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妊娠期急性肾损伤(急性肾衰竭)

Author
Phyllis August, MD, MPH
Section Editors
Charles J Lockwood, MD, MHCM
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD
Translators
蔡业平, 主任医师

引言

急性肾损伤(acute kidney injury, AKI)是指肾功能的突然丧失，导致尿素和其他含氮废物潴留以及细胞外容积失调和电解质紊乱。术语AKI已基本取代了急性肾衰竭(acute renal failure, ARF)，这反映了人们已经认识到：不会造成明显器官衰竭的肾功能小幅下降具有重要的临床意义，并且与并发症发病率和死亡率的增加相关。

任何能够引起一般人群出现AKI的疾病，均能导致妊娠相关AKI。然而，每个妊娠阶段所特有的并发症也可能与肾损伤相关[1,2]。本专题将总结妊娠期最常见的AKI病因。一般人群AKI的病因将在别处讨论。 (参见“急性肾损伤(急性肾衰竭)或慢性肾脏病患者的诊断方法”，关于‘肾脏病的主要病因及分类’一节)

妊娠期肾结石也将在别处讨论。 (参见“妊娠期肾结石”)

定义

AKI是指肾功能的突然丧失。为了提供统一的、量化的AKI定义，学者已制定了数个AKI共识定义用于一般人群。这包括RIFLE定义、急性肾损伤网络(Acute Kidney Injury Network, AKIN)定义，以及改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes, KDIGO)对AKIN定义的修订版。 (参见“急性肾损伤(急性肾衰竭)或慢性肾脏病患者的诊断方法”，关于‘肾脏病的主要病因及分类’一节)

然而，尚不清楚AKI共识标准在妊娠期是否适用。这是因为妊娠期的肾小球滤过率(glomerular filtration rate, GFR)明显增加(增加约50%)，从而导致妊娠女性的基线血清肌酐低于健康程度相当的非妊娠个体(参见“正常妊娠时的肾脏及尿路生理”，关于‘GFR增加’一节)。大多数产科医生不在妊娠前或妊娠较早期常规检查血清肌酐水平。因此，看似“正常”的血清肌酐水平(如，0.7-0.9mg/dL)可能已经明显高于基线值，而这在就诊时可能被忽视。

              

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-08.
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