Lameire Norbert, Van Biesen Wim, Hoste Eric, Vanholder Raymond
Department of Medicine, University Hospital.
Division of Nephrology, University Hospital.
NDT Plus. 2008 Dec;1(6):392-402. doi: 10.1093/ndtplus/sfn162.
This narrative clinical review in two parts discusses the prevention of clinical acute kidney injury (AKI). The first part focuses on general prevention measures, including identification of individuals at high risk for AKI, and on the role of volume expansion and fluid therapy. The latter discusses the timing, the goals, the selection of the fluids and the haemodynamic management of the patient receiving parenteral fluids for the prevention of AKI. In addition, this part summarizes the interaction of intensivist-nephrologist in the ICU with attention to tight glycaemia control and the use of low doses of corticoids in the septic shock patients. Finally, the avoidance of drug- and nephrotoxin-induced AKI is discussed. The second part of this review will summarize the possible pharmacological interventions in the patient at risk.
这篇分两部分的叙述性临床综述讨论了临床急性肾损伤（AKI）的预防。第一部分重点关注一般预防措施，包括识别AKI高危个体，以及容量扩充和液体治疗的作用。后者讨论了接受肠外补液以预防AKI的患者的补液时机、目标、液体选择和血流动力学管理。此外，这部分总结了重症监护病房（ICU）中重症医学科医生与肾内科医生的相互作用，重点关注严格血糖控制以及脓毒性休克患者低剂量皮质类固醇的使用。最后，讨论了避免药物和肾毒素诱导的AKI。本综述的第二部分将总结对高危患者可能的药物干预措施。
