Tamargo Christina, Hanouneh Mohamad, Cervantes C Elena
Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
Nephrology Center of Maryland, Baltimore, MD 21239, USA.
J Clin Med. 2024 Apr 23;13(9):2455. doi: 10.3390/jcm13092455.
Acute kidney injury (AKI) is a complex and life-threatening condition with multifactorial etiologies, ranging from ischemic injury to nephrotoxic exposures. Management is founded on treating the underlying cause of AKI, but supportive care-via fluid management, vasopressor therapy, kidney replacement therapy (KRT), and more-is also crucial. Blood pressure targets are often higher in AKI, and these can be achieved with fluids and vasopressors, some of which may be more kidney-protective than others. Initiation of KRT is controversial, and studies have not consistently demonstrated any benefit to early start dialysis. There are no targeted pharmacotherapies for AKI itself, but some do exist for complications of AKI; additionally, medications become a key aspect of AKI management because changes in renal function and dialysis support can lead to issues with both toxicities and underdosing. This review will cover existing literature on these and other aspects of AKI treatment. Additionally, this review aims to identify gaps and challenges and to offer recommendations for future research and clinical practice.
急性肾损伤（AKI）是一种复杂且危及生命的病症，病因多方面，从缺血性损伤到肾毒性暴露不等。其治疗基于处理AKI的潜在病因，但通过液体管理、血管加压药治疗、肾脏替代治疗（KRT）等进行的支持性护理也至关重要。AKI患者的血压目标通常更高，可通过液体和血管加压药实现，其中一些可能比其他药物更具肾脏保护作用。KRT的启动存在争议，研究并未始终证明早期开始透析有任何益处。目前尚无针对AKI本身的靶向药物治疗，但针对AKI的并发症有一些药物治疗；此外，药物成为AKI管理的关键方面，因为肾功能变化和透析支持可能导致毒性和剂量不足问题。本综述将涵盖有关AKI治疗这些及其他方面的现有文献。此外，本综述旨在识别差距和挑战，并为未来研究和临床实践提供建议。
