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血红素诱导性急性肾损伤(急性肾衰竭)的预防和治疗

Authors
Joseph A Eustace, MB, MHS, MRCPI
Sinead Kinsella, MD, MBS, MRCPI
Section Editor
Paul M Palevsky, MD
Deputy Editor
Alice M Sheridan, MD

引言

急性肾损伤(acute kidney injury, AKI)可发生于横纹肌溶解患者和溶血患者(发生于后者的情况较少见)[1,2]。在这2类患者中，AKI由肌红蛋白或血红蛋白释放的非蛋白血红素所引起，该非蛋白血红素对肾脏有毒性。

由非创伤性横纹肌溶解或溶血引起的血红素诱导性AKI的预防和治疗将总结在此。该疾病的临床特征和诊断、创伤性肌损伤引起的AKI、横纹肌溶解和溶血的概述、少尿性急性肾衰竭(acute renal failure, ARF)及其并发症的一般处理将在别处讨论。 (参见“血红素所致急性肾损伤(急性肾衰竭)的临床特征及诊断”和“挤压相关急性肾损伤(急性肾衰竭)”和“横纹肌溶解的临床表现与诊断”和“成人溶血性贫血的诊断方法”和“急性肾损伤(急性肾衰竭)的肾脏替代疗法(透析)：肾功能的恢复和血液透析膜的影响”)

预防

除治疗潜在横纹肌溶解或溶血外，对于具有血红素诱导性AKI风险的所有患者，预防性治疗的一般目标是双重的：

●纠正容量不足(如存在)

●预防小管内管型形成

          

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-16.
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