切换至 "中华医学电子期刊资源库"

第五届中国出版政府奖音像电子网络出版物奖提名奖

中国科技核心期刊

中国科学引文数据库(CSCD)来源期刊

中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (01) : 9 -13. doi: 10.3877/cma.j.issn.2096-1537.2017.01.004

所属专题: 重症医学 文献

专家论坛

急性肾损伤的诊断:肌酐还是尿量?
罗旭颖1, 周建新1,(), 席修明2,()   
  1. 1. 100050 北京,首都医科大学附属北京天坛医院重症医学科
    2. 100038 北京,首都医科大学附属复兴医院重症医学科2
  • 收稿日期:2016-12-29 出版日期:2017-02-28
  • 通信作者: 周建新, 席修明
  • 基金资助:
    北京市科学技术委员会资助项目(D101100050010058)

Diagnosis of acute kidney injury: creatinine or urine output?

Xuying Luo1, Jianxin Zhou1,(), Xiuming Xi2,()   

  1. 1. Department of Critical Care Medicine, Beijing Tian Tan Hospital, Capital Medical University, Beijing 100050, China
    2. Department of Critical Care Medicine, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
  • Received:2016-12-29 Published:2017-02-28
  • Corresponding author: Jianxin Zhou, Xiuming Xi
  • About author:
    Zhou Jianxin, Email: ;
    Xi Xiuming, Email:
引用本文:

罗旭颖, 周建新, 席修明. 急性肾损伤的诊断:肌酐还是尿量?[J/OL]. 中华重症医学电子杂志, 2017, 03(01): 9-13.

Xuying Luo, Jianxin Zhou, Xiuming Xi. Diagnosis of acute kidney injury: creatinine or urine output?[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(01): 9-13.

急性肾损伤(acute kidney injury,AKI)是临床常见疾病,在危重症患者中发病率更高,导致患者病死率增加。近年来普遍应用的AKI诊断标准,均以血清肌酐(Scr)及尿量改变为依据,进行诊断及分级。但是,二者在临床应用中仍存在争议,如基础肌酐值的确定、尿量减少阈值及持续时间的判断,以及液体平衡对二者的影响等。而Scr与尿量联合应用,虽可提高AKI的诊断敏感度,有助于筛查高危AKI患者,但却降低了AKI的诊断特异度,可能误诊AKI;并且二者对住院病死率的预测能力,亦尚无确切结论。

Acute kidney injury (AKI) is very common, especially in patients in the intensive care unit (ICU) which is associated with increased mortality. In recent years, several criteria were proposed based on changes of serum creatinine (Scr) and urine output to diagnose and classify the AKI stages. However, there were also some controversies among these criteria in clinical application, such as the definition of baseline creatinine, the threshold value and persistence time of hypourocrinia, and the influence of fluid balance on Scr and urine output, etc. The combination criteria of Scr and urine output canimprove the sensitivity of AKI diagnosis and find out the high risk patients of AKI. Howevere, it decreases the specificity and misleads the clinicians. Moreover, there is no definite conclusion of which is better to predict the hospital mortality of AKI

[1]
Fujii T, Uchino S, Takinami M, et al. Validation of the Kidney Disease Improving Global Outcomes criteria for AKI and comparison of three criteria in hospitalized patients[J]. Clin J Am Soc Nephrol, 2014, 9(5): 848–854.
[2]
Mandelbaum T, Scott DJ, Lee J, et al. Outcome of critically ill patients with acute kidney injury using the Acute Kidney Injury Network criteria[J]. Crit Care Med, 2011, 39(12): 2659–2664.
[3]
Rodrigues FB, Bruetto RG, Torres US, et al. Incidence and mortality of acute kidney injury after myocardial infarction: a comparison between KDIGO and RIFLE criteria[J]. PLoS ONE, 2013, 8(7): e69998.
[4]
Kim WY, Huh JW, Lim CM, et al. A comparison of acute kidney injury classifications in patients with severe sepsis and septic shock[J]. Am J Med Sci, 2012, 344(5): 350–356.
[5]
Nisula S, Kaukonen KM, Vaara ST, et al. Incidence, risk factors and 90-day mortality of patients with acute kidney injury in Finnish intensive care units: the FINNAKI study[J]. Intensive Care Med, 2013, 39(3): 420–428.
[6]
Wen Y, Jiang L, Xu Y, et al. Prevalence, risk factors, clinical course, and outcome of acute kidney injury in Chinese intensive care units: a prospective cohort study[J]. Chin Med J, 2013, 126(23): 4409–4416.
[7]
Bellomo R, Ronco C, Kellum JA, et al. Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J]. Crit Care, 2004, 8(4): R204–R212.
[8]
Mehta RL, Kellum JA, Shah SV, et al. Acute Kidney Injury Network: report of an initiative to improve outcomes in acute kidney injury[J]. Crit Care, 2007, 11(2): R31.
[9]
Kidney Disease, Improving Global Outcomes (KDIGO). Acute Kidney Injury Work Group: KDIGO clinical practice guideline for acute kidney injury[J]. Kidney Inter Suppl, 2012, 2: 1–138.
[10]
Lafrance JP, Miller DR. Defining acute kidney injury in database studies: the effects of varying the baseline kidney function assessment period and considering CKD status[J]. Am J Kidney Dis, 2010, 56(4): 651–660.
[11]
Bagshaw SM, Uchino S, Cruz D, et al. A comparison of observed versus estimated baseline creatinine for determination of RIFLE class in patients with acute kidney injury[J]. Nephrol Dial Transplant, 2009, 24(9): 2739–2744.
[12]
Siew ED, Matheny ME, Ikizler TA, et al. Commonly used surrogates for baseline renal function affect the classification and prognosis of acute kidney injury[J]. Kidney Int, 2010, 77(6): 536–542.
[13]
Candela-Toha AM, Recio-Vázquez M, Delgado-Montero A, et al. The calculation of baseline serum creatinine overestimates the diagnosis of acute kidney injury in patients undergoing cardiac surgery[J]. Nefrologia, 2012, 32(1): 53–58.
[14]
Pickering JW, Endre ZH. Back-calculating baseline creatinine with MDRD misclassifies acute kidney injury in the intensive care unit[J]. Clin J Am Soc Nephrol, 2010, 5(7): 1165–1173.
[15]
Závada J, Hoste E, Cartin-Ceba R, et al. A comparison of three methods to estimate baseline creatinine for RIFLE classification[J]. Nephrol Dial Transplant, 2010, 25(12): 3911–3918.
[16]
Siew ED, Ikizler TA, Matheny ME, et al. Estimating baseline kidney function in hospitalized patients with impaired kidney function[J]. Clin J Am Soc Nephrol, 2012, 7(5): 712–719.
[17]
Siew ED, Matheny ME. Choice of reference serum creatinine in defining acute kidney injury[J]. Nephron, 2015, 131(2): 107–112.
[18]
Lassnigg A, Schmid ER, Hiesmayr M, et al. Impact of minimal increases in serum creatinine on outcome in patients after cardiothoracic surgery: do we have to revise current definitions of acute renal failure?[J]. Crit Care Med, 2008, 36(4): 1129–1137.
[19]
Palevsky PM, Liu KD, Brophy PD, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury[J]. Am J Kidney Dis, 2013, 61(5): 649–672.
[20]
Thomas ME, Blaine C, Dawnay A, et al. The definition of acute kidney injury and its use in practice[J]. Kidney Int, 2015, 87(1): 62–73.
[21]
Schetz M, Gunst J, Van den Berghe G. The impact of using estimated GFR versus creatinine clearance on the evaluation of recovery from acute kidney injury in the ICU[J]. Intensive Care Med, 2014, 40(11): 1709–1717.
[22]
Pickering JW, Ralib AM, Endre ZH. Combining creatinine and volume kinetics identifies missed cases of acute kidney injury following cardiac arrest[J]. Crit Care, 2013, 17(1): R7.
[23]
Liu KD, Thompson BT, Ancukiewicz M, et al. Acute kidney injury in patients with acute lung injury: impact of fluid accumulation on classification of acute kidney injury and associated outcomes[J]. Crit Care Med, 2011, 39(12): 2665–2671.
[24]
Macedo E, Bouchard J, Soroko SH, et al. Fluid accumulation, recognition and staging of acute kidney injury in critically-ill patients[J]. Crit Care, 2010, 14(3): R82.
[25]
Bouchard J, Soroko SB, Chertow GM, et al. Fluid accumulation, survival and recovery of kidney function in critically ill patients with acute kidney injury[J]. Kidney Int, 2009, 76(4): 422–427.
[26]
Grams ME, Estrella MM, Coresh J, et al. Fluid balance, diuretic use, and mortality in acute kidney injury[J]. Clin J Am Soc Nephrol, 2011, 6(5): 966–973.
[27]
Macedo E, Malhotra R, Claure-Del Granado R, et al. Defining urine output criterion for acute kidney injury in critically ill patients[J]. Nephrol Dial Transplant, 2011, 26(2): 509–515.
[28]
Macedo E, Malhotra R, Bouchard J, et al. Oliguria is an early predictor of higher mortality in critically ill patients[J]. Kidney Int, 2011, 80(7): 760–767.
[29]
Teixeira C, Garzotto F, Piccinni P, et al. Fluid balance and urine volume are independent predictors of mortality in acute kidney injury[J]. Crit Care, 2013, 17(1): R14.
[30]
Uchino S, Bellomo R, Goldsmith D, et al. An assessment of the RIFLE criteria for acute renal failure in hospitalized patients[J]. Crit Care Med, 2006, 34(7): 1913–1917.
[31]
Ali T, Khan I, Simpson W, et al. Incidence and outcomes in acute kidney injury: a comprehensive population-based study[J]. J Am Soc Nephrol, 2007, 18(4): 1292–1298.
[32]
Zeng X, McMahon GM, Brunelli SM, et al. Incidence, outcomes, and comparisons across definitions of AKI in hospitalized individuals[J]. Clin J Am Soc Nephrol, 2014, 9(1): 12–20.
[33]
Endre ZH, Pickering JW. Outcome definitions in non-dialysis intervention and prevention trials in acute kidney injury (AKI)[J]. Nephrol Dial Transplant, 2010, 25(1): 107–118.
[34]
Md Ralib A, Pickering JW, Shaw GM, et al. The urine output definition of acute kidney injury is too liberal[J]. Crit Care, 2013, 17(3): R112.
[35]
Engoren M, Maile MD, Heung M, et al. . The association between urine output, creatinine elevation, and death[J/OL]. Ann Thorac Surg, 2016, Oct 4.[2017-01-10]. Epub ahead of print)

URL    
[36]
Leedahl DD, Frazee EN, Schramm GE, et al. Derivation of urine output thresholds that identify a very high risk of AKI in patients with septic shock[J]. Clin J Am Soc Nephrol, 2014, 9(7): 1168–1174.
[37]
Ad-hoc working group of ERBP, Fliser D, Laville M, et al. A European Renal Best Practice (ERBP) position statement on the Kidney Disease Improving Global Outcomes (KDIGO) clinical practice guidelines on acute kidney injury: part 1: definitions, conservative management and contrast-induced nephropathy[J]. Nephrol Dial Transplant, 2012, 27(12): 4263–4272.
[38]
Quan S, Pannu N, Wilson T, et al. Prognostic implications of adding urine output to serum creatinine measurements for staging of acute kidney injury after major surgery: a cohort study[J]. Nephrol Dial Transplant, 2016, 31(12): 2049–2056.
[39]
Wlodzimirow KA, Abu-Hanna A, Slabbekoorn M, et al. A comparison of RIFLE with and without urine output criteria for acute kidney injury in critically ill patients[J]. Crit Care, 2012, 16(5): R200.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[3] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[4] 熊鹰, 林敬莱, 白奇, 郭剑明, 王烁. 肾癌自动化病理诊断:AI离临床还有多远?[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 535-540.
[5] 王秋生. 胆道良性疾病诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[6] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[7] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[8] 林科灿, 罗柳平. 肝胰十二指肠切除术在胆囊癌和胆管癌应用中的关键问题[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 774-778.
[9] 袁雨涵, 杨盛力. 体液和组织蛋白质组学分析在肝癌早期分子诊断中的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 883-888.
[10] 李浩, 陈棋帅, 费发珠, 张宁伟, 李元东, 王硕晨, 任宾. 慢性肝病肝纤维化无创诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 863-867.
[11] 谭瑞义. 小细胞骨肉瘤诊断及治疗研究现状与进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 781-784.
[12] 王子阳, 王宏宾, 刘晓旌. 血清标志物对甲胎蛋白阴性肝细胞癌诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 677-681.
[13] 陈慧, 邹祖鹏, 周田田, 张艺丹, 张海萍. 皮肤镜对头皮红斑性皮肤病辅助鉴别诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 692-698.
[14] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[15] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
阅读次数
全文


摘要