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急性肾损伤(急性肾衰竭)中肾前性疾病与急性肾小管坏死的病因与诊断

Authors
Uta Erdbruegger, MD
Mark D Okusa, MD
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD

引言和定义

急性肾损伤(acute kidney injury, AKI)，以前被称为急性肾衰竭(acute renal failure, ARF)，是一种常见的临床疾病[1-7]。2012年改善全球肾脏病预后组织(Kidney Disease: Improving Global Outcomes, KDIGO)AKI临床实践指南将AKI定义为满足以下3项标准中的1项或多项[1]。前2项标准是：48小时内血清肌酐(serum creatinine, SCr)水平升高至少0.3mg/dL(26.5μmol/L)和/或SCr在7日内上升至大于等于基线值1.5倍的水平[1]。

第3项标准为尿量小于或等于0.5mL/(kg·h)，持续6小时。但是，对于一名70kg的成年男性来说，这代表着6小时尿量可高达210mL，若保持下去，尿量将达到840mL/d。许多健康人如果限制液体摄入，也可达到此标准。因此，本专题的作者和评议人员并不赞成仅依靠尿量来诊断AKI。

也已经提出了AKI的其他定义及严重程度分期。这些问题将在别处详细讨论。 (参见“急性肾损伤(急性肾衰竭)的定义”)

医院内发生AKI的2个主要病因是肾前性疾病和急性肾小管坏死(acute tubular necrosis, ATN)。两者大约共占了AKI病例的65%-75% 。 (参见下文‘可导致AKI的肾前性疾病与急性肾小管坏死的发生率’)

本专题将总结作为AKI病因的肾前性疾病和ATN的病理生理学、病因、临床表现、评估及诊断。急性或慢性肾脏疾病(chronic kidney disease, CKD)患者的诊断方法、ATN可能的预防措施和治疗，以及ATN后肾脏和患者的结局将在别处讨论。 (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”和“缺血后(缺血性)急性肾小管坏死可能的预防及治疗”和“急性肾小管坏死后肾脏和患者结局”)

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-04-01.
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