Yu Xiang, Feng Zhe
State Key Laboratory of Kidney Diseases, Department of Nephrology, National Clinical Research Center of Kidney Diseases, Chinese PLA Institute of Nephrology, Chinese PLA General Hospital, Beijing, China.
Front Med (Lausanne). 2021 Dec 24;8:751793. doi: 10.3389/fmed.2021.751793. eCollection 2021.
Acute kidney injury (AKI) is a serious clinical syndrome, and one of the common comorbidities in the perioperative period. AKI can lead to complications in surgical patients and is receiving increasing attention in clinical workup. In recent years, the analysis of perioperative risk factors has become more in-depth and detailed. In this review, the definition, diagnosis, and pathophysiological characteristics of perioperative AKI are reviewed, and the main risk factors for perioperative AKI are analyzed, including advanced age, gender, certain underlying diseases, impaired clinical status such as preoperative creatinine levels, and drugs that may impair renal function such as non-steroidal anti-inflammatory drugs (NASIDs), ACEI/ARB, and some antibiotics. Injectable contrast agents, some anesthetic drugs, specific surgical interventions, anemia, blood transfusions, hyperglycemia, and malnutrition are also highlighted. We also propose potential preventive and curative measures, including the inclusion of renal risk confirmation in the preoperative assessment, minimization of intraoperative renal toxin exposure, intraoperative management and hemodynamic optimization, remote ischemic preadaptation, glycemic control, and nutritional support. Among the management measures, we emphasize the need for careful perioperative clinical examination, timely detection and management of AKI complications, administration of dexmedetomidine for renal protection, and renal replacement therapy. We aim that this review can further increase clinicians' attention to perioperative AKI, early assessment and intervention to try to reduce the risk of AKI.
急性肾损伤（AKI）是一种严重的临床综合征，是围手术期常见的合并症之一。AKI可导致手术患者出现并发症，在临床检查中受到越来越多的关注。近年来，对围手术期危险因素的分析变得更加深入和详细。在这篇综述中，回顾了围手术期AKI的定义、诊断和病理生理特征，分析了围手术期AKI的主要危险因素，包括高龄、性别、某些基础疾病、术前肌酐水平等临床状态受损，以及可能损害肾功能的药物，如非甾体类抗炎药（NASIDs）、ACEI/ARB和一些抗生素。注射用造影剂、一些麻醉药物、特定的手术干预、贫血、输血、高血糖和营养不良也受到关注。我们还提出了潜在的预防和治疗措施，包括在术前评估中纳入肾脏风险确认、尽量减少术中肾脏毒素暴露、术中管理和血流动力学优化、远程缺血预适应、血糖控制和营养支持。在管理措施中，我们强调围手术期需要仔细的临床检查、及时发现和处理AKI并发症、使用右美托咪定进行肾脏保护以及肾脏替代治疗。我们旨在通过这篇综述进一步提高临床医生对围手术期AKI的关注，进行早期评估和干预，以试图降低AKI的风险。
