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揭开急性肾病之谜:预测预后、探索干预措施并采用多学科方法。

Unveiling the enigma of acute kidney disease: predicting prognosis, exploring interventions, and embracing a multidisciplinary approach.

作者信息

Pan Szu-Yu, Huang Thomas Tao-Min, Jiang Zheng-Hong, Lin Li-Chun, Tsai I-Jung, Wu Tsung-Lin, Hsu Chih-Yi, Wang Ting, Chen Hui-Chuen, Lin Yu-Feng, Wu Vin-Cent

机构信息

Department of Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, Taipei, Taiwan.

Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.

出版信息

Kidney Res Clin Pract. 2024 Jul;43(4):406-416. doi: 10.23876/j.krcp.23.289. Epub 2024 Jun 25.

Abstract

Acute kidney disease (AKD) is a critical transitional period between acute kidney injury and chronic kidney disease. The incidence of AKD following acute kidney injury is approximately 33.6%, and it can occur without identifiable preceding acute kidney injury. The development of AKD is associated with increased risks of chronic kidney disease, dialysis, and mortality. Biomarkers and subphenotypes are promising tools to predict prognosis in AKD. The complex clinical situations in patients with AKD necessitate a comprehensive and structured approach, termed "KAMPS" (kidney function check, advocacy, medications, pressure, sick day protocols). We introduce "MAND-MASS," an acronym devised to summarize the reconciliation of medications during episodes of acute illness, as a critical component of the sick day protocols at AKD. A multidisciplinary team care, consisting of nephrologists, pharmacists, dietitians, health educators, and nurses, is an optimal model to achieve the care bundle in KAMPS. Although the evidence for patients with AKD is still lacking, several potential pharmacological agents may improve outcomes, including but not limited to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists. In conclusion, accurate prognosis prediction and effective treatment for AKD are critical yet unmet clinical needs. Future studies are urgently needed to improve patient care in this complex and rapidly evolving field.

摘要

急性肾脏病(AKD)是急性肾损伤和慢性肾脏病之间的关键过渡期。急性肾损伤后发生AKD的发生率约为33.6%,且其可在无明确前驱急性肾损伤的情况下发生。AKD的发展与慢性肾脏病、透析及死亡风险增加相关。生物标志物和亚表型是预测AKD预后的有前景的工具。AKD患者复杂的临床情况需要一种全面且结构化的方法,即“KAMPS”(肾功能检查、支持、药物、血压、患病日方案)。我们引入“MAND-MASS”,这是一个首字母缩写词,旨在总结急性疾病发作期间药物的调整,作为AKD患病日方案的关键组成部分。由肾病学家、药剂师、营养师、健康教育工作者和护士组成的多学科团队护理是实现KAMPS护理套餐的最佳模式。尽管仍缺乏针对AKD患者的证据,但几种潜在的药物制剂可能改善预后,包括但不限于血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、盐皮质激素受体拮抗剂、钠-葡萄糖协同转运蛋白2抑制剂和胰高血糖素样肽1受体激动剂。总之,对AKD进行准确的预后预测和有效治疗是关键但尚未满足的临床需求。迫切需要未来的研究来改善这个复杂且快速发展领域的患者护理。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1012/11237330/157efcab46bc/j-krcp-23-289f1.jpg

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