Mohsenin Vahid
Section of Pulmonary, Critical Care and Sleep Medicine, Yale School of Medicine, New Haven, CT USA.
Department of Medicine, Lippard Laboratory of Clinical Investigation, Yale School of Medicine, 15 York Street, LLCI-106-E, New Haven, CT 06510 USA.
J Intensive Care. 2017 Sep 16;5:57. doi: 10.1186/s40560-017-0251-y. eCollection 2017.
Acute kidney injury (AKI) is a common complication in critically ill patients and is associated with high morbidity and mortality. This paper provides a critical review of the etiologies of AKI and a systematic approach toward its diagnosis and management with emphasis on fluid volume assessment and the use of urine biochemical profile and microscopy in identifying the nature and the site of kidney injury.
The search of PubMed and selection of papers had employed observational designs or randomized control trials relevant to AKI.
AKI is defined by the rate of rise of serum creatinine and a decline in urine output. The pathophysiology is diverse and requires a careful and systematic assessment of predisposing factors and localization of site of injury. The majority of AKIs are due to prerenal causes such as fluid volume deficit, sepsis, or renal as in acute tubular injury. The use of central venous and arterial blood pressure monitoring and inferior vena cava echocardiography complemented by urine analysis and microscopy allows assessment of fluid volume status and AKI etiology.
Timely intervention by avoidance of fluid volume deficit and nephrotoxic agents and blood pressure support can reduce the incidence of AKI in critically ill patients.
急性肾损伤（AKI）是危重症患者常见的并发症，与高发病率和死亡率相关。本文对AKI的病因进行了批判性综述，并提供了一种系统的诊断和管理方法，重点是液体量评估以及利用尿液生化指标和显微镜检查来确定肾损伤的性质和部位。
检索PubMed并选择与AKI相关的采用观察性设计或随机对照试验的论文。
AKI由血清肌酐上升速率和尿量减少来定义。其病理生理学是多样的，需要对易感因素和损伤部位进行仔细且系统的评估。大多数AKI是由肾前性原因引起的，如液体量不足、脓毒症，或如急性肾小管损伤那样的肾性原因。使用中心静脉和动脉血压监测以及下腔静脉超声心动图，并辅以尿液分析和显微镜检查，能够评估液体量状态和AKI的病因。
通过避免液体量不足和肾毒性药物以及血压支持进行及时干预，可以降低危重症患者AKI的发生率。
