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中华重症医学电子杂志 ›› 2018, Vol. 04 ›› Issue (02) : 123 -127. doi: 10.3877/cma.j.issn.2096-1537.2018.02.004

所属专题: 重症医学 文献

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重症患者之急性肾损伤
庄乔琳1, 尹汇文2, 唐高骏3,()   
  1. 1. 台北荣民总医院内科部;台北,阳明大学医学院
    2. 台北,阳明大学医学院
    3. 台北,阳明大学医学院;台北,阳明大学附设医院外科ICU
  • 收稿日期:2017-07-05 出版日期:2018-05-28
  • 通信作者: 唐高骏

Acute kidney injury in intensive care unit

Chiaolin Chuang1, Hueywen Yien2, Gaujun Tang3,()   

  1. 1. Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, China; Yang-Ming University School of Medicine, Taipei, Taiwan, China
    2. Yang-Ming University School of Medicine, Taipei, Taiwan, China
    3. Yang-Ming University School of Medicine, Taipei, Taiwan, China; Surgical Intensive Care Unit, Yang-Ming University Hospital, Taipei, Taiwan, China
  • Received:2017-07-05 Published:2018-05-28
  • Corresponding author: Gaujun Tang
  • About author:
    Corresponding author: Tang Gaujun, Email:
引用本文:

庄乔琳, 尹汇文, 唐高骏. 重症患者之急性肾损伤[J/OL]. 中华重症医学电子杂志, 2018, 04(02): 123-127.

Chiaolin Chuang, Hueywen Yien, Gaujun Tang. Acute kidney injury in intensive care unit[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(02): 123-127.

重症监护病房中,急性肾损伤的发生率逐年增加,台湾地区全民健康保险研究数据库显示ICU的患者约有10%需要肾脏替代治疗。造成肾损伤主要的原因为脓毒症及低血容积休克,静脉输液补充血管内容积及维持稳定血压及肾灌注为最基本的治疗。由于利尿剂在防止或治疗肾损伤中的角色已淡出,肾脏替代疗法应在无尿期时尽早实施。连续性肾脏替代治疗(CRRT),可以避免洗肾时的低血压发生,持续性低效率每日透析(SLEDD)是一种复合型治疗,结合了CRRT血流动力状态稳定的优点,也具备间歇性肾脏替代治疗节省人力与治疗时间的好处。一个多专科团队能及时矫正即有的疾病,充分的血流动力及营养支持,早期的肾脏替代治疗,可防止多重器官衰竭发生,改善患者的结果。

The incidence of acute kidney injury (AKI) is increasing and up to 10% of total ICU patients need renal replacement therapy. The major causes of AKI are sepsis and hypovolemic shock. Adequate intravascular fluid and stable blood pressure to maintain renal perfusion remain the basis for the managements of AKI. Since the efficacy of diuretics was challenged, renal replacement therapy should be implemented at the early phase of anuria. Continuous renal replacement therapy (CRRT) is preferred to avoid of intradialytic hypotension. Either continuous veno-venous hemofiltration (CVVH) or hybrid therapy using sustained low efficiency daily dialysis (SLEDD) is good choice for the hemodynamic unstable sepsis patients. A multi-disciplinary team approach to correct underlying disease, optimize hemodynamic and nutritional support, backup with early renal replacement intervention can prevent multiple organ failure and improve outcome.

表1 急性肾损伤的诊断标准(KDIGO)
表2 急性肾损伤患者的蛋白质补充建议[g/(kg?d)]
[1]
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.
[2]
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.
[3]
Kellum JA,Lameire N,Aspelin P, et al. Kidney Disease: Improving Global Outcomes (KDIGO) Acute Kidney Injury Work Group. KDIGO clinical practice guideline for acute kidney injury [J]. Kid Intern Suppl, 2012, 1(2): 1-138.
[4]
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.
[5]
Kaddourah A,Basu RK,Bagshaw SM, et al. Epidemiology of Acute Kidney Injury in Critically Ill Children and Young Adults [J]. N Engl J Med, 2017, 376(1): 11-20.
[6]
Siew ED,Davenport A. The growth of acute kidney injury: a rising tide or just closer attention to detail? [J]. Kidney Int, 2015, 87(1): 46-61.
[7]
Hoste EA,Bagshaw SM,Bellomo R. Epidemiology of acute kidney injury in critically ill patients: the multinational AKI-EPI study [J]. Intensive Care Med, 2015, 41(8): 1411-1423.
[8]
Uchino S,Kellum JA,Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study [J]. JAMA, 2005, 294(7): 813-818.
[9]
Wald R,McArthur E,Adhikari NK, et al. Changing incidence and outcomes following dialysis-requiring acute kidney injury among critically ill adults: a population-based cohort study [J]. Am J Kidney Dis, 2015, 65(6): 870-877.
[10]
Langenberg C,Wan L,Egi M, et al. Renal blood flow in experimental septic acute renal failure [J]. Kidney Int, 2006, 69(11): 1996-2002.
[11]
Calzavacca P,Evans RG,Bailey M, et al. Cortical and medullary tissue perfusion and oxygenation in experimental septic acute kidney injury [J]. Crit Care Med, 2015, 43(10): e431-e439.
[12]
Prowle JR,Bellomo R. Sepsis-associated acute kidney injury: macrohemodynamic and microhemodynamic alterations in the renal circulation [J]. Semin Nephrol, 2015, 35(1): 64-74.
[13]
Kosaka J,Lankadeva YR,May CN, et al. Histopathology of septic acute kidney injury: a systematic review of experimental data [J]. Crit Care Med, 2016, 44(9): e897-e903.
[14]
Tran M,Tam D,Bardia A, et al. PGC-1α promotes recovery after acute kidney injury during systemic inflammation in mice [J]. J Clin Invest, 2011, 121(10): 4003-4014.
[15]
Gomez H,Ince C,De Backer D, et al. A unified theory of sepsis-induced acute kidney injury: inflammation, microcirculatory dysfunction, bioenergetics, and the tubular cell adaptation to injury [J]. Shock, 2014, 41(1): 3-11.
[16]
Mehta RL,Pascual MT,Soroko S, et al. Diuretics, mortality, and nonrecovery of renal function in acute renal failure [J]. JAMA, 288(20): 2547-2553.
[17]
Koyner JL,Davison DL,Brasha-Mitchell E, et al. Furosemide stress test and biomarkers for the prediction of AKI severity [J]. J Am Soc Nephrol, 2015, 26(8): 2023-2031.
[18]
Osman D,Ridel C,Ray P, et al. Cardiac filling pressures are not appropriate to predict hemodynamic response to volume challenge [J]. Crit Care Med, 2007, 35(1): 64-68.
[19]
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.
[20]
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.
[21]
Yunos NM,Bellomo R,Hegarty C, et al. Association between a chloride-liberal vs chloride-restrictive intravenous fluid administration strategy and kidney injury in critically ill adults [J]. JAMA, 2012, 308(15): 1566-1572.
[22]
Young P,Bailey M,Beasley R, et al. Effect of a buffered crystalloid solution vs saline on acute kidney injury among patients in the intensive care unit: the SPLIT randomized clinical trial [J]. JAMA, 2015, 314(16): 1701-1710.
[23]
Gaudry S,Hajage D,Schortgen F, et al. Initiation strategies for renal-replacement therapy in the intensive care unit [J]. N Engl J Med, 2016, 375(2): 122-133.
[24]
Zarbock A,Kellum JA,Schmidt C, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the ELAIN randomized clinical trial [J]. JAMA, 2016, 315(20): 2190-2199.
[25]
Bell M,Swing,Granath F, et al. Continuous renal replacement therapy is associated with less chronic renal failure than intermittent haemodialysis after acute renal failure [J]. Intensive Care Med, 2007, 33(5): 773-780.
[26]
Wald R,Shariff SZ,Adhikari NK, et al. The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study [J]. Crit Care Med, 2014, 42(4): 868-877.
[27]
Truche AS,Darmon M,Bailly S, et al. Continuous renal replacement therapy versus intermittent hemodialysis in intensive care patients: impact on mortality and renal recovery [J]. Intensive Care Med, 2016, 42(9): 1408-1417.
[28]
Liang KV,Sileanu FE,Clermont G, et al. Modality of RRT and recovery of kidney function after AKI in patients surviving to hospital discharge [J]. Clin J Am Soc Nephrol, 2016, 11(1): 30-38.
[29]
Ronco C,Bellomo R,Homel P, et al. Effects of different doses in continuous veno-venous haemofiltration on outcomes of acute renal failure: a prospective randomised trial [J]. Lancet, 2000, 356(9223): 26-30.
[30]
Tolwani AJ,Campbell RC,Stofan BS, et al. Standard versus high-dose CVVHDF for ICU-related acute renal failure [J]. J Am Soc Nephrol, 2008, 19(6): 1233-1238.
[31]
VA/NIH Acute Renal Failure Trial Network, Palevsky PM, Zhang JH, et al. Intensity of renal support in critically ill patients with acute kidney injury [J]. N Engl J Med, 2008, 359(1): 7-20.
[32]
RENAL Replacement Therapy Study Investigators, Bellomo R, Cass A, Cole L, et al. Intensity of continuous renal-replacement therapy in critically ill patients [J]. N Engl J Med, 2009, 361(17): 1627-1638.
[33]
Joannes-Boyau O,Honoré PM,Perez P, et al. High-volume versus standard-volume haemofiltration for septic shock patients with acute kidney injury (IVOIRE study): a multicentre randomized controlled trial [J]. Intensive Care Med, 2013, 39(9): 1535-1546.
[34]
McClave SA,Taylor BE,Martindale RG, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) [J]. Crit Care Med, 2016, 40(2): 159-211.
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