Infante Barbara, Franzin Rossana, Madio Desirèe, Calvaruso Martina, Maiorano Annamaria, Sangregorio Fabio, Netti Giuseppe Stefano, Ranieri Elena, Gesualdo Loreto, Castellano Giuseppe, Stallone Giovanni
Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical Sciences, University of Foggia, Viale Pinto Luigi 251, 71122 Foggia, Italy.
Nephrology, Dialysis and Transplantation Unit, Department of Emergency and Organ Transplantation, University of Bari, 70124 Bari, Italy.
J Clin Med. 2020 Aug 8;9(8):2574. doi: 10.3390/jcm9082574.
Acute kidney injury (AKI), a critical syndrome characterized by a sudden reduction of renal function, is a common disorder among elderly patients particularly in Intensive Care Unit (ICU). AKI is closely associated with both short- and long-term mortality and length of hospital stay and is considered a predictor of chronic kidney disease (CKD). Specific hemodynamic, metabolic, and molecular changes lead to increased susceptibility to injury in the aged kidney; therefore, certain causes of AKI such as the prerenal reduction in renal perfusion or vascular obstructive conditions are more common in the elderly; moreover, AKI is often multifactorial and iatrogenic. Older patients present several comorbidities (diabetes, hypertension, heart failure) and are exposed to multiple medical interventions such as the use of nephrotoxic contrasts media and medications, which can also trigger AKI. Considering the emerging relevance of this condition, prevention and treatment of AKI in the elderly should be crucial in the internist and emergency setting. This review article summarizes the incidence, the risk factors, the pathophysiology, the molecular mechanisms and the strategies of prevention and treatment of AKI in elderly patients.
急性肾损伤（AKI）是一种以肾功能突然减退为特征的危急综合征，在老年患者中尤其是在重症监护病房（ICU）较为常见。AKI与短期和长期死亡率以及住院时间密切相关，被认为是慢性肾脏病（CKD）的一个预测指标。特定的血流动力学、代谢和分子变化导致老年肾脏对损伤的易感性增加；因此，某些急性肾损伤的病因，如肾灌注的肾前性减少或血管阻塞性疾病在老年人中更为常见；此外，急性肾损伤往往是多因素和医源性的。老年患者存在多种合并症（糖尿病、高血压、心力衰竭），并接受多种医疗干预，如使用肾毒性造影剂和药物，这也可能引发急性肾损伤。鉴于这种疾病的新出现的相关性，老年急性肾损伤的预防和治疗在内科医生和急诊环境中应该至关重要。这篇综述文章总结了老年患者急性肾损伤的发病率、危险因素、病理生理学、分子机制以及预防和治疗策略。
