Swaminathan Sundararaman, Rosner Mitchell H, Okusa Mark D
Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, VA.
Division of Nephrology, Center for Immunity, Inflammation and Regenerative Medicine, University of Virginia Health System, Charlottesville, VA.
Semin Nephrol. 2015 Jan;35(1):38-54. doi: 10.1016/j.semnephrol.2015.01.005.
Sepsis-associated acute kidney injury (SA-AKI) is linked to high morbidity and mortality. To date, singular approaches to target specific pathways known to contribute to the pathogenesis of SA-AKI have failed. Because of the complexity of the pathogenesis of SA-AKI, a reassessment necessitates integrative approaches to therapeutics of SA-AKI that include general supportive therapies such as the use of vasopressors, fluids, antimicrobials, and target-specific and time-dependent therapeutics. There has been recent progress in our understanding of the pathogenesis and treatment of SA-AKI including the temporal nature of proinflammatory and anti-inflammatory processes. In this review, we discuss the clinical and experimental basis of emerging therapeutic approaches that focus on targeting early proinflammatory and late anti-inflammatory processes, as well as therapeutics that may enhance cellular survival and recovery. Finally, we include ongoing clinical trials in sepsis.
脓毒症相关急性肾损伤（SA-AKI）与高发病率和死亡率相关。迄今为止，针对已知导致SA-AKI发病机制的特定途径的单一方法均告失败。由于SA-AKI发病机制的复杂性，重新评估需要采用综合方法来治疗SA-AKI，包括使用血管加压药、液体、抗菌药物等一般支持性疗法，以及靶向特异性和时间依赖性疗法。最近，我们对SA-AKI的发病机制和治疗的理解取得了进展，包括促炎和抗炎过程的时间特性。在本综述中，我们讨论了侧重于靶向早期促炎和晚期抗炎过程的新兴治疗方法的临床和实验基础，以及可能增强细胞存活和恢复的疗法。最后，我们纳入了正在进行的脓毒症临床试验。
