急性肾损伤的临床研究进展

肾脏急性损害是临床最常见的危重急症之一,各种疾病及病因皆可引起。由于临床表现隐匿,特异指标匮乏,给早期诊断、及时治疗设置了巨大障碍。近百年来,临床一直用急性肾功能衰竭作为肾脏急性受损的信号,少尿、氮质血症曾是早年急性肾功能衰竭的标志,问题不少;近几十年又流行用内生性肌酐清除率估计肾脏滤过功能来判断是否出现急性肾功能衰竭,实践亦显示此项检测比肾脏损伤的实际情况明显滞后,检测结果尚受不少因素影响。上述传统定义及判断方法,使肾脏急性损伤被赋予一个静态的、终点性定义,临床诊断亦陷入有或无的简单、绝对的概念,即便得到及时确诊,病情往往已达极期,错过了最佳治疗时机。本文以近70篇最新文献为依据,深入分析了有关肾脏急性损害传统概念和经典指标的优劣,精炼地介绍了肾脏急性损害的现代概念急性肾损伤———AKI定义及其判断标准RIFLE和AKIN,并从临床视角论述了有关AKI的诊治进展及今后方向,为AKI的临床研究工作尤其是中毒性急性肾损伤国家诊断标准的制订提供了极有价值的参考资料。

Clinical research progress on acute kidn ey injury

Renal acute damage is one of th e most common critical illnesses which m ay come from various diseases and causes,owing to lacking of definite clinical m anifestation and specific diagnostic ind ex,there is a huge obstacle setted in ea rly diagnosis and timely therapy on the disease.For nearly a hundred years,ARF( acute renal failure)has always been cons idered as the signal of renal acute dama ge,while oliguria and azotemia were used as the indicators of ARF at early time, that leads to not a small fallacy in cli nical practice.Recent several decades,th e glomerular filtration function estimat ed by detecting endogenous creatinine cl earance(Ccr),that quite easy be interfer ed by many factors,was taken as the judging criterion of ARF,but it also much d elayed than the occurrence of r eal renal damage.All the above showed th at the traditional definition on renal a cute damage is so static,terminal and ab solute that the only answer to diagnosis of renal damage is yes or no.Therefore,even a timely diagnosed case,the illness cond ition already reached the critical phase and losed the best rescure opportunity. This paper in the light of 69 latest literatures makes a deep analysis on the merits and drawbacks of traditio nal concept on acute renal damage and it s classical indices,concisely introduces the modern concept of renal acute damag e,AKI(acute kidney injury)and its criter ia RIFLE and AKIN,additionally,it also d iscusses the progress and future orientation from clinical visual a ngle,that will well update our knowledge on renal acute damage,thereby further push our clinical work.