒症、大手术和低心输出量是全球范围内急性肾损伤的主要原因。在大多数这些情况下，扩容是预防和治疗管理的一部分，可恢复外周灌注并减轻药物肾毒性。对脓毒症患者进行早期积极的容量复苏可阻止组织缺血，并与更高的生存率相关。然而，六小时后采用自由液体输注策略可能会导致液体过载。液体过载与重症患者的发病率和死亡率增加有关。在此，我们对评估净液体平衡/液体过载对重症患者发病率和死亡率影响的主要研究进行综述。我们认为，正水平衡可作为这些患者急性肾损伤的潜在早期生物标志物。
