Acute kidney injury in intensive care unit

doi:10.3877/cma.j.issn.2096-1537.2018.02.004

Abstract

Abstract:

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.

Key words: Acute kidney Injury, Continuous renal replacement therapy, Sustained low efficiency daily dialysis

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

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2018.02.004

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References 34

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分期	血清肌酐值	尿量
1	上升为基础值的1.5~1.9倍或增加≥0.3 mg/dl（26.5 μmol/L）	<0.5 ml/（kg?h），连续6~12 h
2	上升为基础值的2.0~2.9倍	<0.5 ml/（kg?h），≥12 h
3	上升为基础值的3倍以上或增加到≥4 mg/dl（353.6 μmol/L），或开始肾脏替代治疗，或<18岁，肾小球滤过率（eGFR）<35 ml/（min?1.73 m²）	>0.3 ml/（kg?h），≥24 h或无尿>12 h

分期	血清肌酐值	尿量
1	上升为基础值的1.5~1.9倍或增加≥0.3 mg/dl（26.5 μmol/L）	<0.5 ml/（kg?h），连续6~12 h
2	上升为基础值的2.0~2.9倍	<0.5 ml/（kg?h），≥12 h
3	上升为基础值的3倍以上或增加到≥4 mg/dl（353.6 μmol/L），或开始肾脏替代治疗，或<18岁，肾小球滤过率（eGFR）<35 ml/（min?1.73 m²）	>0.3 ml/（kg?h），≥24 h或无尿>12 h

指南	无肾脏替代治疗	间歇性肾脏替代治疗	连续性肾脏替代治疗
KDIGO^[3]	0.8~1.0	1.0~1.5	1.7
SCCM^[34]	1.2~2.0	~2.5	2.0~2.5

指南	无肾脏替代治疗	间歇性肾脏替代治疗	连续性肾脏替代治疗
KDIGO^[3]	0.8~1.0	1.0~1.5	1.7
SCCM^[34]	1.2~2.0	~2.5	2.0~2.5

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