急性肾损伤(AKI)幻灯片.ppt

新生儿急性肾损伤（AKI）及其治疗进展 暨南大学附属第一医院儿科 杨方 历史背景 20世纪：急性肾衰的名称、定义、标准众多、混乱 21世纪开始有新进展 2002 RIFLE 2005年AKIN， 以AKI概念替代ARF 2011年KDICO 指南 AKI定义 成人: 48小时内 Scr上升 ≧ 26.5umol/L (0.3mg/dl) 7天内Scr上升 ≧ 1.5 倍 GFR下降≧25%, 尿量0.5ml/kg.h,6小时 小儿: eCCL(eGFR）下降≧25%, 尿量0.5ml/kg.h,8小时 Pediatric-modified RIFLE(pRIFLE) criteria Estimated CCI Urine output Risk eCCI decrease by 25% 0.5 ml/kg/h for 8h Injury eCCI decrease by 50% 0.5 ml/kg/h for 16h Failure eCCI decrease by 75% or 0.3ml/kg/h for 24h or eCCI 35ml/min/1.73 ㎡ anuric for 12h Loss Persistent failure 4 weeks End End-stage renal disease Stage (persistent failure3 months) eCCI,estimated creatinine clearance;pRIFLE,pediatric risk,injury,failure,loss and end-stage renal disease. Akcan-Arikan,et al. Kidney Int.2007,71:1028-1035 成人AKI的RIFLE标准 Class GFR criteria Urine output criteria Risk Increased creatinine x 1.5 Urine output or GFR decrease 25% 0.5ml/kg/h x 6h Injury Increased creatinine x 2 Urine output or GFR decrease50% 0.5ml/kg/h x 12h Failure Increased creatinine x 3 Urine output or GFR decrease 75% 0.3ml/kg/h x 24h or creatinine ≧4 mg/dl or anuria x 12h (acute rise of ≧0.5 mg/dl) Loss Persistent AKI=complete loss of renal function 4 weeks ESKD End-stage kidney disease 3 months 婴幼儿肾脏发育特点 新生儿肾脏发育及功能不成熟 肾脏体积仅为成人的17% GFR为成人的1/4，到1~2岁时达到成人水平 新生儿及婴幼儿肾小管重吸收功能差，易出现水及电解质紊乱。 早产儿及足月新生儿的GFR Age Clearance(ml/min per1.73㎡) Pre-term infants 1-3 days 14.0±5 1-7 days