Dtsch Arztebl Int. 2019 Mar 1;116(9):149-158. doi: 10.3238/arztebl.2019.0149.
10-20% of hospitalized patients develop acute kidney injury (AKI)/acute renal failure during their hospital stay. The mortality of nosocomial AKI is approximately 30%.
This review is based on relevant publications retrieved by a search in multiple databases (PubMed and Uptodate), archives, and pertinent medical journals.
The most common causes of nosocomial AKI are volume depletion, sepsis, heart diseases, polytrauma, liver diseases, and drug toxicity. AKI can also be of postrenal (obstructive) origin, or a result of renal diseases including glomeruloneph- ritis, vasculitis, tubulointerstitial nephritis, and cholesterol embolism. In about 13% of cases, nosocomial AKI develops on the basis of pre-existing chronic renal disease. Patients with AKI are at elevated risk of developing chronic renal disease and must be followed up appropriately after they are discharged from the hospital. Indispens- able elements of the evaluation of nosocomial AKI include renal ultrasonography, the exclusion of postrenal obstruction, urine chemistry, and microbiological urinaly- sis. Potentially nephrotoxic drugs and those that impair renal hemodynamics must be avoided to the greatest possible extent in patients with acute renal damage. Hypotension must be avoided as well.
Early, specific nephrological diagnosis and treatment are important components of the management of nosocomial AKI, particularly because causally directed treatment is available for some of the conditions that underlie it.
住院患者中有 10-20%在住院期间会发生急性肾损伤（AKI）/急性肾衰竭。医院获得性 AKI 的死亡率约为 30%。
本综述基于在多个数据库（PubMed 和 UpToDate）、档案和相关医学期刊中检索到的相关出版物。
医院获得性 AKI 的最常见原因是血容量不足、败血症、心脏病、多发伤、肝病和药物毒性。AKI 也可能是肾后（梗阻性）原因，或是肾小球肾炎、血管炎、肾小管间质性肾炎和胆固醇栓塞等肾脏疾病的结果。在约 13%的病例中，医院获得性 AKI 是在慢性肾脏病的基础上发展而来的。发生 AKI 的患者发生慢性肾脏病的风险增加，出院后必须进行适当的随访。医院获得性 AKI 的评估不可或缺的内容包括肾脏超声检查、排除肾后梗阻、尿液化学和微生物尿液分析。在急性肾损伤患者中，必须尽可能避免使用潜在的肾毒性药物和影响肾血流动力学的药物。还必须避免低血压。
早期、具体的肾脏科诊断和治疗是医院获得性 AKI 管理的重要组成部分，特别是因为一些导致 AKI 的疾病可以进行病因治疗。
