Nian Wanning, Tao Weichen, Zhang Haiyi
Department of Health Management, Shengjing Hospital of China Medical University, ShenYang, China.
Department of Emergency Medicine, Shengjing Hospital of China Medical University, ShenYang, China.
Front Mol Biosci. 2025 Jul 11;12:1603392. doi: 10.3389/fmolb.2025.1603392. eCollection 2025.
Sepsis-associated acute kidney injury (SAAKI) poses a significant challenge in critical care medicine, characterized by high morbidity and mortality rates and often leading to chronic kidney disease (CKD). This article provides a comprehensive overview of the pathophysiological mechanisms, diagnostic advancements, therapeutic strategies, and prognostic studies of SAAKI. In terms of pathophysiological mechanisms, research has shifted from the traditional renal ischemia-centric view to a multidimensional interplay involving microcirculatory disturbances, immune metabolic disorders, and programmed cell death. Regarding diagnosis, traditional Kidney Disease: Improving Global Outcomes (KDIGO) criteria exhibit limitations, whereas novel biomarkers and imaging techniques offer new avenues for early diagnosis. Therapeutic strategies encompass early intervention, hemodynamic management, renal replacement therapy, and targeted therapies; however, controversy persists regarding the optimal timing and methods of their initiation. Prognostic studies focus on the mechanisms underlying the transition from SAAKI to CKD and corresponding preventive strategies. Future research should bridge the gap between animal models and human pathology and explore the potential of multi-omics technologies and artificial intelligence in optimizing management.
脓毒症相关性急性肾损伤（SAAKI）在重症医学中构成了重大挑战，其特点是发病率和死亡率高，且常导致慢性肾脏病（CKD）。本文全面概述了SAAKI的病理生理机制、诊断进展、治疗策略和预后研究。在病理生理机制方面，研究已从传统的以肾缺血为中心的观点转向涉及微循环紊乱、免疫代谢紊乱和程序性细胞死亡的多维度相互作用。在诊断方面，传统的改善全球肾脏病预后组织（KDIGO）标准存在局限性，而新型生物标志物和成像技术为早期诊断提供了新途径。治疗策略包括早期干预、血流动力学管理、肾脏替代治疗和靶向治疗；然而，关于其启动的最佳时机和方法仍存在争议。预后研究关注从SAAKI转变为CKD的潜在机制及相应的预防策略。未来的研究应弥合动物模型与人类病理学之间的差距，并探索多组学技术和人工智能在优化管理方面的潜力。
