急性心肾综合征的临床处理方法

A Clinical Approach to the Acute Cardiorenal Syndrome.

作者信息

Jentzer Jacob C, Chawla Lakhmir S

机构信息

Department of Critical Care Medicine, UPMC Presbyterian Hospital, University of Pittsburgh Medical Center, 200 Lothrop Street, Pittsburgh, PA 15213, USA.

Division of Intensive Care Medicine, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA; Division of Nephrology, Department of Medicine, Washington DC Veterans Affairs Medical Center, 50 Irving Street, Washington, DC 20422, USA.

出版信息

Crit Care Clin. 2015 Oct;31(4):685-703. doi: 10.1016/j.ccc.2015.06.006.

DOI:10.1016/j.ccc.2015.06.006

PMID:26410138

Abstract

Acute kidney injury is a frequent complication of acute heart failure syndromes, portending an adverse prognosis. Acute cardiorenal syndrome represents a unique form of acute kidney injury specific to acute heart failure syndromes. The pathophysiology of acute cardiorenal syndrome involves renal venous congestion, ineffective forward flow, and impaired renal autoregulation caused by neurohormonal activation. Biomarkers reflecting different aspects of acute cardiorenal syndrome pathophysiology may allow patient phenotyping to inform prognosis and treatment. Adjunctive vasoactive, neurohormonal, and diuretic therapies may relieve congestive symptoms and/or improve renal function, but no single therapy has been proved to reduce mortality in acute cardiorenal syndrome.

摘要

急性肾损伤是急性心力衰竭综合征的常见并发症，预示着不良预后。急性心肾综合征是急性心力衰竭综合征特有的一种急性肾损伤形式。急性心肾综合征的病理生理学涉及肾静脉淤血、前向血流无效以及神经激素激活导致的肾自动调节受损。反映急性心肾综合征病理生理学不同方面的生物标志物可能有助于患者表型分析，从而为预后和治疗提供依据。辅助性血管活性、神经激素和利尿治疗可能缓解充血症状和/或改善肾功能，但尚无单一疗法被证明可降低急性心肾综合征的死亡率。