The Renal and Metabolic Division, The George Institute for Global Health, Level 5, 1 King Street, Newtown, New South Wales 2042, Australia.
Concord Clinical School, The University of Sydney, New South Wales 2139, Australia.
Nat Rev Nephrol. 2017 Nov;13(11):697-711. doi: 10.1038/nrneph.2017.119. Epub 2017 Sep 4.
Cardiac surgery-associated acute kidney injury (CSA-AKI) is the most common clinically important complication in adult patients undergoing open heart surgery, and is associated with increased mortality and morbidity. In patients in intensive care units, CSA-AKI is the second most common type of AKI after septic AKI. In this Review, we explore the definition of CSA-AKI, discuss its epidemiology and identify its risk factors. We discuss current theories of the pathophysiology of CSA-AKI and describe its clinical course. Furthermore, we introduce diagnostic tools with particular reference to novel biomarkers of AKI and their potential utility; we analyse currently applied interventions aimed at attenuating AKI in patients undergoing cardiac surgery; and describe evidence from randomized controlled trials aimed at preventing or treating CSA-AKI. Finally, we explore issues in the use of renal replacement therapy, its timing, its intensity and its preferred modalities in patients with CSA-AKI, and we discuss the prognosis of CSA-AKI in terms of patient survival and kidney recovery.
心脏手术相关急性肾损伤（CSA-AKI）是成人心脏直视手术患者最常见的临床重要并发症，与死亡率和发病率增加有关。在重症监护病房患者中，CSA-AKI 是继脓毒症 AKI 后第二常见的 AKI 类型。在这篇综述中，我们探讨了 CSA-AKI 的定义，讨论了其流行病学并确定了其危险因素。我们讨论了 CSA-AKI 的病理生理学的现有理论，并描述了其临床过程。此外，我们引入了诊断工具，特别提到了 AKI 的新型生物标志物及其潜在用途；我们分析了目前旨在减轻心脏手术患者 AKI 的干预措施；并描述了旨在预防或治疗 CSA-AKI 的随机对照试验的证据。最后，我们探讨了在 CSA-AKI 患者中使用肾脏替代治疗的问题，包括其时机、强度和首选方式，并讨论了 CSA-AKI 的预后，包括患者生存率和肾脏恢复情况。
