Acute kidney injury

被引:7
|
作者
Monedero, P. [1 ]
Garcia-Fernandez, N. [2 ]
Perez-Valdivieso, J. R. [1 ]
Vives, M. [1 ]
Lavilla, J. [2 ]
机构
[1] Univ Navarra, Dept Anestesiol & Reanimac, Pamplona, Spain
[2] Clin Univ Navarra, Serv Nefrol, Navarra, Spain
来源
REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION | 2011年 / 58卷 / 06期
关键词
Acute kidney injury; Kidney failure; prevention; Biological markers; renal; Renal replacement therapy;
D O I
10.1016/S0034-9356(11)70086-X
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Acute kidney injury (AKI) is defined as an abrupt decline in the glomerular filtration rate with accumulation of nitrogenous waste products and the inability to maintain fluid and electrolyte homeostasis. Occurring in 7% of all hospitalized patients and 28% to 35% of those in intensive care units, AKI increases hospital mortality. Early evaluation should include differentiating prerenal and postrenal components from intrinsic renal disease. Biological markers can give early warning of AKI and assist with differential diagnosis and assessment of prognosis. The most effective preventive measure is to maintain adequate circulation and cardiac output, avoiding ischemia- or nephrotoxin-induced injury. To that end, patients and situations of risk must be identified, hemodynamics and diuresis monitored, hypovolemia reversed, and nephrotoxins avoided. Protective agents such as sodium bicarbonate, mannitol, prostaglandins, calcium channel blockers, N-acetyl-L-cysteine, sodium deoxycholate, allopurinol, and pentoxifylline should be used. Treatment includes the elimination of prerenal and postrenal causes of AKI; adjustment of doses according to renal function; avoidance of both overhydration and low arterial pressure; maintenance of electrolytic balance, avoiding hyperkalemia and correcting hyperglycemia; and nutritional support, assuring adequate protein intake. For severe AKI, several modalities of renal replacement therapy, differentiated by mechanism and duration, are available. Timing-neither the best moment to start dialysis nor the optimal duration has been not established. Early detection of AKI is necessary for preventing progression and starting renal replacement therapy at adjusted doses that reflect metabolic requirements.
引用
收藏
页码:365 / 374
页数:10
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