From the Department of Anesthesiology, Intensive Care and Pain Medicine, University of Münster, Münster, Germany.
Anesth Analg. 2017 Oct;125(4):1223-1232. doi: 10.1213/ANE.0000000000002369.
The incidence of perioperative acute kidney injury (AKI) is more common than previously recognized, especially in high-risk patients undergoing higher risk procedures. The growing number of patients who develop perioperative AKI is related, in part, to the aging population and increase in the number of individuals with chronic comorbidities, particularly those with premorbid chronic kidney disease. Despite the acceptance of standardization in the definition of AKI, clinicians routinely underdiagnose it and fail to appreciate that it is associated with considerable morbidity and mortality. Unfortunately, few, if any, preemptive therapies have proven effective in preventing AKI. Timely diagnostic methods using evolving biomarkers raises the prospect of detection of kidney damage before the onset of irreversible loss of function, but remain under investigation. Clear evidence supporting any therapeutic intervention except renal replacement therapy remains elusive. Renal replacement therapy is indicated for select patients with progressive AKI; however, the ideal timing, method, and application of it remain under debate. It is fundamental to identify patients at risk for AKI. The Kidney Disease: Improving Global Outcomes guidelines suggest preventive strategies that include avoidance of nephrotoxic agents and hyperglycemia, optimization of hemodynamics, restoration of the circulating volume, and institution of functional hemodynamic monitoring. Clear evidence in support of this approach, however, is lacking. Recently, the perioperative administration of dexmedetomidine and the provision of remote ischemic preconditioning have been studied to potentially limit the development of perioperative AKI. This review discusses accepted standard definitions of AKI, highlights associated risk factors for its development, and provides an overview of its epidemiology and pathology. It emphasizes potential preventive strategies, the possible role of emerging biomarkers in defining its presence more expeditiously before irreversible injury, and current recommended guidelines and therapeutic approaches. The ultimate goal of this article is to bring to the attention of clinicians the seriousness of this potentially preventable or modifiable perioperative complication.
围手术期急性肾损伤（AKI）的发病率比以前认识到的更为常见，尤其是在接受高风险手术的高危患者中。围手术期 AKI 患者数量的增加部分与人口老龄化以及患有慢性合并症的人数增加有关，特别是那些有潜在慢性肾脏病的患者。尽管 AKI 的定义已经标准化，但临床医生仍经常误诊该病，并且未能认识到它与相当大的发病率和死亡率有关。不幸的是，即使有，也很少有预防性治疗方法被证明能有效预防 AKI。使用不断发展的生物标志物的及时诊断方法提高了在功能不可逆转丧失之前检测肾脏损伤的可能性，但仍在研究中。除了肾脏替代疗法外，支持任何治疗干预的明确证据仍然难以捉摸。肾脏替代疗法适用于少数进展性 AKI 患者；然而，其理想的时机、方法和应用仍存在争议。确定有 AKI 风险的患者至关重要。肾脏疾病：改善全球预后指南建议了预防策略，包括避免使用肾毒性药物和高血糖、优化血液动力学、恢复循环血量以及实施功能血液动力学监测。然而，缺乏对此方法的明确证据支持。最近，研究了围手术期给予右美托咪定和提供远程缺血预处理，以潜在地限制围手术期 AKI 的发展。这篇综述讨论了 AKI 的公认标准定义，强调了其发展的相关危险因素，并概述了其流行病学和病理学。它强调了潜在的预防策略、新兴生物标志物在更快速地定义其存在之前可能发挥的作用，以及当前推荐的指南和治疗方法。本文的最终目标是让临床医生注意到这种潜在可预防或可改变的围手术期并发症的严重性。
