Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
George Institute for Global Health, University of New South Wales, New Delhi, India; School of Public Health, Imperial College, London, UK; Manipal Academy of Higher Education, Manipal, India.
Semin Nephrol. 2020 Sep;40(5):456-467. doi: 10.1016/j.semnephrol.2020.08.002.
Community-acquired acute kidney injury (CA-AKI) is the dominant form of AKI encountered in developing countries in Asia. Economic disparities, variations in access to health care services, geographic conditions, environmental risk factors, and sociocultural circumstances shape the causes and outcomes of CA-AKI. Infections, drugs, plant and chemical toxins, envenomations, and obstetric complications are common causes of CA-AKI. Previously healthy young individuals who often work outdoors in fields or farms are exposed to a wide variety of work-related or environmental risk factors for CA-AKI. Improving disease definitions, better data, and evolving host-pathogen interactions have changed disease descriptions and presentations over the past 20 years. Among infections, although the incidence of malaria has decreased, the number of cases with dengue and scrub typhus have increased sharply. The recognition of AKI in relation to Plasmodium knowlesi, Plasmodium vivax, scrub typhus, and leptospirosis in areas not traditionally considered at risk, association of infections with the future development of chronic kidney disease, and the role of complement dysregulation in infection-associated AKI are important new findings. Snake-bite-related toxic envenomation continues to be an important cause of AKI in some counties and is a neglected public health problem. On the other hand, significant decreases in the incidence of AKI related to acute diarrheal illness or obstetric causes are signs of hope. Coordinated efforts between administrative stakeholders, society, and health care delivery services at all levels have the potential to propel research and improve outcomes in CA-AKI.
社区获得性急性肾损伤（CA-AKI）是亚洲发展中国家常见的 AKI 形式。经济差距、医疗保健服务获取的差异、地理条件、环境风险因素和社会文化环境共同塑造了 CA-AKI 的病因和结局。感染、药物、植物和化学毒素、蛇咬伤和产科并发症是 CA-AKI 的常见病因。通常在户外田间或农场工作的健康年轻人会接触到各种与工作或环境相关的 CA-AKI 风险因素。过去 20 年来，疾病定义的改进、更好的数据和宿主-病原体相互作用的演变改变了疾病的描述和表现。在感染方面，尽管疟疾的发病率有所下降，但登革热和恙虫病的病例数却急剧增加。在传统上认为没有风险的地区发现 AKI 与疟原虫 knowlesi、疟原虫 vivax、恙虫病和钩端螺旋体病有关，感染与慢性肾脏病未来发展的关联，以及补体失调在感染相关性 AKI 中的作用，都是重要的新发现。在某些国家，蛇咬伤相关的有毒毒液仍然是 AKI 的重要病因，也是一个被忽视的公共卫生问题。另一方面，与急性腹泻病或产科原因相关的 AKI 发生率显著下降是一个希望的迹象。行政利益相关者、社会和各级医疗服务提供者之间的协调努力有可能推动 CA-AKI 的研究并改善其结局。
